Overcoming the resource limitation in Myanmar
Authors: Aung Thida 
Published: June 2016

AbstractBackgroundAs many of other developing countries, Myanmar has been straggled with improving the blood transfusion services in resource‐limited setting. It was started in 1935 with paid donor and Central National Blood Bank committee, established in 1962, introduced voluntary blood donation. The frequent repeated donors who donate more than 50 times started to be awarded by Ministry of Health, and the ceremony for awarding has been conducted 38 times since then. Transfusion‐transmissible infection (TTI) screening was started with HIV in 1995 by the support of National AIDS Program and extended to HBs antigen and HCV antibody screening in 2002 with cost‐sharing basis. Major challenges in those days were (1) lack of awareness on blood transfusion among both administrators and public, (2) relatively high prevalence of TTIs in general and (3) weakness in human, technical and financial resources.AimTo raise quality status of blood transfusion services with available resources.MethodRetrospective review of system.ResultTo overcome those challenges, Blood and Blood Product Law were enacted in 2003 and National Blood Center (NBC) was assigned to strengthen the nationwide service.Firstly, NBC has focused on awareness rising on blood transfusion service including importance of voluntary donation. HIV serology screening reactive rate was 1·08% in 2000 and was decreasing as increasing voluntary donors. Donor deferral and systematic donor registration were introduced to strengthen the donor selection since downtrend was obtained in 2004. After that, it has been decreasing to 0·18% in 2013. Hepatitis B vaccine programme was also introduced as motivation and retention programme for safer donors. As a result, voluntary donations were increased from 8035 (34·9%) in 2000 to 38 814 (88·5%) in 2013.Secondly, NBC has tackled quality improvement of the services. NBC participated in International External Quality Assessment Scheme (EQAS) for TTI testing since 2002. NBC has a chance to change HBs antigen testing method which used locally produced reagents, in 2003 because of false‐negative results from that programme. National EQAS Program for HIV testing by National Health Laboratory covered other hospital blood banks. Monitoring for those hospital blood banks has been conducted since 2008. Finally, the guidelines on blood transfusion services, which adapted to country's situation, were published in 2010 and started to be utilized in the training as reference.Summary/ConclusionsLooking back the journey of improving blood transfusion service in Myanmar, we would like to emphasize three key points. First, social mobilization was the most important fundamental for developing blood transfusion services. Without the support from community, private sectors and publics, we cannot do anything. Second, technical supports from expert groups were crucial for quality improvement in various areas and various ways. Third, the political commitment from the government was the most essential for long time sustainability. We are still in the middle of the journey and continue to work harder to improve quality of BTS for our patients, remembering those three keys.