Regulation of Blood Transfusion Services in Khyber Pakhtunkhwa

Khyber Pakhtunkhwa province, earlier known as North-West Frontier Province, is in the northwestern region of

the country along the Afghanistan border, to the west; Gilgit-Baltistan to the northeast; and Azad
Kashmir, Islamabad and Punjab to the east and southeast. The province has 7 divisions and 26 districts and
covers an area of 74,521 km² with a population of 30,523,371.

The Department of Health, Khyber Pakhtunkhwa aims ‘to improve the health status of the population in the
province through ensuring access to a high quality, responsive healthcare delivery system which provides
acceptable and affordable services in an equitable manner’. The province first approved blood safety legislation
in 1999 titled ‘North-West Frontier Province Transfusion of Safe Blood Act No. IX of 1999’. The Act covered
the establishment of a Blood Transfusion Authority under its Section 5. But the Authority was never notified. In
2002, NWFP Medical Health Institutions and Regulation of Health Care Services Ordinance was approved
which in addition to hospitals, nursing homes, maternity home, medical/consulting clinic, dental clinics, clinical
laboratory, x-ray clinics, psychiatry clinics, operation theaters, etc also covered the blood banks. The Health
Regulatory Authority established in 2003 under section 20 of this Ordinance was thus also responsible for
registration and licensing of blood banks in the province.

In 2010, the blood safety system reforms were initiated throughout the country including the then NWFP. A
major agenda of the reform process was the introduction of uniform updated blood safety legislations. The
Technical Cooperation component of the SBTP prepared a draft legislation after comprehensive national
consultations. The draft legislation was shared with all provinces including the KP in 2015. The KP government
accepted the draft and the Act was finally approved by the provincial legislature in 2016 titled ‘Khyber
Pakhtunkhwa Blood Transfusion Authority Act No. XXV 2016’. Subsequently, the Khyber Pakhtunkhwa Blood
Transfusion Authority (KPBTA) was notified under this Act. The inaugural meeting of the KPBTA was held in
October 2017. The KP Secretary Health chaired the meeting as the Chairman of the Authority and decided to
operationalize the BTA including notification of a CEO.

The new CEO of the KP BTA has been coordinating with the Islamabad Blood Transfusion Authority to initiate
the BT regulation work in the province by utilizing the IBTA developed tools and documents. A partial mapping
exercise has been conducted and 18 blood banks were identified in Peshawar city in addition to 19 DHQ
hospital Blood Banks in the province. The primary focus of the KP BTA is to ensure minimum standards and
quality services in the blood banks operating in the province. The BTA intends to follow a constructive non-
punitive approach to strengthen the large public sector blood banks and to curb the commercial blood banking
activity in the province.

The KP BTA has been receiving technical assistance from the IBTA. The IBTA conducted an orientation
meeting of the blood transfusion experts of the province to enable them to perform the role of honorary Blood
Bank Inspectors for KPBTA. The Authority then in collaboration with IBTA inspected the public and private
sector blood banks in Peshawar and granted licenses to 17 blood banks in Peshawar city so far. The Authority
plans to complete the first round of blood banks inspection in the rest of the province soon.

A total of 43 blood banks have been identified in KP as per the National Data Collection Report 2018. The total
number of donations in 2018 in these blood banks was 267,640. Out of these 266,042 (98%) donations came
from male donors and 1,598 (2%) donations from female donors. Family/replacement donations contributed
214,406 (80%) while the voluntary donations comprised 53,234 (20%). In 2018, 104,108 (39%) blood
collections in KP were processed into at least three blood components, i.e. Red Cell Concentrates (RCC), Fresh
Frozen Plasma (FFP) and Platelet Concentrates while 163,532 (61%) blood collections were used as whole
blood