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National Baseline Survey for Assessment, Monitoring and Evaluation of Blood Screening Systems in Pakistan SBTP-WHO 1 WORKSHOP REPORT NATIONAL BASELINE SURVEY FOR ASSESSMENT, MONITORING AND EVALUATION OF BLOOD SCREENING SYSTEMS IN PAKISTAN Islamabad, July 02, 2013 SAFE BLOOD TRANSFUSION PROGRAMME WORLD HEALTH ORGANIZATION

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WORKSHOP REPORT

NATIONAL BASELINE SURVEY FOR ASSESSMENT, MONITORING AND EVALUATION OF BLOOD

SCREENING SYSTEMS IN PAKISTAN

Islamabad, July 02, 2013

SAFE BLOOD TRANSFUSION PROGRAMME WORLD HEALTH ORGANIZATION

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Table of Contents 1. Introduction ...................................................................................................................... 3

2. Workshop Proceedings .................................................................................................... 4

3. Working Group Results .................................................................................................... 9

ANNEXES ............................................................................................................................. 10

A: List of Participants ...................................................................................................... 10

B: Workshop Programme ............................................................................................... 11

C: Group Photograph ...................................................................................................... 12

D: Newspaper Clipping .................................................................................................... 13

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1. Introduction The ‘National Baseline Survey for Assessment, Evaluation and Monitoring of Blood

Screening System in Pakistan’ was conducted by the Safe Blood Transfusion Programme

from September 2012 to April 2013. The survey was supported through WHO/OFID Joint

Project (OPEC Fund for International Development) on Prevention of Transfusion

Transmitted HIV/AIDS and Hepatitis Infections. For data collection, the Provincial Blood

Transfusion Programmes and the private sector Blood Centres extended full cooperation to the

Programme and their support is very much appreciated. A total of 170 blood banks were

covered in the survey. The findings and recommendations of the survey have provided the

stakeholders an excellent evidence to base their future course of action on. The survey also

helps the SBT Programme, policy makers and other key stakeholders to take necessary

corrective actions which will prove beneficial to reduce the burden of the risk of transmission

of infections through transfusions in Pakistan.

The subject workshop was conducted to share the results of the survey and to plan a way

forward in the light of the recommendations. The participants included key stakeholders for

the transfusion sector; policy makers, transfusion experts, haematologists and researches.

The Programme is very grateful to the WHO and OFID for supporting the survey and looks

forward to deriving maximum benefit from the evidence generated through this excercise.

Prof. Hasan Abbas Zaheer, PhD Incharge, Blood Transfusion Services Project Director Pakistan Institute of Medical Sciences Safe Blood Transfusion Programme Islamabad, Pakistan Government of Pakistan Ph: 0092 51 926 12 72 Ph: 0092 51 926 32 36 Email: [email protected] URL: http://www.sbtp.gov.pk

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2. Workshop Proceedings

The Safe Blood Transfusion Programme in collaboration with the World Health Organization

conducted a 1-day workshop on ‘National Baseline Survey for Assessment, Monitoring and

Evaluation of Blood Screening Systems in Pakistan’ on July 2, 2013, in Islamabad. The

objective of the workshop was to share the result and findings of the national baseline

survey on assessment, monitoring and evaluation of blood screening systems in Pakistan.

The survey and the workshop were supported by the WHO/OFID Joint Project.

The programme started with opening remarks by the Programme Officer WHO, Dr. Quaid

Saeed who introduced the WHO/OFID Joint Project for the prevention of TTIs. He also shed

light on the National Baseline Survey on Assessment, Evaluation and Monitoring of Blood

Screening Systems in Pakistan which was conducted between September 2012, and April

2013, as part of a WHO/OFID Joint Programme in collaboration with the Safe Blood

Transfusion Programme (SBTP). The survey tools were based on WHO evaluation

framework for assessment, monitoring and evaluation of blood screening systems adapted

for application in Pakistan in 2011. He said the purpose of the survey was to encompass all

aspects of the blood screening process. The findings of the survey provide a comprehensive

situation analysis of the state of the blood screening process in the country.

PUNJAB BTA PRESENTATION

Dr. Jafar Saleem, Secretary

Blood Transfusion Authority

Punjab, made a special

presentation on the progress of

the regulatory authority in

Punjab with special reference to

prevention of TTIs. PBTA is a

regulatory body responsible for

Prof. HA Zaheer Dr. Quaid Saeed Dr. Jafar Saleem Dr. Farrukh Hasan Mr. Usman Waheed

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regulating both the public and private sector blood banks. It is involved in registration of

blood banks, issuance of licenses and provision of quality blood. Dr. Saleem gave a brief

history of the Punjab BTA which was notified in 1999, under the Punjab Safe Blood

Transfusion Act on the directives of

the Chief Minister. However, it

remained limited in its operations due

to inadequate financial,

administrative and logistic support. In

2012, the CM announce to re-notify

the BTA with an aim to check illegal

blood banks and business of

substandard and unscreened blood

and monitoring of blood banks to ensure that these banks are managed and run by qualified

professionals preferably having post graduate qualifications in blood transfusion. One of the

members’ provincial assembly Dr. Saeed Elahi, was elected as the Chairman BTA and the

first meeting was held on February 28, 2013 which took important decisions regarding the

registration of blood banks, issuance of licenses and provision of quality blood. The BTA is

doing efforts for resource mobilization and staff hiring to become fully active.

PRESENTATION ON SURVEY REPORT

Prof. Hasan Abbas Zaheer, Project Director SBTP, gave a detailed overview of the survey

findings. The survey documented quantitative (sample size 170 blood centres, both in public

and private sector in all the four provinces and AJK, GB, and FATA) and qualitative aspects

to the extent possible. The survey findings were analyzed under following headings:

Regulatory Framework: The findings of the survey indicate that the blood transfusion

regulatory framework is inconsistent in different provinces. Sindh is the only province that

has a functional blood transfusion authority.

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Physical Infrastructure: Almost all the blood centers surveyed had power and water supply

connections. Seventy five percent of the blood centers faced power cuts in the range of 5-12

hours daily. Backup generation facilities were available in 70 percent of the blood centers.

Management, Technical, & Financial Capacity: In the absence of MIS, both in the public

and private sector, data management is not accorded priority in almost half of the blood

centres surveyed. The survey findings indicate limited scale and scope of technical support

to blood centres.

Quality Assurance

System: Only 58 % of the

total blood centres

surveyed have a quality

assurance policy as

compared to 71 (42 %)

that had none. The

situation is worse in public

sector blood centres

where the majority (55%) of the blood centres lack an internal quality audit system.

Screening Processes: Operations and processes of blood centres including screening

strategies are; irregular, unsafe and unregulated in the majority of the blood centres. Almost

43 percent of the blood centres had no internal quality audit system and none of the blood

centres surveyed had any external quality control system.

Procurements: In the public sector blood centres, 95% of the equipment was purchased

centrally by the health departments in comparison to the private sector where 80% of the

equipment was procured locally. The procurement process involves little input of the

technical staff. Almost 92% of the blood centres surveyed (n=157) had a programme or

system for equipment maintenance.

Management Environment:

The survey findings indicate

the existence of a

fragmented blood transfusion

system in which blood

centres function in isolation

and with limited regulatory

control.

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The major findings of the study lead to the

several recommendations to improve the

overall blood transfusion services in the

country. Prof. Zaheer’s presentation was

followed by a detailed question and answer

session. The participants took keen interest in

the survey findings and gave useful

recommendations.

SAATM PRESENTATION

Taking advantage of the presence of Dr. Farrukh Hasan, Executive Council Member, South

Asian Association of Transfusion Medicine (SAATM), the recent collaborations with the

Association were discussed. Dr. Farrukh Hasan provided an update on SAATM and its roles

and objectives. SAATM is a regional organization promoting Transfusion Medicine in the

South Asian countries and working towards finding solutions for their common problems and

issues. The primary objective of the Association is to accelerate the scientific progress and

common standards in Blood Transfusion Services (BTS) in member states.

GROUP WORK

Mr. Usman Waheed, Technical Expert

SBTP gave a brief introduction to the

working groups which were task

oriented. He discussed the proposed

topics and possible deliverables from

each working group. All participants

were distributed in three groups and

each group was assigned a facilitator

and specific topic to discuss. Group 1, 2

and 3 were facilitated by Dr. Jafar

Saleem (BTA Secretary Punjab), Dr. Muhammad Tahir Khan (Project Director KPK SBT

Project) and Dr. Sarfraz H. Jaffri (Administrator Husaini Blood Bank, Karachi) respectively.

The topics discussed during the working group sessions were; Group 1: Improvements in

data management system in Blood Transfusion Services; Group 2: dissemination and

implementation plan of survey report and the possible road map for formulation of National

Blood Policy; and Group 3: Future Recommendations for the WHO/OFID project. The

presentations made by the working group were very well received and followed by a detailed

question and answer session.

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CONCLUDING REMARKS

Concluding remarks were given by Dr. Quaid Saeed who lauded the efforts of the SBT

Programme in conducting this survey and facilitating the workshop.

CERTIFICATE DISTRIBUTION Following the successful technical session and group work, certificates were distributed among the participants by Prof. Zaheer and Dr. Quaid.

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3. Working Group Results

Dr. Jaffer Saleem from Group I presented recommendations on “Data Management System Improvement’ which are summarized as below: Data management tools such as registers, donors and recipients forms should have

uniform information in all the hospitals. There should be training programs conducted for staff. Donors and recipients data should be collected and managed carefully and

effectively. Feedback system must be implemented from donors and recipients. Data manager must regulate data compilation, analysis, validation and report

generation. The topic of Group II was ‘Dissemination and Implementation plan of survey Report and screening strategies for Transfusion Transmissible Infections, National Blood Policy Mechanism’. Dr. Tahir Khan presented the following recommendations on behalf of Group II; According to them National Blood Policy already exists but expired in 2012 so all the

stakeholders should do amendments in the policy according to their requirements and regulatory coordination division should help to approve this policy.

Input or feedback must be obtained from end users from public and private sector blood centers.

There should be awareness programs among the technicians and public. Pressure from masses is also essential for the implementation of the policy.

Dr. Sarfaraz Jafri from Group III gave some recommendations on “Future strategy recommendations for the project” which are given below:

Regulatory body should be responsible to ensure functioning of an internal as well as external quality assurance systems.

There should be a communication through SMS for proper reporting systems. Pathologists and Hematologists should supervise the blood bank. If not then medical

officer should do this job. Procurements should be monitored by regulatory authority and standard operating

procedures (SOPs) must be provided to blood centers. It is very important to dispose of waste properly and for this purpose there should bea

waste management team in every blood bank.

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ANNEXES

A: List of Participants

S. No. Name Designation Hospital/Institute

1. Prof. Hasan A. Zaheer Project Director SBTP

2. Dr. Quaid Saeed Programme Officer WHO Pakistan

3. Dr. Saeed Ahmed Head/Consultant Husaini Blood Bank, Karachi

4. Prof. Tahir Shamsi Consultant Haematologist NIBD, Karachi

5. Prof. Syed Irfan Consultant Haematologist LNH, Karachi

6. Dr. Nisar Ahmed Associate Professor Children Hospital, Lahore

7. Dr. Ashraf Memon Senior Pathologist Sindh AIDS Control Programme

8. Dr. Shah Muhammad Deputy Program Manager Sindh Blood Transfusion Authority

9. Dr. Tahir Khan Project Director KPK SBT Project

10. Dr. Naveed Ahmed Programme Manager SBTP AJK

11. Dr. Farhat Abbas Infection Control Committee Benazir Bhutto Hospital, Rawalpindi

12. Dr. Naila William Infection Control Committee Benazir Bhutto Hospital, Rawalpindi

13. Dr. Sarfaraz H. Jaffri Administrator Husaini Blood Bank, Karachi

14. Mr. Zahid Mahmood Team Leader EPOS Health Management

15. Dr. Farrukh Hasan Vice President SAATM

16. Mr. Wasiq Paracha Vice President PWA, Karachi

17. Mr. Usman Waheed Technical Expert SBTP

18. Dr. Shahtaj Khan Assistant Professor HMC, Peshawar

19. Dr. Jafar Saleem Secretary Punjab Blood Transfusion Authority

20. Dr. Suryya Hashmi Public Health Specialist Institute of Public Health

21. Mr. Bilal Tareen Medical Technologist PIMS, Islamabad

22. Dr. M. Aamir Mirza Associate Professor Dow University of Health Sciences

23. Mr. Sajd Shah Admin Officer SBTP

24. Mr. Muhammad Fareed Managing Editor Medical Review

25. Ms. Tayyaba Komal Internee, BTS, PIMS Student, NUST Univ.

26. Ms. Isra Mahmood Internee, BTS, PIMS Student, NUST Univ.

27. Ms. Hafsa Inam Internee, BTS, PIMS Student, NUST Univ.

28. Ms. Kaenat Nasir Internee, BTS, PIMS Student, NUST Univ.

29. Ms. Ayesha Sajid Internee, BTS, PIMS Student, NUST Univ.

30. Ms. Fatima Darakhshan Internee, BTS, PIMS Student, NUST Univ.

31. Mr. Uzair Hashmi Internee, BTS, PIMS Student, NUST Univ.

32. Ms. Aqsa Abbasi Internee, BTS, PIMS Student, NUST Univ.

33. Ms. Sana Javed Internee, BTS, PIMS Student, NUST Univ.

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B: Workshop Programme

WORKSHOP ON

NATIONAL BASELINE SURVEY FOR ASSESSMENT, MONITORING AND EVALUATION OF BLOOD

SCREENING SYSTEMS IN PAKISTAN

Tuesday, July 02, 2013 Hotel Hill View, Islamabad

Time Subjects Format Actor

08:30 Registration Individual All participants

09:00 OPENING

09:05 Recitation from the Holy Quran

09:10-09:20 Introductory Remarks Speech Dr. Quaid Saeed

09:20-09:50 Punjab Blood Transfusion Authority Speech Dr. Jafar Salem

09:40-10:50 Survey Report Summary Presentation Prof. Hasan A. Zaheer

(30 min) Group Photograph and Tea Break

11:20-11:50 An Update on SAATM Presentation Dr. Farrukh Hasan

11.50-12.10 Questions / Answers Discussion Forum

12:10–12:20 Introduction to Working Groups Speech Mr. Usman Waheed

12:20-13:20

WORKING GROUP ACTIVITY 1. Data Management in BTS 2. Dissemination and Implementation and NBP 3. Plans for WHO/OFID Project

Group Work Group Work Group Work

Dr. Jafar Saleem

Dr. M. Tahir Khan

Dr. Sarfraz H. Jaffri

(40 minutes) Lunch/Prayer Break

14:00-15:00 Results from Working Groups Presentations/ Discussion

Forum

15.00-15.10 Questions / Answers Discussion Forum

15:10-15:20 Closing Remarks

Dr. Quaid Saeed

15:20-15:30 Certificates Distribution Prof. Hasan A. Zaheer / Dr. Quaid Saeed

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C: Group Photograph

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D: Newspaper Clipping