For a long time, there has been disgruntlement from various sections of society over the highly priced precious liquid of blood in Zimbabwe. The bone of contention over years has been around the cost of blood and blood products despite the fact that the National Blood Service of Zimbabwe (NBSZ) gets blood free of charge from blood donors.
By Michael Gwarisa
In 2018, the Ministry of Health and Child (MoHCC), then under the regime of Dr David Parirenyatwa launched the Free Blood Initiative that would see pregnant women and vulnerable citizens getting blood for no charge from all public health institutions. Through the health levy that is deducted from voice phone calls, the Minister of Health has been receiving funds from treasury which they would disburse towards subsidising the free blood initiative other health services.
However, owing to the prevailing economic challenges, middle class citizens who under normal circumstances are supposed to be paying for services mainly through health insurance or medical aid are now being forced to use out of pocket payments in hard currency to get treatment either in public or private hospitals due to medical aid shortfalls.
This has also exerted pressure on the free blood initiative as demand for free blood and blood products has increased in public health institutions. Due to perennial blood supply shortages especially for Blood type O which is the universal blood group, majority of patients are currently being referred to private health facilities where blood costs an arm and a leg despite it being a freely donated product.
In January 2021, one would buy a pint of blood for ZWL$8 400. However, by March the same year, a pint of blood was attracting not less than US$145.00. Even though the Ministry of Health still maintains that the free blood initiative is still effective in public hospitals. The situtaion on the ground speaks otherwise.
So why is blood costing above US$100.00 depsite it being donated for free?
To shed light on why blood in Zimbabwe is costly and not free like in other parts of the Africa such as Rwanda, the NBSZ Finance Executive, Mr Radhi Chikwereti told HealthTimes in an interview that while blood from the public is freely donated, voluntarily and without coercion, it is not without cost.
Blood transfusion activities should not be perceived as simply a social obligation, provided for free, without charge. The overall cost of producing a unit of red blood cells (RBC) is US$140.00. The Service relies on fees levied based on a cost recovery model that takes into account all incurred in the activity chain from collection, processing, storage to distribution of blood components,” said Mr Chikwereti.
He added NBSZ collects blood through static and mobile clinics in five major branches countrywide (Harare, Bulawayo, Gweru, Masvingo and Mutare) Blood collections costs.
“On average, a mobile team vehicle and donor promotion vehicle travels a distance of about 300km daily, and this requires an all-terrain vehicle with a capacity to tow a trailer weighing a minimum of 750kg – 2,000kg. The current cost of fuel is US$1.74 and the mobile team requires fuel averaging US$104.40 daily apart from wear and tear. Apart from donor promotion salary, the mobile team is made-up of 3 Registered General Nurse (RGN), donor attendant and mobile team driver.
“The major consumables that are required in order to collect blood include blood bags; grouping reagents; syringes; specimen tubes; swabs; donor incentives; and refreshments. The current cost of a triple top, bottom blood bag is averaging US$9.45 CIF Harare and the total cost per month varies in tandem with the number of donations. Other imports include Eldon cards, specimen tubes and cuvettes. The total collection costs average $31.18 per donation, including costs for incentives and refreshments.”
Transfusion Transmissible Infections (TTI) testing.
Mr Chikwereti also said the NBSZ performs 100% testing for transfusion transmissible infections for all units of blood collected from the donors, whether new or regular. The organisation thus requires adequate resources for the consistent and reliable screening for the following markers:
• HIV-1 and HIV-2: screening for either a combination of HIV antigen- antibody or HIV antibodies.
• Hepatitis B: screening for hepatitis B, surface antigen (HBsAg).
• Hepatitis C: screening for either a combination of HCV antigen-antibody or HCV antibodies.
• Syphilis (Treponema pallidum): screening for specific Treponema antibodies.
NBSZ maintains a centralised testing system for blood and blood products, therefore, all blood samples from every unit collected across the country are couriered to Harare from Masvingo, Mutare, Gweru and Bulawayo branches using overnight Services.
These tests are important for blood safety and they are performed on an Automated Architect i2000 and Alinity S, instruments on a reagent lease/rental agreement between the NBSZ and the supplier. The major total cost per profile is US$15.24.
Blood Grouping – ABO and RhD
Donated blood is grouped by ABO and Rhesus type using a closed automated Neo Iris Blood Grouping system from Germany. These instruments use long-shelf reagents from Germany and short-shelf-life reagents from United States of America. Although all these tests are automated, there is manual intervention required by laboratory scientists for sorting samples, loading reagents, quality control checks on the machine as well as transfer and review of results. The major cost of blood grouping is US$3.19 per unit.
Component Preparation – Production
The donated blood is separated into various components using refrigerated centrifuges and automated blood separators. Our Production Section is responsible for processing blood into components, which include fresh frozen plasma; platelets; packed cells and cryoprecipitate. Confirmatory blood grouping is then manually performed for each red cell blood unit. The laboratory Scientist, SBTT and Production Assistants oversee the whole process.
Quality Control, Storage and distribution
All the processed blood is subject to quality control before distribution to hospitals. Processed blood and blood products are kept in specialised blood bank fridges monitored by laboratory scientists. The major costs include personnel, reagents, courier and blood cold chain maintenance, including back-up generators to ensure an unbroken power supply. The Service outsources the maintenance of these cold chain equipment and other essential equipment.
How volatility of economic environment has impacted on the cost of producing safe blood and blood products in Zimbabwe.
The significant changes that have occurred in the economy, which has impacted negatively on the revenue include, but not limited to inflation, exchange rate movements, monetary policies and the depreciation of the local currency.
“The volatile economic environment contributed immensely to the loss of value, which has worsened the ability of NBSZ to meet international payments for critical raw materials. Most goods and services available on the market are indexed to the parallel market rates, which makes them very expensive.
“The Service revenue is mainly in local currency, but it requires foreign currency to import critical raw materials used in the processing of blood components. NBSZ applies for the foreign currency through the Reserve Bank of Zimbabwe foreign currency auction market and in most cases the allocated is not always enough to cater for the procurement of critical raw materials and consumables such as test kits and blood bags. This is further compounded by the fact that even if we get the foreign currency allocation, the Service hardly has enough funds in local currency to offset with the foreign currency allocation, because of delays in settlement of invoices by customers.
“Furthermore, the foreign currency allocation can take several weeks or even months before the funds are released to our bankers for payment. This has caused disruption on the supply chain, resulting in shortages of blood products because suppliers are demanding prepayment. The foreign exchange rate movement in the past few months also weighed heavily on the Service revenue resulting in massive losses due to exchange rate differences between the time of transaction and settlement date by our customers.”
Operational challenges being faced by the blood bank
Mr Chikwereti added that NBSZ is facing re-capitalisation challenges, with some of the equipment constantly broken down due to excessive wear and tear because of years in use averaging twenty (20) without replacement.
“In order for the Service to function efficiently the following laboratory and clinical equipment such as refrigerated centrifuge, platelets agitators, blood bank freezers and haemoflow scales are required urgently.”