An ASAR Data Story
By ASAR Blogs Team
Calculations & Visualisations
Yash Kamath, Gaurav Urs, Padmavathy KK
Ideation & Drafting
Gaurav Urs, Padmavathy KK, Madhav Bansal
Review & Editing
Siddesh Zadey, Jatin Terde
“Giving is not just about making a donation, but about making a difference”
-Kathy Calvin, CEO (United Nations Foundation)
Kiran Verma, a regular blood donor from Delhi, came across an 11-year-old boy from Bihar who was suffering from cancer and required regular blood transfusions. When Kiran donated blood to him in June 2018, he was happy knowing that he had contributed to saving one life. But this happiness didn't last long. In August of the same year, the young boy died due to a lack of blood when needed. This inspired Kiran to create Simply blood, an app that connects patients and their families who urgently need blood in case of a medical emergency to donors nearby.
Simply Blood and similar platforms that encourage voluntary blood donations among the general public are significant yet small steps towards the ambitious and unmet goal of adequate and timely blood supply for all in India. The COVID-19 pandemic exacerbated an already existing problem of insufficient blood supply, forcing private hospitals in areas such as Delhi to perform fewer surgical and other procedures that require blood or refuse to admit critically ill patients. Why is it important that there are enough blood donors or that each hospital has a dependable and effective blood bank?
Blood banks are essential for healthcare because they provide a steady supply of blood during emergencies and trauma care, as well as for dialysis, routine surgical and obstetric procedures, cancer management, and treatment of blood-related illnesses. The demand for blood is increasing due to the demographic transition to an ageing population, the increased burden of chronic diseases, and India's ambitious efforts toward universal healthcare coverage (UHC). In low- and middle-income countries like India, the Lancet Commission on Global Surgery (LCoGS) has highlighted issues such as the lack of blood volume and unsafe blood transfusions.
Rajasthan is one of India's most popular tourist destinations. Despite being India's largest state by area and seventh largest by population with 33 districts, it lags behind the national average in a number of critical areas, including the gender ratio, female literacy rate, school enrollment rate, and some important healthcare-related parameters. For example, Rajasthan's maternal mortality rate (MMR) is alarmingly high at 164 per one lakh live births, compared to the national average of 113. Additionally, Rajasthan was one of the few Indian states with a high number of fatalities resulting from traffic accidents on national highways. How many of these lives could be saved if timely blood was administered during a caesarean section for a woman in labour or to mitigate fatal blood loss after a traffic accident?
So, in this ASAR Data Story, we look at the accessibility, collection, and quality of blood banks in Rajasthan.
We answer four important questions using data from the Rajasthan state report from the National Blood Transfusion Council (NBTC) of India, last published in 2016. This story is a part of the broader Surgical Care India project run at ASAR.
1. How well are blood banks distributed in Rajasthan?
Access to blood banks plays a vital role in blood availability and broder healthcare quality especially during accidents, caesarean deliveries, surgeries etc. Rajasthan had a total of 99 blood banks for a population of 7,42,40,000, with 1.33 blood banks per million (BBpm). The districts of Kota (3.6) and Jaipur (3.3) had the most number of blood banks per million residents, indicating better accessibility, while Jodhpur and Sirohi had minimal access with 1.9 BBpm. Two of the largest districts, Jaisalmer and Bikaner had 1.5 and 1.3 BBpm, respectively, which were comparatively less than smaller districts like Sawai Madhopur, and Bharatpur. Surprisingly, Tonk, given its proximity to Jaipur, had low access given by 0.7 BBpm.
2. Is the state’s blood collection meeting the requirement?
Annual blood collection is a vital indicator as it reflects the health system’s ability to meet the required demand. According to LCoGS, to ensure steady blood supply, the collection should be 1.5 blood units per 100 people (BUhp) every year. In 2016, the state's annual collection was 0.89 BUhp, with Jaipur ranking the highest (10.1 BUhp) and Jaisalmer the lowest (<0.1 BUhp). The state’s overall value did not meet the LCoGS recommended threshold. Furthermore, 27 of the 33 districts in the state collected far less blood units than the recommended threshold of 1.5.
3. What percentage of blood banks in Rajasthan are standardised?
NBTC recommends that blood transfusions need to be readily available, inexpensive, safe, and of high quality. The National AIDS Control Organisation (NACO) accredits blood banks to ensure that these standards are met. Expanding NACO accreditation can standardise blood bank functions and improve quality. Of the 99 blood banks in Rajasthan, 49 were NACO accredited. On the positive side, each district had at least one NACO-accredited blood bank.
4. How well do blood banks perform?
NBTC blood banks in the state were evaluated on a self-assessment questionnaire (max. score: 100) that covered ownership, collection, voluntary donation, human resource, training, and technical equipment. This was conducted in collaboration with programme administrators and specialists in transfusion medicine, epidemiology, public health, and biostatistics. The final score called the mean assessment score (MAS) was computed by the Clinical Data Management Centre, Department of Biostatistics, Christian Medical College, Vellore, India. MAS for the state was 62.16 with Pratapgarh (73) and Dholpur (11) scoring the highest and the lowest, respectively. Out of 33, 16 districts scored higher than the state average.
The difference in MAS between NACO (63.86) and non-NACO (60.49) blood banks was minimal at the state level. However, in 13 of the 19 districts that had both NACO and non-NACO blood banks, the MAS for NACO blood banks was higher.
The overall situation of the blood bank accessibility, collection, and quality in Rajasthan needs attention from decision makers and the public. A standardisation by the state government for setting up and monitoring blood banks is crucial. Data on blood banking status should be collected annually and made publicly available through digitised web portals to enhance accountability and transparency. Systemic solutions like these, if consistently implemented, could go a long way in ensuring sustainable and easy access to blood banks to even those living in the remotest parts of the ‘Land of Maharajas’