Yemen Blood Safety Seeks Top priority Urgent Donors Support For Blood Supply Reform [Archives:2002/05/Health]
Dr.Ahmed Lotf Al-Amari,
Ph. Coordinator, Blood Board, Yemen Red Crescent Society
Yemen is Technically in the Asian continent, however, it is just a stones throw from Africa, across the Red Sea and the Gulf of Aden.
The country has almost as large population as Saudi Arabia, yet lacks much of natural resources. Indeed, it is one of the poorest countries in the world with some of the highest rates of infant mortality, chronic diseases and illiteracy in the world [Yemen, the USA and al-Qaeda, By Stephen Zunes Dec. 19.2001].
The country gained independent from the Ottoman Empire in 1918. The British, who set up a protectorate area around southern port of Aden in the 19th century, withdrew in 1967 from what became south Yemen.
The two parts merged in May 1990, creating a democratic constitution which makes Yemen one of the most genuinely representative Government in the region (same reference).
The president is popularly chosen and new locally picked councils were established to shift power away from traditional system by making elected representatives responsible for providing basic government services.
A recent study by the World Health Organization (WHO) that looked at the overall quality and reliability of national public health laboratories and blood banks in Yemen [Emory who mission report, Yemen 2001] found that:
1-Yemen has experienced over the last 10 years several outbreaks of measles, diarrheal diseases including cholera, malaria, rabies, typhoid fever and rift valley fever.
2- the capacity of the ministry of public health and population for the surveillance and response to epidemic prone disease is very poor. Data reporting is absent and there is no list of noticeable infectious diseases at national level.
3- there is total lack of quality measures, no job descriptions are available, no standard operating procedures or guidelines are there. No manuals, no calibration or quality control is performed, neither reporting forms not inventory records are kept, and no validation of reagent is practiced and no performance indicators are recorded for equipment.
4- Bio-safety measures are absent, no sharps containers are there, and bio-safety cabinets are non-functional, no training of personnel on laboratory safety is received. laboratory and nosocomial infections are common, as well as cross contamination of specimens.
5-voluntary non-remunerated blood donation amounts to 10% of donors, the rest being family replacement donors, the rest being family replacement donors.
No fractionation activities in all blood banks is in place in Yemen.
Earlier study by the swigs Red Cross of Quality, efficiency and accessibility of the present blood system in Yemen (pole, D.Etal fact finding mission 1999) found that the total number of blood units collected in 1998 was 136.209 provided nationwide by fragmented blood program activities, no well-organized national blood banks authority with its own management structure, budget, regulation and policy.
The collected amount of blood units as per to intl figures related to hospital deeds and population falls far short of the national requirement for blood supply in Yemen. There are no regulations relating to the optimal clinical use of blood and blood components a very important measure in order to use collected blood appropriately.
The usage of blood is based mostly on whole blood, the main reason for this is that blood banks do not prepare component due to lack of training and equipment.
Another report by the (WHO) consultant on laboratory diagnostics (browning 1997) found that there is no national coordination of blood banks services. Blood banks are associated with the laboratories and each blood bank works independently, sometimes using out of date grouping reagents and with no opportunities to quality control at any aspect of its work. Despite this there is rudimentary record keeping but blood for testing is not always separated from that issued for transfusion, the hospital blood banks do not operate to high standards and a national blood banks authority with donor facilities and fractionation equipments are urgently required. A strategy must be developed for the national blood bank in Sanaa and central blood banks in the governorates to ensure that the highest standards in the hospital blood banks at all national levels. The sound finding of the WHO consultant (sibinga 2000) indicated that the existing blood supply system is inadequate, unsatisfactory and potentially dangerous, highly fragmented, non-professional and full of risk for donors, personnel and patients. The net effect is that blood transfusion takes place in dangerous conditions, its lifesaving purpose subverted by non effected control including:
-lack of commitment, awareness at all levels.
-lack of defined national policy, strategies, legislation and regulations.
-lack of budget for a safe and sustainable blood supply system.
-absence of a reliable and healthy donor registry [voluntary, non-remunerated and regular.]
-absence of equity in delivery of sate and efficacious blood components and supportive hemotherapy .
absence of technical efficiency on the clinical use of blood and quality of blood supply.
WHO reform approach for the blood safety program (sibinga 2000), a striking parallel to the Yemen drugs action program approach, is recognized and the Ministry of Public Health recognizes the need to reconsider and re-prioritize the health sector reform [HSR] plan and would call for urgent high priority donors support of blood supply reform focused on blood safety and community involvement (healthy voluntary, non-remunerated regular donor base and registry) to seriously consider such support as part of the HSR branch of the health sector.
WHO plan of action (SIBINGA2000) outlines steps needed to ensure the long-term stability and sustainability of a blood program and describes systematic approach to enhance each phase of setting up and running it based on stable cost-recovery system that will grow with the blood program and the national health and population program.
The entire blood program operation will be the responsibility of the Ministry of Public Health and Population [Morph] along sector wide approach swap principles and will work with donors towards strengthening its institutional capacity and to develop an effective national Red Crescent society that will focus on specific phases related to public education and donors recruitment.
Recent efforts by the WHO to develop Global Collaboration for Blood Safety which includes an objective framework for policy debate decision making, is a major step in the right direction.
Giving the urgent need to reform the blood supply system in order to better meet the needs of the healthcare system development and to prevent the extensive and increasing activities of the private firms in trying to establish commercial blood banks on ad hoc basis, it must be recognized by those who are responsible for maximizing blood safety in wealthy countries that they have responsibility to promote Yemen to reach self-sufficiency in blood and plasma through anonymous, voluntary and non-remunerated donations.
For more information contact:
-Ministry of Public Health and Population
P.O. Box 299 Sanaa- Yemen
-Ministry of Planning and Development
-Blood Donation Board of Yemen Red
Crescent Society, P.O. box 299 Sanaa- Yemen
Tel, (967-1-) 252281, fax (961-1-) 251614. E-mail: [email protected] ye