18 July 2018

Uganda: Referral Hospitals Continue to Battle Shortage of Blood

According to the document, this would be achieved by focusing on six areas including staffing of health facilities, rehabilitation and provision of health facilities with vital equipment and facilities, and disease control

Others were addressing issues around infant and maternal health and giving support to private health service providers and introduction of a social health insurance policy.

Under the action point on rehabilitation of health facilities and equipping them with vital equipment and facilities, the party committed itself to, "Construction of Regional Blood Banks in the remaining regional referral hospitals."

By the time the NRM unveiled the manifesto at the International Conference in October 2010, the country was just emerging from an acute shortage of blood.

In January that year, the national blood bank had run dry and could not afford to send blood to the regional referral hospitals. The national referral hospital, Mulago, was as a result swamped by patients who had been referred there from upcountry facilities.

Whereas Mulago had previously been attending to an average of 40 cases that required blood transfusion, the crisis pushed the numbers to above 140 per, day more than 75 per cent of them from upcountry.

Well as allocations to Mulago had risen from 1,328 units of blood in October 2009 to 1,756 units in November, the units dropped to 1,704, which caused more anxiety.

Back then, the spokesperson of Uganda Blood Transfusion Services (UBTS), William Mugisha, said whereas the blood bank was receiving around 60,000 units of blood per month, the demand for blood was much higher.

UBTS had at the time been sending about 30 units of blood to Mbarara and 45 to Jinja, but demand had risen to 60 units and about 92 ,respectively.

At the time, Director of UBTS, Ms Dorothy Kyeyune, blamed the high demand for blood on a surge in the number of malaria cases, which she said had reached epidemic levels on the account of the heavy rains that were experienced in the country in December 2009.

The paediatrics' ward in Hoima, which had a capacity of 40 children had been forced to take in more than 100 children, who had all become anaemic on account of severe malaria. The tale of lack was replicated in all the regional referrals.

Demand not matching supply

Matters were complicated by the fact that donations were simply not matching demand. For example while UBTS had in December 2009 managed to get 2,977 units of blood from donors in Mbarara, up from 2,272 that had been collected from there in 2008, demand for blood in the same area was about 5,000 units.

Similarly, whereas the Uganda People's Defence Forces (UPDF), the Uganda Police Force, the Indian Community and Staff at Nsambya hospital had jointly rallied, albeit at different times and places, to donate blood, they had raised a total of 1,080 units, which was 920 units short of what UBTS required to offset the crisis in the Central region alone.

Matters were also not being helped by the fact that students, on whom UTBS and the Uganda Red Cross have always relied on to donate blood had gone on holiday and could therefore not be tapped to help stem the crisis.

Against such a background, it was believed that establishing blood banks in all the regional referral hospitals would not only make it easier for patients in need of blood to access it, but also give the hospitals the capacity to organise their own blood donation drives and clean up the blood for storage and later use.

Setting up the promised blood banks was meant to have happened in the period between 2011 and 2015, but now more than eight years since the promise was made, the only blood bank in the country is Nakasero Blood Bank.

All the 14 referral hospitals do not have blood banks. Gulu, Mbale, Fort Portal and Mbarara hospitals claim to have blood banks, but they are not blood banks in the real sense as they do not have capacity to process the blood it into transfusable components or testing it for, among others, blood types and infectious diseases. They also do not have capacity to label and package the blood into units suitable for transfusion.


Failure to develop blood banks in the regions means that blood transfusion services remains a highly centralised affair with Nakasero Blood Bank as the only place where blood donated from all parts of the country is tested for infectious diseases, processed into transfusable components, labelled and packaged for onward distribution to the hospitals.

This inevitably raises issues around the costs. Blood donated from upcountry has to be moved from upcountry stations to Kampala for processing before it is sent back. This cost could have been avoided if the testing and processing were to be done at source.

The failure to open up these centres has also often meant that hospitals are entirely dependent on Nakasero Blood Bank for supply of blood, a scenario which has often resulted into shortages and scarcity even in crisis or emergency situations such as child birth emergencies and accidents. This has in many cases resulted into deaths that could have been avoided.


The State Minister for Health, Ms Sarah Opendi, told Daily Monitor that it is difficult for government to open up new blood banks in all regional referral hospitals at a time when it has challenges maintaining Nakasero Blood Bank.

"We need to first ensure that we have the necessary reagents to clean up and properly process what we collect and make it available to the hospitals. We are currently focusing on that. That is what has halted the process (of setting up blood banks in the referral hospitals), but it is still very much within our plans," she said.

She said that the immediate plan is to construct regional blood banks in Lira and Moroto. The Karamoja region, she said, currently relies on facilities at Mbale Regional Referral Hospital for its blood needs.


While the idea of opening up blood banks in all the regional referral hospitals is good, it would appear that opening up the facilities without addressing issues around the law governing blood donation and transfusion services would be an exercise in futility.

It will not heal the chronic blood shortages that have plagued the country for more than a decade now.

UBTS has a standing Memorandum of Understanding with the Uganda Red Cross Society (URCS) to manage blood donation drives. The fact that shortages recurring is a pointer at major flaws within the existing provisions. While the Red Cross deserves credit for keeping the blood donation drives alive, its dependence on the student communities for the bulk of its collection is not tenable. Blood shortages have tended to follow a similar pattern. They occur when students are away on holiday. This calls for a re-evaluation.

UBTS should be casting its net wider to involve more organisations, both public and private, in finding blood donors. While the World Health Organisation (WHO) insists on voluntary non-paid donations, countries like the United States and Nigeria have done themselves well by encouraging paid-for donations.

ABD News reported in January 2017 that some of the citizens of the United States of America receive between $30 and $40 for their donations, which has turned the business into a $19.7 billion global industry for the companies involved. Uganda could consider introduction of paying for donations.

Lastly, it is of utmost importance that government and the stakeholders expedite work on drafting a law to regulate and govern blood transfusion services.

Why not make UBTS an autonomous authority and not simply a semi-autonomous authority under the Ministry of Health?


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