A hub and spoke model and a 100 per cent non-remunerative blood donation structure will help India and Assam reduce deaths
The United Nations (UN) Sustainable Development Goal (SDG) 3 seeks to ensure health and well-being for all as a social capital. SDG 3, more specifically SDG 3.1, aims to reduce the global Maternal Mortality Ratio (MMR) to less than 70 per 1,00, 000 live births by 2030. As per the World Health Organisation (WHO), maternal death is the demise of a woman while pregnant or within 42 days of termination of pregnancy, from any cause related to or aggravated by the pregnancy or its management. As per the goal laid down in the National Health Policy 2017, the target for MMR per 1,00,000 live births by 2020 is 100.
Figures from a special bulletin released by the Office of the Registrar General’s Sample Registration System (SRS) in July this year show that MMR in India stood at 113 in 2016-18. Although it has seen a reduction from 122 in 2015-17 and 130 in 2014-2016, the number is way behind the SDG target. The most disturbing figure comes from Assam where MMR is at 215. However, if one compares it to the 2012-13 data of the State, it has been significantly brought down from 301. Nevertheless, given India’s SDG commitment, immediate intervention is needed to bring down the ratio further.
As recently as July, Prime Minister Narendra Modi delivered the keynote address virtually at the high-level segment of the United Nations Economic and Social Council (ECOSOC) session, wherein he highlighted that India’s developmental motto of “Sabka saath, sabka vikaas, sabka vishwas (Together, for everyone’s growth, with everyone’s trust)” resonates with the core SDG principle of leaving no one behind. He also emphasised that India’s success in improving the socio-economic indicators of its vast population has a significant impact on global SDG targets. Hence, addressing individual health indicators like MMR is certainly critical in improving the country’s public health and meeting targets set by the SDG.
The role of individual States is also critical. For example, it is important for a State like Assam with a high MMR to tackle the problem on a priority basis. According to an Epidemiological study of maternal death in Assam, data show that 21.3 per cent of the deaths were due to haemorrhage, 17.3 per cent due to pregnancy-induced hypertension and 10 per cent due to sepsis. Blood loss of 500 ml or more within 24 hours after birth is known as postpartum haemorrhage. Such deaths can be brought down significantly by developing a robust blood transfusion system, which provides universal access to safe and adequate blood. The annual blood collection in Assam in 2018-19 was 2,34,488 units whereas the State needed 2,42,000 units against the total number of hospital beds in 2019. As per a State-wise ranking, which maps the annual requirement to actual collections of blood units, Assam comes at the bottom five. With 82 blood banks in the State, it is regrettable that shortage of blood remains an area of concern.
Another crucial aspect is the quality of the blood available. The National AIDS Control Organisation revealed that around 1,342 people contracted HIV infection due to blood transfusion in 2018-19 pan India. This information raised several questions on the existing blood transfusion system in the country. An effective solution to ensure availability of safe blood involves shifting to 100 per cent voluntary help and doing away with replacement donation. Recruitment of donors becomes one of the most crucial features of blood transfusion services and a system supported by healthy, responsive and motivated voluntary blood donors can significantly reduce the associated quality issues. The percentage of voluntary donation in Assam is 47.9 per cent, which is way below the national average of 71.9.
Another problem that exists in a developing country like India is a fragmented blood transfusion system. For effective operation of the 3,321 blood banks in the country, it is imperative that there is transparency and guaranteed quality systems. But ensuring surveillance of 3,321 blood banks for effective operation is not practically feasible. However, empirical data from developing countries show that adopting a centralised hub and spoke model can help in accessing safe blood to a great extent.
Sadly, such a centralised blood transfusion system is currently non-existent in India, even though it prevents wastage of extra blood collected, particularly now that bulk transfers between banks have been permitted by the National Blood Transfusion Council. It enhances access, too, as blood can be redirected from the hubs to wherever there is a shortage. In case of emergencies, the collection of blood becomes simpler, too. A hub and spoke model and a 100 per cent non-remunerative blood donation structure will help India and States like Assam to reduce the MMR burden.
(The writer is a public policy consultant, Chase India)
