According to the World Health Organisation, WHO, national blood policy is a formal statement of intent that addresses the key organisational, financial, technical and legal issues for the establishment and development of the national blood system.
The policy document also affirms government commitment, defines the measures to meet the transfusion requirements of the patient through provision of adequate supplies of safe blood and blood products, defines the strategy for promoting the safety and health of blood donors, the recipients of blood and blood products, health care workers and the environment. Although Nigeria’s policy captures all these and more, Mrs Grace Olaode and many other pregnant women and their husbands in Lagos may not enjoy it.
This is because in Lagos, even though the national blood policy recommends that blood be recruited voluntarily in line with WHO’s standards, Mr. Alex Olaode and husbands of other pregnant women must donate blood before their wives deliver in any of the Lagos State public hospitals. Mrs. Olaode, after a laboratory pregnancy test confirmation, registered for antenatal care at the Island Maternity Hospital, Lagos. During her first visit to the hospital, she was intimated by one of the nurses that she had to bring her husband to donate a unit of blood to the hospital.
According to the nurse attending to her, the hospital would need the blood during her delivery, in case of emergency. Grace tried to resist the position of the hospital. According to her, her husband is a voluntary blood donor in Lagos and recently donated to the hospital. Unfortunately, all the explanations fell on deaf ears as the nurse maintained that she would not be attended to during subsequent visits including delivery if she failed to bring her husband to donate blood.
“I went as far as showing them my husband’s card as a voluntary blood donor in Lagos. To them, I was just making noise. I tried to resist the policy but they had their way. My husband donated.” Unlike Grace, Mrs. Bridget Ekwume could not deliver in any of the Lagos hospitals because her husband vehemently refused to donate blood.
Bridget delivered at a private hospital because her husband barred her from visiting the government owned hospital ever again. Investigation by Sunday Vanguard revealed that the compulsory blood donation has scared many pregnant women who ordinarily would have delivered in government – owned hospitals away from the facilities. Meanwhile, the Country Director, E4A Mamaye, Dr. Tunde Segun, mandatory blood donation is not ideal in saving life.
Reports showed that 34 percent of pregnant women die in labour as a result of complications of bleeding and lack of blood for transfusion in Nigeria. Unfortunately, blood and blood components transfusions are required every day to save thousands of lives in our hospitals. At the moment, with Nigeria’s level of health care delivery, it is estimated that about 1.5 million units of blood is required generally per annum.
A national baseline data survey on blood transfusion indicated that, in the public sector, donor population was made up of 25 percent commercial donors and 75 percent of replacement donors while voluntary unpaid donors were negligible. But the question on the lips of the people is, should a woman whose husband refused to donate blood die from child birth? The national blood policy in Nigeria states that blood donation shall be based on the principle of regular, voluntary and non-remunerative. The policy also notes that financial reward for the donation of blood or blood component shall be prohibited and donor appreciation by the giving of tokens, certificates, badges and the refund of direct transport expenses are acceptable. The policy also draws attention to donor safety, care and comfort to be paramount throughout the service, adding that the family replacement donation system shall be gradually phased out as voluntary donation programmes become established. From WHO’s point of view, national blood policy must ensure the safety and availability of blood and blood products as they play a major role in preventing the transmission of HIV, hepatitis, virus and other blood borne pathogens in health care settings.
When Sunday Vanguard contacted the Lagos State Permanent Secretary, Health Service Commission, Dr. Jemilade Longe, he explained that the policy to get the husbands of expectant women to donate blood was to save lives during emergencies. Longe, who gave a brief background on blood donation in the state, said: “The commonest cause of maternal mortality is bleeding; in cases of emergency, women in labour need blood and, if the blood is not available, anything can happen. Justifying the policy, he said: “We encourage men to donate blood because if someone who has not donated blood comes in during emergency, is it at that point we would be asking people to go and donate blood? Some may require four or six pints of blood, so anybody can be a beneficiary of it.” Acknowledging that not all pregnant women would require blood during emergencies, he said, currently, only Lagos has been able to export blood to other states. According to him, the state has continued to emphasis on voluntary blood donation.
“There are so many religious and cultural taboos. Even when some men’s wives are pregnant, they start looking for touts to donate. It is not because they don’t have enough blood, but just that they don’t want to donate. We don’t take blood from people who don’t have enough blood, or who have blood that can contaminate others. We do test to certify people before donation,” he stated. Longe, who disclosed that the state is gradually moving away from compulsory blood donation, said: “In order to generate more blood for use in Lagos, the state set up an agency which goes out on blood donation drive. We are gradually moving away from compulsory donation by husbands to voluntary donation in some of our hospitals.
For instance, in Amuwo Odofin, husbands walk in voluntarily to donate blood. In Amuwo Odofin, we have stopped voluntary blood donation.” The Permanent Secretary condemned a situation whereby a pregnant woman would leave government-owned hospitals due to compulsory blood donation by her spouse, lamenting that such a woman later comes back to the hospitals battered. “Most people who refused to come to the hospitals because of blood donation later come back in a terrible state. Most people that refused to donate are the ones that usually need blood most. We are still advocating voluntary blood donation.
In other parts of the world they donate voluntarily”. On the claim that the blood so compulsorily acquired from the husbands of pregnant women is being sold in the hospitals, he dismissed it as untrue. “Patients only pay for the cost of the tests carried out on the blood. We have to screen the blood for several diseases and somebody has to pay.”