THE NBTS — A HISTORICAL JOURNEY
Blood is a scarce and precious human resource. No suitable alternative has been found yet. Blood is life. Blood for transfusion has been described as an actively therapeutic perishable biological substance obtainable from healthy human donors.
Blood ‘transfusion’ has had a history through the ages, with very bizarre practices. The English Physician, William Harvey discovered the circulation of blood in 1628. Early in the twentieth century, a number of advances had been made in transfusion medicine from the discoveries of Blood ABO groups by the Austrian Physician, Karl Landsteiner, in 1907 and the preservation of blood, making transfusion safer. Blood transfusion however did not become a key part of modern Medicine until the 1930s.
Blood transfusion ensures the provision of safe, adequate and quality blood and blood products for all patients requiring transfusion at the right time for the right reasons. Blood transfusion in Colonial Nigeria was fragmented, haphazard, unregulated and whose safety could not be guaranteed. Nigeria became an independent sovereign nation on October 1st 1960 with just one University Teaching Hospital and numerous General or District hospitals scattered over a land mass area of over 900,000 square kilometres.
The idea of a National Blood Transfusion Service was first mooted in post independence Nigeria during the regime of Late Sir Abubukar Tafawa Balewa, first Prime Minister of Nigeria. The Honourable Minister of Health then was Dr Moses Adekoyejo Majekodunmi who passed away recently in April 2012. As was the practice in those days, there was a pragmatic effort to give effect to the idea with the strengthening of blood banking activities in the Blood Transfusion Unit of the Pathology Laboratory under the aegis of the Federal Laboratory Service at the General Hospital, Lagos. This service which was located on the ground floor of the Lagos Island Maternity Hospital, also provided blood for patients in the Royal Orthopaedic Hospital, Igbobi, the Massey Street Children Hospital, the Military Hospital Yaba, the Creek Hospital and numerous private health facilities in the Lagos area. At that time, the Federal Ministry of Health was responsible for the provision of Health services in Lagos being the Federal Capital Territory then and administered by the Federal Government.
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A building to house the service was acquired on Harvey Road, Yaba. The onset of political crises in the early 1960s and the civil war which subsequently ensued disrupted plans for the service and the idea was shelved. This building was later transferred to the newly established University of Lagos as the Anatomy Dept of the College of Medicine.
In 1974, the Nigerian Society Haematology and Blood Transfusion (which was inaugurated in 1972) made a strong proposal to the Federal Ministry of Health for appropriate legislation to regulate and provide adequate safe Blood and Blood products. So strong was this proposal that a National Advisory Committee was established by the then Federal Commissioner for Health, Alhaji Saka Tinubu. Consequently, the NBTS project was included in the 4th National Development Plan, 1975-1979 as a result of the good work done by this committee. Even though the government at the time realised it had the responsibility of ensuring adequate provision of safe blood for its citizens, it lacked the political commitment to pursue the goal for its establishment. Fortuitously, and soon after, Nigeria signed the WHA resolution 28.72 of 1975 urging member states to promote the development of National Blood Transfusion Service based on voluntary non remunerated blood donation. Specifically the resolution states that:
- The safety and adequacy of blood and blood products is the responsibility of the National government.
Blood donation should be based on voluntary non remunerated donation from low risk donor populations. Unfortunately, the enthusiasm could not be sustained as a result of lack of sufficient political will and funding. It was not until the emergence of HIV/AIDS in the early 1980s and reports that blood transfusion is a significant mode of transmission accounting for up to 10% of all HIV infections in sub-Saharan Africa that government decided to resuscitate the project. The Federal Ministry of Health tried to strengthen blood transfusion activities in Federal Tertiary Health Institutions through the provision of extra budgetary in-puts, sundry equipment and consumables. This was in the late 1980s.
The National Aids and Sexually transmitted Control Programme (NASCP), as part of its Medium term plan organised a National Workshop on Blood transfusion in 1990. Consequently a Task Force on NBTS was inaugurated in June 1990 by Prof. Olikoye Ransome-Kuti under the chairmanship of Prof Aba Sagoe with Dr Cyril Unogu as Secretary. The goals of the Task Force were to:
- Formulate a National Blood Transfusion policy.
- Formulate appropriate Legislation to back it up
- Develop and articulate guidelines towards achieving the objectives.
This Task Force worked extremely hard and produced a draft National Blood Transfusion policy which was approved by the National Council Health at its 35th meeting in Kaduna in May 1991. It even went ahead and produced a document on the appropriate use of blood and blood products in August 1991.The WHO Global programme on AIDS provided a short-term consultant Dr. John Watson-Williams to assist the Task force in producing a budget proposal for the policy implementation. He advised on a judicious phasing implementation by establishing four centres in the then four health zones in the country in states that met certain criteria. The criteria were:
- Infrastructure facility availability and reliability
- Physical structures – available buildings, hospitals
- Skilled manpower in blood transfusion
- Need for at least 7500 units of blood per year
- Willingness to participate in cost recovery programme
- Good communication network
These centres were to serve as models for contiguous States until all States in the Federation were covered. Government had accepted this option and decided on establishing a centre of the NBTS in each of the four (4) health zones which later transmuted into the present six (6) geo-political zones These zones are North West, North East, North Central, South West , South East and the South South. It wasn’t until the year 1996 that government provided funds for the visits to identify centres in Ibadan, Port Harcourt, Kaduna, Maiduguri, Enugu and Jos. The South East was revisited in 1997 and Owerri emerged as the centre for the zone. Benin City became designated as the South- South zonal centre in 2006 following the decision to convert the Port Harcourt facility to an Armed Forces centre as provided for in the policy.
Dr Cyril Unogu’s service as Secretary of the NBTS Task Force formally marked the opening of a NBTS desk in the Department of Hospital Services of the Ministry; however in April 1996, Mr Godwin Ihimekpen was transferred from Jos to the headquarters and part of his remit was to join Dr Unogu on the NBTS desk which thereafter crystallised to the NBTS UNIT. Dr Unogu effectively became the National Co-ordinator of the NBTS, a position he held until retirement from service in May 2005.In 1997 the Ministry of Health commenced its formal movement to Abuja, the new Federal Capital. That activity appeared to overshadow all other issues the Ministry had to deal with at the time. In-spite of this, the NBTS carried on, albeit on a low key with plenty of support from the former Director of the Department of Hospital Services, Dr Suleiman Sani. That year, Nigeria was a beneficiary of the UK Department for International Development (DFID) grant of £1.5m (one and half million pounds Sterling) to strengthen blood safety activities over a 3-year period. Though not directly involved in the programme implementation, the NBTS unit was invited to many of the meetings for networking purposes and was the proud recipient of a donation of two (2) sets of complete ELIZA equipment. These equipment later formed a part of the sets of ELIZA equipment that were deployed to the Kaduna and Ibadan Zonal centres of the service. In 1999, Nigeria benefitted from a European Union (EU) grant to sponsor a four (4) man team to a three months course in Uganda to understudy the operations of the Ugandan Blood Transfusion Service (UBTS) which was considered a model for Africa. Dr Unogu, Dr Folake Ayo (now Ade-Majekodunmi), Mr Ihimekpen and Mrs Okonji were members of that team. Subsequently Dr Okeke, Mrs Goyo, Ms Gyang and Mr Ajala also attended the same programme and indeed a third team from Nigeria visited Uganda on a similar mission. These individuals provided the first group of “trained” personnel to oversee the NBTS project.
The policy that was adopted in 1991 was not formally launched until the year 2000 when WHO in celebration of the world health day adopted ‘Safe Blood Saves Life’ as its theme for that year. It was launched on the April 2000 by Dr Tim Menakaya the Hon Minister of Health. That activity set the tone to galvanize government into action in establishing a well organised NBTS. This policy underwent 2 revisions in November 2002 and in 2005. It was adopted by the National Council on Health (NCH) which took place in Jalingo in February 2006 and was presented to the public on the 15th September 2006.
Dr E.J Watson-Williams (later turned Professor) who advised a judicious phasing of the NBTS project, has had a long standing relationship with blood Transfusion efforts in Nigeria. He was Head of Haematology at the University College Hospital Ibadan, from 1957 to 1962. He played a major role in establishing a blood transfusion service in UCH. In 1962 about 5000 volunteers were said to donate blood annually. Prof Watson-Williams was the European Union Technical Assistant to the Ugandan Blood Transfusion Service project in 1988 having previously carried out a survey and recommended the establishment of a volunteer donor programme. The UBTS has since become a model for Tropical Africa. He was again in Nigeria in 2005 on behalf of Rotary International to evaluate progress towards achieving safe blood transfusion in five (5) hospitals in Eastern Nigeria. He visited the NBTS Headquarters in Abuja where he made a personnel donation of computer software for blood bank database and record keeping. This software has been adapted for use by the NBTS and is currently in use in all its centres nationwide. Prof Williams is instrumental to the building of the training facilities in Ibadan Zonal Centre. This facility is designed to provide training over a 2 week period in approved techniques and practices of the NBTS and endorsed by the International Society of Blood Transfusion.
Prof Watson-Williams who now lives in California USA met with the former HMH, Prof Eyitayo Lambo in May 2006 in Arlington Virginia to express a personal ‘thank you’ for the coming into fruition of his dreams after over four decades and to promise further assistance in any way possible.
Sometime in 2002, a “not for profit” NGO, Safe Blood for Africa Foundation (SBFAF) through Mr .A. Ayida, made initial contact with the Federal Ministry of Health. SBFAF, with funding from the United States Agency for International Development had as its main goal; to put a stop to the spread of HIV/AIDS in Africa by ensuring the provision of Safe Blood for Transfusion. SBFAF worked as Technical Partner to the NBTS and partnered with it to establish the Abuja Demonstration Centre of the NBTS which was originally housed by the SBFAF in its Abuja offices. This Centre was formally commissioned by the former President and Commander in Chief of the Armed Forces Chief Olusegun Obasanjo on the 12th of May 2005. The President donated a unit of blood on that occasion. It is on record that the first volunteer blood of the NBTS was drawn in December 2004 at this Centre.
In addition to all these, the Federal Ministry of Health (Nigeria) has been a beneficiary of President George W. Bush (USA) initiative – termed President Emergency Plan For Aids Relief (PEPFAR) fund – to fight HIV/AIDS in fourteen (14) selected countries in Africa and the Caribbean. Part of this fund has been utilised in strengthening Blood Transfusion Services in Nigeria. In 2003, the CDC sponsored a Consultant, Dr. Povwoski, to Nigeria to help draw up a PEPFAR budget for the NBTS. The initial funds provided by this grant was utilised in purchasing, refurbishing and equipping the building in Abuja which serves as the National Headquarters of the NBTS.
Since 1997, the Government of Nigeria has provided a budget line for the NBTS. Initially it was small but with the onset of civil rule in 1999 and the desire of the former President Olusegun Obasanjo to stop the ravaging HIV/AIDS pandemic, NBTS’ budget line increased considerably; and with assistance coming from PEPFAR and SBFAF, the stage was now set to kick start the project in a big way. While SBFAF was concentrating on delivering the Abuja Demonstration Centre, the NBTS unit was working on Kaduna and Owerri Zonal Centres. Ambulances for donor drives were purchased and equipment for the 2 other centres were procured. The Abuja Demonstration Centre commenced operation in December 2004 with the collection, testing and distribution of blood to clients in the immediate vicinity. The Centre was formally commissioned at its temporary site on Kikuyu Close off Nairobi Street, Wuse II Abuja on the 12 of May 2005 by the former President Olusegun Obasanjo. The crowd at this ceremony included a high powered delegation from the US headed by the US Ambassador to Nigeria at the time, his Excellency Howard Jetter. The Centre later moved to its present site in Wuse Zone 3 in 2006.
The Centres in Kaduna and Owerri became operational in 2005 but were formally commissioned by Prof Eyitayo Lambo (former HMH) in March 2006, Kaduna with Dr Ifeoma Ogbue as the Zonal Co-ordinator and Owerri with Dr Dennis Onyetenu as the zonal Co-ordinator by Arc. Halima Alao (former HMSH).
In May 2005, Dr Folake Ayo (now Dr Ade-Majekodunmi) replaced Dr Unogu as National Co-ordinator. Dr Folake Ayo and her dedicated and proficient team worked day and night so that within a year of her assumption, NBTS was proud to have established functional centres in Abuja, Kaduna, Owerri. This was followed in quick succession by Ibadan (Dr Shittu and thereafter Dr Egbewunmi), Jos (Dr Bolorunduro), Benin-City (Dr Philip Eragha and then Dr Eirewele), Lokoja (Dr Cele Ejeh), Port Harcourt (Dr Bolorunduro and later Col Dr Aiyemoba) and Maiduguri (Dr Baba Kagu). In the following year work commenced in delivering Abeokuta, Potiskum-Nangere and Sokoto centres and by 2008, Ado-Ekiti, Enugu, Katsina and Calabar centres. Sites for Yola, Jalingo and Ilorin were identified in 2009 where work continued on them into 2010 and 2011. The operations at the Abuja Demonstration Centre were taken over formally by the NBTS in January 2007 and became the Abuja operational centre. SBFAF with additional funding from the Centres for Disease Control and Prevention (CDC), became full time technical assistance providers to the NBTS.
Dr. Ifeoma Ogbue took over in January 2009 from Dr. Folake Ade-Majekodunmi as the National Co-ordinator of the NBTS.
Prof Eyitayo Lambo who took over the mantle of leadership in the FMoH from late 2004 was really the “modern day” architect of Blood Service in Nigeria. His support was unstinting. He was willing and ready to travel anywhere (even to the office of Senator Jo Biden in the US Congress) to provide advocacy at the highest levels for the project. He provided strong political will and facilitated, to a very great extent the work of Dr. F. Ayo and her team so much so, one might have been tempted to think that the NBTS was his only agenda. It is no wonder that so much was achieved during his tenure. The NBTS owes so much to this fine indefatigable gentleman who lives by what he preaches. He was a regular guest at the Abuja Centre and there is no doubt in my mind that his presence at the Family Worship Centre in Abuja propelled that centre into becoming one of our cherished outside blood donation Centres. He was a great motivator indeed.
As a fervent believer in strengthening the stewardship role of government, he inaugurated a 15-man National Technical Committee on the NBTS on September 15th 2005. This team of relevant stakeholders in Blood Transfusion provided a platform for the management team of the service to do even more. It participated in the year 2005 review of the National Blood Transfusion policy document. Under its guidance, the NBTS in 2007 carried out a baseline data survey of Blood Transfusion Service in the country to update information from a limited exercise carried out earlier in 2003. The survey was carried out with a view of identifying the challenges of safe blood practices and to determine whether our health institutions meet the basic safety standards for collecting blood from donors, processing blood for transfusion and disposal of blood and blood products appropriately. It produced an operational manual (The Red book), for use in all Blood Transfusion practice centres nationwide. This “Vade Mecum” provides a comprehensive guideline and information to assist clinical, laboratory and other workers involved in the provision of safe blood.
Funding for the establishment of the State centres had come mainly from the Debt Relief Fund (MDG) and the FMoH main capital budget. In order to involve the States and to engender a spirit of “ownership,” they were required to provide an existing building (which the FGN refurbished and remodelled) and about 50% of the staff to the centre.
At the moment the NBTS is consolidating on these centres, strengthening them and ensuring sustainability of services provided before embarking on the development of additional centres in the near future.
These historical events have been chronicled by