The Constitution of India guarantees free healthcare to its citizens. However, in the case of private healthcare, expenses are paid out of the pocket of the patient or through insurance. Public healthcare is mostly free or highly subsidised. In a country with a population of 132.42 crores, providing healthcare facilities can be a mammoth task. In many cases, the most essential facilities, like blood and ambulance services are not available adequately in case of emergencies.
Availability of blood in India
According to a blood bank official at R.G. Kar Medical College and Hospital, Kolkata, there is a ‘relative shortage’ in the availability of blood in India. India faced a 10% shortage in its estimated blood requirement in 2015-16. According to a report published in a leading daily, the 2015-16 data was an improvement as compared to the 17% shortfall reported in 2013-14.
As per the Ministry of Health and Family Welfare, blood collection through various sources was 1.1 crore units in 2015-16 and still entailed a shortage of 11.5 lakh units. The availability of blood is also distinctly uneven in different parts of the country. For instance, while Delhi had a surplus of 233% in available blood units, Bihar faced a shortage of 85% in recent times.
The availability of blood units has improved over the years for some states. States like Sikkim, Karnataka, Andhra Pradesh, Uttaranchal and West Bengal moved from a deficit in 2013-14 to a surplus in 2015-16. For example, Sikkim had a 19% shortage in 2013-14 but the blood unit availability improved by around 22% and recorded a surplus of 2.6%.
Availability of ambulance services
An India Today report revealed that three out of five ambulances in India are not in working condition. The government-run ambulance services are on the verge of collapse in most parts of the country. Patient safety is being compromised in Indian ambulance fleets due to sub-standard equipment, unhygienic vehicle conditions and poor response time.
Delhi, a city of 22 million people, has 152 state-run ambulances which translate to one ambulance for 144,736 people. The World Health Organisation (WHO) says that there should be at least one ambulance per 100,000 people. A study by the Delhi-based All India Institute of Medical Sciences (AIIMS) in 2012 found that 28% of the 70,768 emergency calls received between March 2009 and May 2010 in the city were refused because of the shortage of ambulances. Dr Shakti Gupta, who conducted the research, says that many patients who manage to get into an ambulance sometimes expire on the way because of improper care.
Reasons for blood shortage
Despite facing an acute blood shortage, India discards over a crore units of blood collected every year, according to data from the health ministry. The data show that only 99 lakh units of blood are collected on average against the estimated requirement of 1.2 crore units. There are several reasons for discarding the collected blood. They include deterioration during storage and expiry due to outdating. The collected blood is discarded due to its reactivity for infections like malaria, syphilis, HIV, hepatitis B, hepatitis C and expiry due to outdating, especially for platelets, which have a short shelf life of only five days. Other factors include deterioration during storage in the form of discolouration, haemolysis, and bacterial contamination, not meeting quality parameters after collection and production and non-completion of blood collection in requisite quantities due to donor reactions.
There is also a lack of coordination between blood banks and hospitals. According to a report published in a daily, in the last five years, over 28 lakh units of blood and its components were discarded by banks across India. In 2016-17, over three lakh units of fresh frozen plasma were discarded. This appears to be surprising as the product is imported by several pharma companies to produce albumin. Crusaders for safe blood blamed the crisis on the absence of a proper blood sharing network between blood banks and hospitals. Blood donation camps that involve thousands of participants have particularly come under question, with many blaming politicians for using them as a tool to please the constituents. Dr Zarine Bharucha of the Indian Red Cross Society said, “We have seen and heard camps where 1000 to 3000 units are collected. Where is the place to store so much blood?” She added that if people walk into regular blood banks and donate once in three months, it will be of much help.
India’s illegal red market
According to experts, the lack of a central blood collection agency in India along with taboos against exchanging blood with people of different castes and religions, largely accounts for the blood shortage. This produces a vast illegal market despite Supreme Court’s ruling that banned paid donors and unlicensed blood banks in 1996. The illicit market in blood has simply moved underground over the years.
According to a story published in Tehelka magazine, in 2008, Hari Kamat, an impoverished artisan from Bihar, was rescued along with sixteen other people from a ‘blood farm’ in the town of Gorakhpur, Uttar Pradesh. The victims who were all poor migrants were lured to a house on the pretext of being given jobs. They were convinced to sell their blood for the sum of $7 per unit. The journalist who covered the story reported that Kamat and others were forced to give blood three times per week for a period of two and half years. They were never paid the amount they were promised and received only a token sum. There are no official statistics on how the extant of illegal blood market. However, it can be roughly calculated that for the three million units needed in India, multiplied by its street value of $15, the worth of this illegal blood bank could be around $45 million.
Improvement in blood availability scenario
According to the blood bank official at R.G.Kar Medical College and Hospital, Kolkata, the blood availability scenario can be enhanced by improving and increasing the storage capacity and storage infrastructure of blood banks. Presently, there is no appropriate system to prevent wastage of blood. The number of blood banks should increase ‘components separation facility’ to store the blood. The illicit activities involving blood can be avoided only by the blood banks by meeting the blood requirements.
Nagpur based Khushroo Poacha, now 50, way back in 1999, started a website along with his wife that would make connections between the blood donors and recipients. The name of their registered website is www.indianblooddonors.org. Over the years, the numbers on their website only grew and today there are over 50,000 registered donors online. In 2009, they started keeping track of numbers and have connected around 1,36,000 people. Such initiatives can resolve the blood crisis in India.
Federation of Indian Blood Donors Organisation (FIBDO) -09830244388
In 2015, recommendations have been submitted to the telecom department for the adoption of 112 as the national emergency number.