Blood management in disaster situations in Pakistan
Authors: Zaheer H. A. 
Published: June 2012

Background  Pakistan has a fragmented blood transfusion system which is demand driven and predominantly relies on family replacement donors. In order to provide adequate and nationwide access to safe, efficacious and affordable blood supply, the Government of Pakistan, in 2008, initiated a blood safety systems reform programme in the country.Institutional framework  Until recently, Pakistan had followed the conventional relief and response‐oriented model for managing disasters. But following the 2005 Earthquake, appropriate policy and institutional arrangements have been put in place to reduce losses from disasters, and a more proactive approach based on Disaster Risk Reduction has been adopted. The National Disaster Management Authority (NDMA) has been created with the mandate to coordinate and monitor implementation of the National Policies and Strategies on disaster management. The health sector response arm of NDMA is the National Health Emergency Preparedness and Response Network (NHEPRN) which serves as the nerve centre to assess and analyse responses, prioritize interventions, develop action plans and implement emergency responses including transfusion support.Blood management response  In the absence of an integrated healthcare system and the presence of a fragmented blood transfusion system, the national response to blood management in disasters is patchy, insufficient and lacks proper coordination. In addition to the few national service providers like the Armed Forces and the Pakistan Red Crescent Society, a large number of NGOs also provide transfusion support essentially by mobilizing huge numbers of voluntary blood donors. But there is limited evidence or documentation of these efforts. Coordination is limited between various partners causing overestimation of transfusion requirements, duplication of efforts, and at times wastage of collected blood. In contrast to normal times, the response of the public towards voluntary blood donation is overwhelming when calamities strike. But in the absence of a proper donor management system the true potential of the enthusiastic public response during crisis has not been harnessed to make the system safer and better prepared for disasters.Challenges  In the recent past, Pakistan has faced a spate of natural and man‐made disasters including earthquake, floods, internal and externally displaced populations, terrorism, dengue, etc. These disasters are not of an unmanageable dimension. However, due to the lack of a proper system, the real challenge is timely and coordinated response. Recent experiences have identified the impediments of an effective response in disaster situations as damage to health physical infrastructure, breakdown in logistic and communications support, lack of information on available blood stocks, inaccurate determination of the magnitude of the calamity, inability to reasonably estimate the transfusion requirements, lack of coordination and duplication of efforts, lack of priority to transfusion therapy within emergency medical care, absence of documentation and analysis of the transfusion support provided, lack of appointment/identification of national focal points, and absence of platform for experience sharing for stakeholders involved in blood transfusion disaster management.