Abstract
India lacks comprehensive information about blood transfusion systems, which could help ensure universal access to safe blood through evidence-based strategies and programs. We conducted the first national assessment of blood bank systems, services, practices, and performance in India. We conducted a cross-sectional survey of all 2626 blood banks and assessed the administrative, technical, and quality aspects in 2016. In addition to descriptive analysis, we compared the means of different variables using independent t-test or ANOVA and a generalized linear model. We performed linear regression analysis between the collection of blood per 100 people and the number of blood banks per million people. The disaggregated mean score of quality management system and overall performance are presented by different groups. Besides, we graded the performance based on tertile classification, as low, medium and high-performance blood banks. Of the 2493 blood banks that participated in the study, most were public (38%) or not-for-profit(38%), and 51% had component separation facilities. Of the 11.65 million units of blood collected annually, 72% was through voluntary blood donation. There were 2.2 blood banks per one million people, collecting around one unit per 100 persons annually with wide variation between states. The mean overall performance score was 62(95% confidence interval [CI]:61.6–62.5), and the mean quality management system score was 57.4(95% CI:56.8–58.0), with significant variation across different categories of blood banks. This assessment provides critical information for developing evidence-based policies, programs, and monitoring systems to improve the performance of blood transfusion services in India.
Keywords: Blood transfusion services, Assessment of blood banks, Quality management system, National blood transfusion council
Introduction
Ensuring universal access to safe blood is a critical aspect of health care systems and is primarily the responsibility of the government or the appropriate national health authority [1]. Providing safe blood in India is complex and requires a holistic approach to planning, designing, implementing, and integrating multiple services. In 2015, India had approximately 2760 blood banks with an annual collection ranging from 200 to 50,000 units of blood. However, timely access to safe blood is still a challenge in many areas of the country, and there is vast inequity in the availability of blood across geographic regions. It is not clear whether the annual blood collection in India is adequate, equitably distributed, and available to the people who need blood transfusions. The World Health Organization (WHO) recommends obtaining 100% of blood units through voluntary donation, quality-assured testing of donated blood, and strengthening blood transfusion services with evidence-based, innovative, and result-oriented strategies to ensure universal access to blood. Additionally, it is essential to optimize blood usage, develop quality systems in the transfusion chain, strengthen the workforce, and build effective partnerships [2].
The National AIDS Control Organization (NACO), under the Ministry of Health and Family Welfare, and the National Blood Transfusion Council (NBTC; the apex policy-making body) are the key agencies responsible for national blood transfusion services in India. Blood and blood products are considered drugs, so the Central Drug Standard Control Organization (CDSCO) and state drug control authorities play vital roles, such as approving licenses and enforcing standard transfusion practices to ensure the safety and quality of blood and blood components in clinical practices [3].
Though India has a huge network of both public and private blood banks across the country, we do not have updated and comprehensive information about blood banks. Although licensing would ensure a certain level of quality, it may not ensure the required level to ensure patient safety during a blood transfusion. Evidence-based programs and policies to ensure quality require periodic monitoring of blood banks to assess the gaps and understand the nonconformities. A national strategy is essential to coordinate blood transfusion services and assessments at the district, state, and region levels are critical for this. However, there has not been any initiative to assess the blood banks nationally. Considering the importance, we conducted an assessment of blood transfusion facilities, systems, services, practices, and performance in India.
Methods
We conducted a national cross-sectional survey of all functional blood banks in 2016.
We used a self-administered questionnaire that included the details of the annual collection, voluntary blood donation (VBD), immunohematology practices, transfusion transmittable infections (TTI), component separation, quality management systems (QMS), human resources, training, equipment availability and maintenance. QMS questions included the availability of document control system; standard operating procedures; internal quality control for immunohematology and TTI testing; quality control for kits, reagents, blood bags, and components; external quality assessment participation for immunohematology and TTI, accreditation and compliance with NBTC guidelines. Data collected pertained to January–December 2015.
We designed, piloted, and finalized a web-based survey tool using Redcap software (version 6.11.2; Vanderbilt University, Nashville, TN) [4, 5] with built-in validation checks to ensure accuracy and completeness. We sent an exclusive online survey link generated by Redcap to each blood bank. Since many blood banks did not have adequate internet access, we mailed paper-based survey to all blood banks, regardless of internet availability. Later, we entered the data in REDCap.
We analyzed the data using SPSS version 25 (IBM, Armonk, NY) [6]. We used histograms, frequency distribution, and box plots to screen the data for outliers and extreme values. We used descriptive statistics e.g., mean and standard error [SE] for quantitative variables. As the data followed a normal distribution, we compared the means of different variables using independent t-test or ANOVA and a generalized linear model. We performed a linear regression analysis between collection per 100 people and the number of blood banks per million people. We considered p-values < 0.05 statistically significant.
India has two types of blood banks: those with and without a component separation facility. To differentiate these two types, we developed different scoring criteria, based on the technical requirements and expected outputs. The technical components included (i) availability of current licence (ii) annual collection in terms of units (iii) VNRBD, repeat donation, and pre and post-test counselling services (iv) Immunohematology that includes IQC, EQA, testing methods (v) TTI that includes IQC, EQA, testing methods for TTIs (vi) Percentage of component separation and QC for components (vii) QMS that includes the availability of medical officer with relevant qualification, staff nurse with NACO/NBTC training, technician with NACO/NBTC training, designated and trained Quality Manager and Technical Manager, document control system, equipment calibration, AMC for equipment, quality control for kits, availability of reagents and blood bags, quarantine blood bank refrigerator and accreditation (viii) regular reporting to SIMS under National AIDS Control Programme, participation in Haemovigilance program, participation in NBTC/NHP E-blood banking, and compliance with NBTC norms.
The maximum achievable sum of scores under each component totalled 100. The maximum possible score was the same for technical components, such as license (3), QMS (35), and reporting (8) for both types of blood banks. The maximum possible score for annual collection, VBD, repeat donation, and counselling was 11 for blood banks with component separation and 16 for blood banks without component separation. The maximum possible score for technical aspects that include immunohematology, TTI, and component separation was 43 for blood banks with component separation and 35 for blood banks without component separation.
Mean scores of QMS are presented by the five geographic regions in India (north, east, west, south, and northeast); ownership (public, private, and not-for-profit), which includes NGOs/Trust/Charitable); attachment (stand-alone, attached to laboratory, and attached to hospitals); type (with and without component separation); license status (valid and under renewal); annual collection (up to 3,000, 3,001–5,000, and > 5,000 units); and VBD (< 25%, 25%–49%, 50%–74%, 75%–90%, and > 90%; Table 2). Mean scores of overall performance are presented only by region, ownership, and attachment because the remaining variables were included in the overall performance scoring. Besides, we graded the performance based on tertile classification of the blood banks (low-performance, medium-performance, and high-performance). However, a few blood banks scored exactly similar scores in 33.3 and 66.6 percentiles that are medium and high-performance cut-offs. To avoid blood banks being included in two tertile categories, we adjusted the cut-off scores for each tertile: 58.0, 66.9, and ≥ 67. The Technical Resource Group (TRG)-Blood Transfusion Services, NACO and NBTC; and Ethics committee, NACO approved the study.
Table 2.
Quality management system scores of blood banks in India (2015)
| Variables | n | Mean | SE | 95% CI for Mean | p-value |
|---|---|---|---|---|---|
| Region | |||||
| North | 545 | 58.5 | 0.7 | (57.2–59.8) | 0.622 |
| East | 332 | 51.6 | 0.9 | (49.8–53.4) | < 0.001 |
| West | 665 | 59.7 | 0.6 | (58.6–60.9) | 0.789 |
| South | 847 | 57.3 | 0.5 | (56.3–58.3) | 0.204 |
| Northeast | 104 | 56.7 | 1.7 | (53.3–60.1) | Ref |
| Attachment | |||||
| Stand-alone | 551 | 59.3 | 0.6 | (58.1–60.4) | 0.037 |
| Attached to lab | 23 | 56.3 | 3.9 | (48.2–64.4) | 0.161 |
| Attached to hospital | 1919 | 56.9 | 0.4 | (56.2–57.6) | Ref |
| Ownership | |||||
| Not-for-profit | 947 | 59.7 | 0.4 | (58.8–60.5) | < 0.001 |
| Private | 597 | 61.3 | 0.6 | (60.2–62.3) | < 0.001 |
| Public | 949 | 52.8 | 0.5 | (51.7–53.8) | Ref |
| Voluntary blood donation % | |||||
| < 25 | 479 | 60.0 | 0.7 | (58.7–61.3) | 0.180 |
| 25–49 | 224 | 57.9 | 1 | (56–59.9) | 0.696 |
| 50–74 | 322 | 58.1 | 0.8 | (56.4–59.7) | 0.164 |
| 75–90 | 337 | 55.3 | 0.9 | (53.5–57) | 0.199 |
| > 90 | 1071 | 56.9 | 0.5 | (55.9–57.8) | Ref |
| Annual collection in units | |||||
| < 3000 | 1279 | 56.0 | 0.4 | (55.2–56.8) | < 0.001 |
| 3001–5000 | 441 | 57.6 | 0.7 | (56.3–59.0) | < 0.001 |
| > 5000 | 712 | 60.2 | 0.6 | (59.0–61.4) | Ref |
| License | |||||
| Valid | 1638 | 58.5 | 0.4 | (57.8–59.3) | 0.269 |
| Under renewal | 855 | 55.3 | 0.5 | (54.2–56.3) | Ref |
| Type of blood bank | |||||
| With component Separation | 1271 | 59.9 | 0.4 | (59–60.7) | 0.866 |
| Without components separation | 1222 | 54.9 | 0.4 | (54–55.8) | Ref |
| Total | 2493 | 57.40 | 0.2 | 56.8–58.0 | – |
SE standard error; CI confidence interval
Results
Basic Description of Blood Banks
Of the 2626 functional blood banks (excluding military blood banks) in India, 2493 (95%) responded to our survey. Half (1271 [51%]) had a component separation facility. Of participating blood banks, 38% (949) were public, 38% (947) were not-for-profit, and 24% (597) were private. Not-for-profit blood banks had a higher proportion (48%) of component separation facilities than public (23%) and private (29%). Most (77% [1919]) were attached to hospitals, 1% (23) to laboratories, and 22% (551) were stand-alone blood banks. Around 16% (392) reported having trained quality managers and technical managers. Two-thirds had a current license, and the remaining one-third had applied for a renewal. For most of those that applied for license renewal, the last inspection was during the preceding year (66.9%), in the last 1–3 years (23%), or in more than 3 years (7%). The region-wise description of key characteristics of blood banks is mentioned in Table 1.
Table 1.
Characteristics of blood banks—Region wise
| Blood banks characteristics | North (n-545) | East (n-332) | West (n-665) | South (n-847) | North east (n-104) | Total 2493 |
|---|---|---|---|---|---|---|
| NACO supported | 235 (43.1) | 194 (58.4) | 314 (47.2) | 312 (36.8) | 64 (61.5) | 1119 (44.9) |
| Public | 238 (43.7) | 191 (57.5) | 214 (32.2) | 238 (28.1) | 68 (65.4) | 949 (38.1) |
| Not-for-profit | 138 (25.3) | 79 (23.8) | 356 (53.5) | 358 (42.3) | 16 (15.4) | 947 (38.0) |
| Private | 169 (31.0) | 62 (18.7) | 95 (14.3) | 251 (29.6) | 20 (19.2) | 597 (23.9) |
| BBs with BCSUs | 304 (55.8) | 100 (30.1) | 398 (59.8) | 446 (52.7) | 23 (22.1) | 1271 (51.0) |
| BBs with qualified MOs | 384 (70.5) | 102 (30.7) | 407 (61.2) | 377 (44.5) | 55 (52.9) | 1325 (53.1) |
| BBs with trained TM | 201 (36.9) | 62 (18.7) | 279 (42.0) | 302 (35.7) | 10 (9.6) | 854 (34.3) |
| BBs with trained QM | 157 (28.8) | 51 (15.4) | 225 (33.8) | 219 (25.9) | 7 (6.7) | 659 (26.4) |
| HIV Testing rapid | 374 (68.6) | 226 (68.1) | 314 (47.2) | 385 (45.5) | 76 (73.1) | 1375 (55.2) |
| HIV Testing ELISA | 380 (69.7) | 239 (72.0) | 544 (81.8) | 700 (82.6) | 75 (72.1) | 1938 (77.7) |
| HIV Testing Chemiluminescence | 60 (11.0) | 21 (6.3) | 69 (10.4) | 102 (12.0) | 5 (4.8) | 257 (10.3) |
| HIV Testing—NAT | 32 (5.9) | 3 (0.9) | 20 (3.0) | 42 (5.0) | 2 (1.9) | 99 (4.0) |
| IH—Forward typing (Tube) | 443 (81.3) | 282 (84.6) | 589 (88.6) | 755 (89.1) | 90 (86.5) | 2158 (86.6) |
| IH—Forward typing (Column) | 156 (28.6) | 52 (15.7) | 151 (22.7) | 173 (20.4) | 15 (14.4) | 547 (21.9) |
| IH—Reverse typing (Tube) | 384 (70.5) | 242 (72.9) | 536 (80.6) | 728 (86.0) | 75 (72.1) | 1965 (78.8) |
| IH—Reverse typing (Column) | 137 (25.1) | 47 (14.2) | 122 (18.3) | 144 (17.0) | 14 (13.5) | 464 (18.6) |
| Average VBD% | 49.1 | 60.5 | 79.7 | 76.5 | 57.6 | 68.5 |
| Haemovigilance | 69 (12.7) | 47 (14.2) | 74 (11.1) | 77 (9.1) | 17 (16.3) | 284 (11.4) |
| BBs with transfusion committee | 356 (65.3) | 146 (44.0) | 362 (54.4) | 578 (68.2) | 73 (70.2) | 1515 (60.8) |
| EQA for TTI | 61 (11.2) | 17 (5.1) | 118 (17.7) | 80 (9.4) | 4 (3.8) | 280 (11.2) |
| EQA for IH | 68 (12.5) | 20 (6.0) | 97 (14.6) | 125 (14.8) | 5 (4.8) | 315 (12.6) |
| Accreditation | 19 (3.5) | 4 (1.2) | 35 (5.3) | 13 (1.5) | 2 (1.9) | 73 (2.9) |
BB Blood Banks; NACO National AIDS Control Organization; BCSU Blood Component Separation Units; TM Technical Manager; QM Quality Manager; TTI Transfusion Transmittable Infections; IH Immunohematology; VBD Voluntary Blood Donation; EQA External Quality Assurance
Availability and Distribution of Blood Banks
According to our study, India reported having 2.2 blood banks per one million people. The state-wide availability of blood banks is depicted in Fig. 1. Bihar, Jharkhand, Uttar Pradesh, West Bengal, Rajasthan, Madhya Pradesh, Manipur, and Odisha reported less than two blood banks per million people. Developed states, such as Kerala (5.0), Tamil Nadu (3.7), Karnataka (3.0), and Maharashtra (2.7) reported a higher number of blood banks per million people compared to less developed states. The ratio was higher in small states and union territories, which have less population.
Fig. 1.
Availability of blood banks and annual collection in India (2015). Figure Legend: BB, Blood banks; AN, Andaman and Nicobar; DNH, Dadar Nagar Haveli. This graph explains the state-wise number of blood banks per million people and annual blood collection (whole blood units) per 100 people
Annual Collection and Voluntary Blood Collection
Of the 11.65 million units collected by blood banks in 2015, 72% (8.48 million) were voluntary blood donations. Around 5.1 million units (43.4%) were collected by public blood banks, followed by 4.54 million (39%) by not-for-profit blood banks and 2.05 (17.6%) million by the private blood banks. The annual collection per 100 people was about 1%, which meets the WHO suggestion that donation from 1% of the population can meet a nation’s basic requirements for blood [7]. However, there is a huge disparity in blood collection between states in India. For instance, 19 states (most of which are developed) reported having a higher ratio than the national average (Fig. 1). We also found that the top quartile of blood banks collected around 66% of the total volume of blood collection, followed by the third quartile (21%), by the second quartile (10%), and the last quartile (3%). Around 38% of blood banks in the country collected less than 2000 units per annum. In specific, around 49% of blood banks in northeast region, followed by 46.4% in south, 37.8% in north, 37% in east and 26.6% in west region collected less than 2000 units per annum. In terms of voluntary blood collection, west region reported to have 82.5% followed by south (77.3%), east (68.9%), northeast (55.5%) and north (52.5%). Of the approximately 8.7 million blood units collected from blood banks with component separation units, 71% of blood units were separated for components, equivalent to 53% of the total collection in the country. The percentage of component separation varied widely between states.
Association Between the Availability of Blood Banks and Annual Collection
Linear regression analysis did not indicate a correlation between the number of blood banks and annual collection (r = 0.29). Irrespective of the number of blood banks, 22 states collected 0.70–1.50 units per 100 people in 2015, and these states reported 1.26–8.23 blood banks per million people. For instance, Puducherry had 13.7 blood banks per million people and collected 3.19 units per 100 people, which is slightly lower than the Delhi annual collection (3.26 units) from 3.94 blood banks per million people (Fig. 1).
Quality Management System Performance
The mean QMS score of blood banks was 57.4 (95% confidence interval [CI]: 56.8–58.0). As shown in Table 2, the east region (51.6 [95% CI: 49.8–53.4]) scored significantly less than the northeast region (p < 0.001). Stand-alone blood banks (59.3 [95% CI: 58.1–60.4]) scored significantly higher than blood banks attached to hospitals (p < 0.037). The not-for-profit (59.7 [95% CI:58.8–60.5]) and private (61.3 [95% CI: 60.2–62.3]) blood banks scored significantly higher than the public (p < 0.001; and blood banks that collected more than 5000 units had a significantly higher QMS score (60.2 [95% CI: 59.0–61.4]) than others (p < 0.001).
Overall Performance of Blood Banks
The mean assessment score of overall performance was (62 [95% CI: 61.6–62.5]. Around 21% (530) scored above 70, 77% (1920) scored between 36 and 70, and the remaining 2% (43) scored below 35. Table 3 shows the overall score by region, attachment of blood banks, and ownership. The west (64.5 [95% CI: 63.7–65.4]; p < 0.001) and south regions (63.4 [95% CI: 62.7–64.0]; p = 0.002) scored significantly higher than northeast region. Not-for-profit (64.2[95% CI: 63.5–64.9]; p < 0.001) and private (63.1 [95% CI:62.2–63.0]; p < 0.001) scored significantly higher than public blood banks.
Table 3.
Overall performance score of blood banks in India (2015)
| Variables | Score | ||||
|---|---|---|---|---|---|
| n | Mean | SE | 95% CI for Mean | p-value | |
| Region | |||||
| North | 545 | 60.3 | 0.52 | (59.2–61.3) | 0.383 |
| East | 332 | 57.5 | 0.62 | (56.3–58.7) | 0.186 |
| West | 665 | 64.5 | 0.43 | (63.7–65.4) | < 0.001 |
| South | 847 | 63.4 | 0.34 | (62.7–64.0) | 0.002 |
| Northeast | 104 | 58.4 | 1.10 | (56.23–60.6) | Ref |
| Attachment | |||||
| Stand-alone | 551 | 63.6 | 0.44 | (62.7–64.5) | 0.237 |
| Attached to lab | 23 | 57.8 | 2.78 | (52.1–63.6) | 0.006 |
| Attached to hospital | 1919 | 61.6 | 0.26 | (61.1–62.1) | Ref |
| Ownership | |||||
| Not-for-profit | 947 | 64.18 | 0.34 | (63.5–64.9) | < 0.001 |
| Private | 597 | 63.1 | 0.45 | (62.2–64.0) | < 0.001 |
| Public | 949 | 59.2 | 0.37 | (58.4–59.9) | Ref |
| Total | 2493 | 62.0 | 0.22 | (61.6–62.5) | – |
SE standard error; CI confidence interval
Analysis of overall score based on tertile classification (Table 4) showed that 33.7% (841) of blood banks were in the low-performance category (≤ 58.0), 32.8% (818) were in the medium-performance category (range, 58.0–67.0), and 33.5% (834) were in the high-performance category (≥ 67.0). A lower proportion of blood banks in the west and south regions were in the low-performance category compared to the north, east, and northeast regions. Similarly, a lower proportion of stand-alone and not-for-profit blood banks were in the low-performance category than other categories.
Table 4.
Tertile distribution of overall score of blood banks in India (2015)
| n (%) | Total | p-value | |||
|---|---|---|---|---|---|
| Low (≤ 58.0) | Medium (58.01–66.99) | High (≥ 67.0) | |||
| Region | |||||
| North | 224 (41.1) | 172 (31.6) | 149 (27.3) | 545 | < 0.001 |
| East | 162 (48.8) | 101 (30.4) | 69 (20.8) | 332 | |
| West | 180 (27.1) | 215 (32.3) | 270 (40.6) | 665 | |
| South | 228 (26.9) | 298 (35.2) | 321 (37.9) | 847 | |
| Northeast | 47 (45.2) | 32 (30.8) | 25 (24.0) | 104 | |
| Attachment | |||||
| Stand-alone | 154 (27.9) | 195 (35.4) | 202 (36.7) | 551 | 0.01 |
| Attached to lab | 9 (39.1) | 10 (43.5) | 4 (17.4) | 23 | |
| Attached to hospital | 678 (35.3) | 613 (35.3) | 628 (32.7) | 1,919 | |
| Ownership | |||||
| Not-for-profit | 254 (26.8) | 313 (33.1) | 380 (40.1) | 947 | < 0.001 |
| Private | 179 (30.0) | 198 (33.2) | 220 (36.9) | 597 | |
| Public | 408 (43.0) | 307 (32.3) | 234 (24.7) | 949 | |
| Total | 841 | 818 | 834 | 2493 | |
Discussion
In 2016, India had substantially more functional blood banks (2626) than other countries, such as the Republic of China (452), the United States of America (600), and Indonesia (375) [8–10]. However, the distribution of blood banks varies widely between and within states and districts in India. Of the 79 districts without a licensed blood bank, most were in northeast states [11]. This inequitable distribution could be due to the absence of established criteria or guidelines that specify the number of blood banks required for the population.
Considering the WHO’s recommended annual requirement of 1 unit of blood per 100 people to address the demand, India’s collection of11.65 million units in 2015 with 53% of component separation should be sufficient to address the demand. However, the inequity in the availability of blood between states is a concern. For example, states like Bihar, Arunachal Pradesh, Meghalaya, Nagaland, and Jharkhand collected less than 0.5 units per 100 people annually, whereas Kerala, Maharashtra, Gujarat, Haryana, Telangana, and Karnataka collected more than 1.25 units per 100 people annually. Moreover, India experiences a significant rural–urban disparity in the distribution of blood supply: most blood banks are located in urban areas. [12] Secondary and tertiary care facilities, which are generally located in urban areas, typically have a high demand for blood [13].
We found that around 25% of blood banks collected 66% of the annual blood volume, 31% collected more than 5000 units and 38% collected less than 2000 units. This finding suggests potential operational inefficiency that could be addressed by improving VBD, optimal component production, rational demand, and clinical practices in health care settings. The number of blood banks in a state was not correlated with the annual blood collection, which could suggest that it is not the number of blood banks that impacts collection, but the better implementation of programs and, perhaps, the demand for blood, which depends on access to healthcare and morbidity patterns. Ensuring that blood banks are established and regulated based on a comprehensive need analysis considering each region’s population size, geographic location, access to health care, clinical demand for blood, and morbidity patterns could help improve access to transfusion services.
The blood banks recorded an overall mean performance score of 62 and a QMS score of 57.4. The performance varied by geographical region and depended on the size, ownership, type, and attachment. The performance aligned with the performance of the health system and social and economic development in the region. For instance, blood banks performed relatively well in the south and west regions, where the socioeconomic and health indicators are better compared to other regions.[14–16]. The relatively lower quality scores in public blood banks indicate the gaps in infrastructure, availability and management of equipment, human resources, quality systems, processes and training compared to private and not-for-profit blood banks that influence the overall performance of blood banks as well.
Blood bank licenses indicate that only the minimum requirements, including infrastructure, standards, and quality, have been met. The quality of services in blood banks is expected to be beyond the minimum requirements. The tertile classification of scores in our study clarifies the current performance of blood banks. Around 66% of blood banks in India were in the first and second tertile (low-performance or medium-performance). These blood banks reported administrative and technical gaps, including adherence to QMS and practices that could be addressed through sustained programmatic interventions. Specifically, the proportion of blood banks in the low-performance tertile was relatively high in the east, northeast, and northern regions and could be improved.
Conclusion
Our assessment of national blood transfusion services, which is first of its kind in India, provides vital information about the distribution and performance of blood banks. Although India may have an adequate number of blood banks and the overall collection of blood, evidence-based programmes and strategies could help increase the accessibility of blood transfusion services throughout the nation. For example, establishing an efficient supply chain management system, which is currently absent in the country; establishing additional blood storage units, especially in rural areas; and providing controlled transfer of blood units to other geographical regions that are facing shortage are possible solutions that could promote universal access to blood transfusion services.
It is critical to have trained and competent employees, up-to-date equipment, adequate materials, and financial resources to ensure high-quality blood transfusion services. Our assessment shows that there is room for improvement in the structure, system, processes, and standards, especially related to the quality management system. The significant variations in QMS performance and overall performance between states stress the need for state/region-specific plans to improve the overall performance and quality of blood transfusion services. Establishing a uniform standard across regions, blood bank types, and ownership could also improve the services. Apart from the licensing process, periodically monitoring and evaluating blood banks, perhaps through the SBTCs/NBTC in collaboration with other relevant stakeholders, could help maintain continuous quality improvement.
Acknowledgments
This project has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) under the terms of cooperative agreement number 5U2G GH001103-02. The findings and conclusions in this manuscript are those of the authors and do not necessarily represent the official position of the funding agencies. We acknowledge the organizational support provided for the study by the National Blood Transfusion Council (NBTC) and the National AIDS Control Organization (NACO) under the Ministry of Health and Family Welfare, India.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
Footnotes
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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