Health
Matters Arising: Blood Transfusion Services in Nigeria
By Saifullahi Attahir
I’m sure once in your life time have experienced or had one of your acquittances received a unit of blood. But have we ever gave a second thought about how this integral part of healthcare system in Nigeria is managed? In this article, I would give the reader a glimpse into this sector due to it’s importance, and some comparison of how it’s manage in other advanced countries.
Blood transfusion was a century old medical practice developed around 1900 by a scientist called Carl landstener, despite several attempts by contemporary scientists before him to devise a means to replace loss of blood encountered by patients either during surgical operations, accidents, or child birth.
Landstener was able to perpect the art of blood transfusion through discovery of major blood groups (ABO, and Rhesus) that played role in matching donor and recipients. Since then, there was continued effort toward safe blood transfusion services across the globe which massively lead to the decline in mortality rate associated with decrease blood supply in the body.
In Nigeria, blood transfusion services was practiced since the colonial-post colonial period mostly starting in Lagos and major urban centres. The major breakthrough was when the National blood transfusion services was established in 2005 during President Obasanjo. The National Health act of 2014 lead to the passage of National blood service Agency bill in 29th /July/ 2021.
According to the NBSA (www.nbsc.gov.ng) site, there was 17 voluntary blood donation centers across the 6 geopolitical zones of Nigeria including separate centers in Federal Capital Abuja, and other centers within the Arm Forces/ Military hospitals. National blood donation day is celebrated every 8th of December, and World safe donation day celebrated every 14th, June.
Nigeria has a population of over 200 million people, and without saying, our demand for blood donation was staggering looking at the number of road traffic accidents, obstetrics patients, major surgical procedures, under 5 years malarial and Schistosomial infections. This is apart from anaemic conditions due to malnutrition (Iron deficiency), other tropical diseases, Chronic Kidney Diseases, abnormal menstruation, and burns.
With all the above mention reasons, our data regarding blood transfusion services was reprehensible.
Several factors have lead to that including community neglect, lack of government intervention, lack of standard private practices, cultural influences, poor funding, and the Almighty mismanagement of resources.
About 1,230, 000 (one million, two hundred and thirty thousand) units/pints of blood are collected annually across Nigeria healthcare facilities, but unfortunately about 90% of this donations are paid commercials. Only 25,000 units are donated by volunteers that are made available to 3,400 hospitals urgent request! This simply shows that less than 5% of blood donation in Nigeria is voluntary.
Let me highlight four different forms of donations practiced worldwide;
* There was voluntary donation done by individuals just for the sake of humanity with no ulterior motive.
*There was direct/replacement donation usually done by relatives of a patients that are called in times of emergency. This one is hugely practice in Nigeria to about 75% in public hospitals.
* There was paid commercial donations in which donors give blood and collect money for it. This practice in Nigeria constitute about 25% in public hospitals and about 75% in some private clinics. This practice carried the major risk of transmitting transfusion-transmitted infections like HIV, Hepatitis B, and C.
* There was the autologous transfusion in which individual give his own blood prior to some surgical operations where the blood is stored, and later transfused back to him. This procedure has the least risk of transmitting infection and eliciting blood transfusion reactions.
Among the four blood transfusion methods, the two most widely practiced in Nigeria are the replacement and the paid commercial. People only care to donate blood when they knew their relatives are in need. This practice was commoner in our society from the villages to the urban. You could donate as soon as you know it’s your parents, wife, son, sister, brother or friend. Any other person can go to hell!
The worst form of practice is the commercial one, where people either out of ignorance or artificial poverty volunteer to donate only if they are going to be paid for it. This business triggers every form of atrocities where the donors sometimes donate multiple times within a short period of time ( The standard is at least an interval of 4-6 months, depending on age, gender, and social status).
The paid donors carries the highest risk of transmitting infections and other abnormalities either to themselves or to the recipients. So this practice need to be discourage by the healthcare personnels and the Government.
As an insider, and with my little period of practice, I have come to realized some of the difficulties blood transfusion services encountered in our health care facilities.
Shortage of blood units
There was the problem of blood supply shortage, this is evident from how Doctors/Lab personnel always advised patient relatives to go home and mobilized their kinsmen when a patient was in need of blood. This happens as if it were the standard thing to do. The ideal is for a patient to be transfused blood from the pool of blood bank regardless of bringing replacement or not. But this can only happens if their was enough units stored in the blood bank, and in most cases their was non.
I have personally witnesses several cases where a patient can almost loose his/her life their donors travelling many kilometers only to be rejected due to mismatch. Imagine the money and time wasted! The blame is not on the healthcare personnel, nor on the government alone, the blame is on the system and our society at large. We are lacking altruism.
This problem can be attributed to the lack of decentralised system of blood banking we operate in Nigeria.
Nigeria has a single National blood donation system. While in places like US, procurement of blood is majorly met by volunteers, they have a pluralistic blood collection programs by ( Red cross, independent community blood centres,and hospitals).
In the US, 15 million units of blood are collected from 10 million donors annually, and only 7% are collected in hospitals, and 93% in regional centres, unlike Nigeria where most of the collection are done in hospitals.
In the US, the blood collection, processing, testing,and preservation are regulated by the FDA. They operated a sharing system where by blood units can be transferred from a region with less demand and higher collection to a region with more demand.
Blood transfusion data
Nigeria has a blood collection data problem, many hospitals especially in the rural areas can not keep the record consistently for a year. This problem can be attributed to the manual (pen and paper) system of health records we are still operating in Nigeria, which is subject to error, missing, or manipulation. Without proper blood collection data it would be difficult to alleviate problem of shortage, and implementation.
Lack of Awareness
A recent data has shown how blood donation is directly proportional to development; in developed countries, 50 units of blood are donated in every 1000 population. In developing countries, 15 units of blood are donated in every 1000 population. While in under developed countries, only 5 units of blood are donated in every 1000 population.
In under developed and developing countries, limited storage facilities, lack of incentives, malnutrition, personal wellbeing,and lack of knowledge can be a contributing factor to low turnout of voluntary blood donation. It’s more likely for a high income University graduate to donate blood voluntarily than a less educated poor labourer. The former might be healthier, more mentally stable, and more aware on the need to donate.
Expertise and Procurement Facilities
The current improvement in blood donation service especially in the tropics can be attributed to the benevolent funding by the US through USAID and President Emergency Plan For AIDS Relief (PEPFAR). Since 2000, there was continued efficiency in transfusion services in Nigeria, thanks to the aforementioned Agencies.
Despite this improvement, there was still problems of procedures, staff proficiency, specific testing,and preparation of separate blood components ( like plasma derivatives, platelets, and white blood cells).
Our screening methods are still qualitative immuno-phenotyping, we are using 4th generation ELISA ( Enzyme linked immunosorbent Assay), and no Nuclear Amplification Technique (NAT ) testing yet.
In 2018, I attended a two weeks training in Abuja organized by the University of Maryland experts under the supervision of Federal Ministry of Health (FMoH). We were trained on the standard serological techniques of Retro viral screening (RVS), Hepatitis, and VDRL. It was in preparation for a six month extensive survey we conducted across Nigeria based on the impact of HIV screening and therapy over the last three decades called Nigeria AIDS INDICATOR AND IMPACT SURVEY (NAIIS 2018). The training was an eye opener for me on the need to standardized our screening methods.
On a way forward, in order to attain the blood transfusion safety target, there is need for more voluntary donations campaign through mass media, schools, Churches, and Mosques.
Factors that prevent people from voluntary donations should be address like establishment of more independent blood donation centres, incentives, availability of storage facilities, and free donation services.
Nigeria should have a centralised registry of people with blood group O rhesus D negative, and such rare blood units should be made available across the country through a systematic sharing arrangement.
There is need for the communities and philanthropies to create more Non governmental organizations (NGOs) to address shortage of blood and to complement government efforts, as the government can not carryout the duty alone.
Saifullahi Attahir is the President of National Association of Jigawa State Medical Students (NAJIMS) National body. He wrote this piece from Federal University Dutse
By Adedapo Adesanya
The National Health Insurance Authority (NHIA) says the number of Nigerians enrolled in health insurance has risen to more than 22 million.
The Director-General of NHIA, Mr Kelechi Ohiri, said this resulted from the implementation of the mandatory health insurance, which has gained momentum nationwide.
He said this on Wednesday at the Annual General Meeting of the Nigerian Association of Insurance and Pension Editors (NAIPE) in Lagos.
Mr Ohiri said enrolment had increased to 22.03 million, representing a 35 per cent year-on-year growth, attributing this to stronger collaboration with state social health insurance agencies, ministries, departments and agencies, organised labour, employers, the private sector, and the gradual implementation of the mandatory health insurance provisions of the NHIA Act.
He said that the country had moved beyond policy formulation to delivering measurable improvements in healthcare access, service quality and consumer protection in line with the federal government’s health sector reform agenda.
According to him, Nigeria already has the necessary policies and legislation to achieve Universal Health Coverage, positing that the key challenge was effective implementation.
“The decisive variable is now implementation- consistent, rigorous and accountable execution that converts political commitment into healthcare access for real Nigerians,” he said.
Mr Ohiri said that the transition from the former National Health Insurance Scheme to the NHIA had strengthened regulation, consumer protection, accountability and strategic purchasing, while providing the legal and operational framework for achieving Universal Health Coverage.
He added that improving the experience of enrollees remained central to the Authority’s reform agenda.
According to him, NHIA has strengthened its complaints management system, introduced faster resolution timelines, and intensified compliance monitoring of Health Maintenance Organisations (HMOs) and healthcare providers.
He further added that NHIA had sanctioned facilities that failed to meet the required standards, adding that his organisation had resolved 3,878 complaints, representing an 87 per cent resolution rate, while 95 per cent of the cases were concluded within prescribed timelines.
Mr Ohiri noted that more than N14.2 million had been refunded to enrollees, while non-compliant healthcare facilities had been sanctioned.
He said NHIA had also introduced service standards, including a one-hour treatment commencement target for enrollees requiring urgent care, to improve access to timely and quality healthcare services.
The NHIA boss further disclosed that capitation payments to healthcare providers had been increased by 93 per cent.
He said fee-for-service reimbursements rose by 378 per cent to enable providers to invest more in personnel, equipment and infrastructure.
According to him, 7,592 healthcare facilities have been assessed under the SafeCare quality framework as part of efforts to institutionalise continuous quality improvement across the country.
Mr Ohiri also highlighted interventions targeted at vulnerable groups, including support for more than 48,500 pregnant women, expanded maternal and newborn healthcare services, the Vulnerable Group Fund, and improved access to healthcare for pensioners and retirees.
He said Universal Health Coverage could only be achieved if every Nigerian, regardless of income or location, had access to quality healthcare services.
By Modupe Gbadeyanka
The new one-hour authorisation response time ultimatum policy introduced by the National Health Insurance Authority (NHIA) has received the full backing of SUNU Health Nigeria Limited.
This policy was introduced by the agency to ensure enrollees get prompt approval codes to access care.
Healthcare service providers have been urged to report any Health Maintenance Organisation (HMO) that violates this initiative through an email, with the HMO in copy and a timestamp attached as evidence of the request. They may proceed to offer services to enrollees thereafter.
Speaking at the company’s second-quarter Providers’ Forum for the Lagos-Ogun region in Lagos recently, the chief executive of SUNU Health, Dr Moyosore Olomola, expressed optimism that this policy would improve healthcare delivery in the country, especially for enrollees, who crave quality service.
At the event themed Improving Quality and Access to Care Through Stronger Provider Network, and held at the Nigerian Institute of Medical Research (NIMR) in Yaba, Lagos, Mr Olomola reaffirmed the HMO’s commitment to operating within legal and operational frameworks to guarantee adequate care for enrollees.
“Access to care and quality of care remain key priorities in our healthcare systems. We know quite well that deliberate collaboration, strategic partnerships, and a shared commitment to excellence are required to achieve these priorities.
“A strong provider network is doubtless the backbone of any effective healthcare system. It ensures that our mutual enrollees receive the right care, at the right time, in the right place, and at the right price,” Mr Olomola, represented at the programme by the organisation’s Chief Operating Officer (COO), Dr Faith Nwachi, stated.
He further assured that SUNU Health would strictly adhere to the one-hour authorisation limit, stressing that this aligns seamlessly with one of the organisation’s core values—promptness and its corporate slogan, Humanity is the centre of our initiatives.
In a bid to further improve access and quality of care, SUNU Health also demonstrated its new operational software and Mobile app, aptly named SUNU Legacy.
Also speaking at the event, the NHIA Lagos State Coordinator (Ikeja), Dr Bethuel-Kasimu Abraham, noted that the forum’s expected outcome is to significantly reduce delays in accessing medical care.
Other key expectations include ensuring continuity of care, improving patient outcomes, and strengthening accountability among HMOs.
Addressing specific pain points faced by enrollees, the NHIA Ogun State Coordinator, Mr Dare Adefeso, acknowledged that the agency had received complaints regarding out-of-stock drugs and the discrimination of enrollees by certain providers.
He affirmed that the NHIA is actively addressing these issues, stressing that moving forward, every facility must ensure enrollees are properly catered to regardless of their status, provided they have an active health insurance plan.
Corroborating the long-standing legacy of SUNU Health, the Ogun State Director of the National Orientation Agency (NOA), Mrs Aishat Tiamiyu, shared that her agency is responsible for public information dissemination and has been enrolled with SUNU Health for over 25 years.
Commending the HMO’s stellar service over two decades, she called for the immediate enrollment of new NOA staff into the scheme.
The Providers’ Forum remains one of the strategic channels employed by SUNU Health to consistently engage healthcare providers, understand their operational challenges, introduce new software updates, and solidify partnerships aimed at fostering premium healthcare delivery across Nigeria.
By Aduragbemi Omiyale
The National Agency for Food and Drug Administration and Control (NAFDAC) has announced the recall of a sexual enhancement product known as WAP Sensual Enhancement Capsules.
In a statement on Monday, the Nigerian agency disclosed that the recall is due to “undeclared pharmaceutical ingredients” in the product, whose country of origin is unknown, but is marketed and distributed online in the US through eBay.
It was emphasised that the recall is being “voluntarily” made by the manufacturer, Best Supplements Best Prices Company.
The detection of the undeclared pharmaceutical ingredients was made by the US Food and Drug Administration (FDA).
Laboratory analysis by the US FDA revealed that the product contained undeclared sildenafil, tadalafil, and flibanserin, which were not mentioned on the product label. Such substances may include phosphodiesterase type-5 (PDE-5) inhibitors or related compounds commonly used for the treatment of erectile dysfunction, the statement by NAFDAC stated.
Sildenafil and tadalafil are ingredients in FDA-approved prescription drugs used to treat erectile dysfunction.
It was noted that these undeclared ingredients may interact with nitrates found in some prescription drugs, such as nitroglycerin, and may lower blood pressure to dangerous levels. Consumers with diabetes, high blood pressure, high cholesterol, or heart disease often take nitrates.
Flibanserin is the active ingredient in an FDA-approved prescription drug used to treat low sexual desire in women. Flibanserin can cause drowsiness, sedation, dangerously low blood pressure, and fainting, especially when combined with alcohol.
Consumers have been encouraged to report compromised products (medicines or medical devices) to the nearest NAFDAC office, call 0800-162-3322, or send an email to sf******@********ov.ng.
