‘Blood is free; paying for blood is illegal in Nigeria’

Dr Oladapo Aworanti is a Consultant Haematologist and the acting Zonal Director, National Blood Service Commission, South-West Zonal Centre. In this interview by SADE OGUNTOLA, he speaks about payment for blood, its wastage and challenges in ensuring that Nigerian patients’ need for blood and blood products are met.

AS we mark the World Blood Donor Day, can you assess the quality and quantity of blood as well as access to its use for medical purposes in Nigeria?

Presently, the quantity of safe blood for medical treatment in Nigeria is not enough to take care of our health challenges in the country. The need for safe blood for therapeutic purposes is large and rising. For instance, Nigeria has the highest burden of sickle cell disease globally and its cases of chronic illnesses such as kidney disease, liver problems and malignancies, all requiring blood for their management are on the rise. There are other emergencies like road traffic accident, attacks by terrorists and unknown gunmen, just as we saw recently in Owo. Currently, we are still falling short of blood for their management.

By WHO’s standard, Nigeria requires at least 2 million units of blood per year. This is equivalent to one percent of its population. Unfortunately, getting this has been a challenge. We don’t have too many people that come in willingly to donate; there are few voluntary non-remunerated donors in Nigeria. Family replacements and paid donors constitute about 95 percent of all blood donors and that subsequently affects the quality of blood that is available for transfusion.

Quality blood is best taken from voluntary non-remunerated blood donors.  Howbeit, the National Blood Service Commission (NBSC) is making frantic efforts to increase the number of voluntary non-remunerated blood donors. Howbeit, access to enough blood in our blood banks for medical treatment is subject to individuals donating blood voluntarily so that even individuals that require the rare blood group types can easily access them. There is a need to be proactive instead of being reactive to blood donation.

Which blood group type is the most and least requested for in our blood banks?

Request is highest for blood group O Rhesus D positive. We also have more donors for blood group O Rhesus D positive because that is the commonest blood group in Nigeria. The scarce blood groups are mostly those blood groups that are Rhesus negative most especially AB Rhesus D negative and it is because not many people have such blood groups. And when there are requests for such blood group types, especially if many units of that type of blood are required, it becomes a challenge.

It is always said that blood is life and individuals that give blood save lives. Why is this so?

Blood is important in the body. Every system in the body depends on blood. A person that lacks blood is almost dead. Take, for instance, the blood takes around the body the oxygen that we breathe in; it ensures the removal of the carbon dioxide that we breathe out. The waste products from the body are also being carried to the kidneys by the same blood. Also, the glucose to every part of the body including our brain is taken by blood. So, when they say blood is life, it means for every activity that you do, blood is important. If you see people with low levels of blood, standing up or even walking short distances that they have been doing before becomes a problem. When you donate blood for these sets of people, you are saving lives.

IN CASE YOU MISSED THESE FROM NIGERIAN TRIBUNE

• Revealed! Details Of South-West APC Leaders Meeting With Presidential Aspirants
• Supreme Court Has Cleared Civil Servants To Participate In Politics, Falana Tells FG
• Battle For New Alaafin Begins As Ruling Houses Insist On Producing Next Oba
• Court Admits More Evidence Against Alleged Fake Army General, Bolarinwa
• I’m Every Man’s Choice Now, My DM Is Crazy —Eniola Badmus
• It Is Now Bye To Decency: Crazy Fashion Trends At Owambe Parties

For years, it has been said that Nigeria is short of blood in its blood banks.  Is there any paradigm shift to make the country self-sufficient?

Certainly things are getting better with the transformation from the National Blood Transfusion Service which was once a unit under the Federal Ministry of Health into NBSC and now with laws to back up its activities. The screening in most zonal centres of the commission is now automated. To further improve on the quality of the blood units, there is need to increase the pool of voluntary blood donors in the country. The current acting Director General of the NBSC is also working on sensitization programmes across the six geopolitical zones of Nigeria. This is to create more awareness about voluntary blood donation and intimate both government and private owned blood banks about the activities of NBSC.

Also, as part of activities to mark this year’s World Blood Donor Day, the South-West zonal centre of NBSC has decided to embark on an awareness creation on blood donation in primary and secondary schools to catch them young and ensure young people over time make blood donation a habit.

Also, the quality of our blood in our banks is changing. For instance, the acting DG, NBSC, recently commissioned an automated blood screening machine in its South-West zone office last year. With all these changes, effort is being put in place to make the country self-sufficient of our transfusion needs.

What is the incidence of blood borne disease in individuals that you screen for blood donation?

These are diseases we also referred to as transfusion transmissible infections (TTIs). They are chronic infections such as HIV 1 & 2, Syphilis and Hepatitis B and C. Anybody with such diseases is not fit to donate blood.

Among people that donate blood at the NBSC, the incidence of those that test positive for HIV and other TTIs is relatively low, this is because only voluntary blood donors donate in our centres unlike in other facilities that still allow family replacement and paid blood donors. The commission only deals with voluntary non-remunerated blood donors.  The chances of a paid donor having any of the TTIs are high. It is believed that if you can sell your blood, you may likely be able to sell other things including your body and be involved in other high risk behaviours. The type of donation determines the incidence of these TTIs.

However, we want new people to also join our pool of voluntary donors even as we try to retain the donors we have currently so that we can minimise wastage in transfusion services in Nigeria.

A common complaint is people have been asked to pay for blood and at the same time donate when a relative requires blood in our hospitals. Why is this so?

When a volunteer donor comes around to donate, I have just mentioned some of the investigations we carry out on the unit of blood like HIV, hepatitis B, C and syphilis screening. We do all these tests free of charge for voluntary donors. Somebody needs to pay for these investigations. When the government is subsidising the cost of running the blood bank, the person that needs the blood also needs to pay part of the cost to screen the blood units. To do these tests using the equipment that we have here at the NBSC South-West zone blood bank in private laboratories will cost between N25, 000 and N30, 000.

So, the payment is actually to partly cover the costs incurred on testing, bagging and storage of blood collected from a voluntary non-remunerated blood donor. It is not that you are paying for the blood. Blood itself is free. Nigerians are paying access fee/ service charge to access the blood. That is why the cost of accessing a unit of blood in any of the NBSC centres in Nigeria is the same, not minding the locality. Getting a unit of blood will be more expensive if it’s actually being sold. By the law that established NBSC, it is illegal in Nigeria to sell blood. And this NBSC intends to enforce even as it is working towards having only voluntary non-remunerated blood donation in Nigeria.

What are the common myths and misconceptions that have contributed to a poor blood donation in Nigeria’s blood bank?

Some people believe that there is no money in Nigeria and that this has affected their blood levels, and as such, they cannot donate blood. Some believe that the donated blood is sold; others say that women cannot donate blood because they lose some blood during menstruation every month. Some also believe since they are not fat, they do not have blood in their system. All these are misconceptions. Before blood is donated at the NBSC, the person would have filled out a questionnaire and tests would have been carried out to be sure that the individual is fit to donate blood.  If you are not fit, they will not take any blood from you. You cannot give what you don’t have.  If you come during working hours to this blood bank, you will see women coming in to donate blood. During the 2021 World blood donor day, we had a young lady that had donated blood 21 times since the inception of this blood bank.

Have the emerging and re-emerging diseases such as COVID-19 and Monkey pox affected access to quality blood in Nigeria’s blood banks?

There is no way these re-emerging infections will not affect access to quality blood in Nigeria. For instance, during the COVID-19 pandemic, blood transfusion services were affected because people were not allowed to move out. Contact and movement were restricted. During the period, we had the lowest unit of blood donated. For now, Monkey pox has not affected our blood transfusions services.

Who needs blood the most in Nigeria based on people’s age, gender and socioeconomic status?

Based on age and gender, children and pregnant women need blood the most. Children under 5 years experience a lot of infections. For example, malaria breaks down red blood cells and when red blood cells are broken down, there is need for blood.

I don’t think socioeconomic class affects the requirement for blood transfusion, although if we say somebody belongs to the low socioeconomic class, some challenges come with it. One of them is nutritional anaemia. And when there is nutritional anaemia, blood transfusion may not be the solution to nutritional anaemia.