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Improving blood availability in peripheral health institutions, Rajasthan
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Subject Area="First Referral Units." Objective="Scope and quality of First Referral Units."
Details for Reform Option "Improving blood availability in peripheral health institutions, Rajasthan"

Background: High maternal mortality is one of the major causes for concern in the health sector in India. One of the factors behind this high rate is a lack of blood for good blood transfusion services, good blood storage facilities and education so that family members and the community are willing to give blood. The Government of Rajasthan, in collaboration with UNICEF, identified the absence of blood storage facilities at Community Health Centres (CHCs) as a major difficulty in averting maternal deaths as rough terrain and lack of adequate transport facilities delayed getting blood from blood banks at district headquarters especially during emergencies. Initially, it was mandatory for the CHC to organize blood storage camps for district hospitals and in return the CHC could procure requisite blood from district hospitals on payment. But in 2003, the maternal and health division, government of India published the guidelines for setting up blood storage centres and first referral units to prevent the delay in transporting blood from the district hospital and the need for payment. This facilitated the states to take up this initiative for the benefit of the population. Action: At the start of this UNICEF/UNFPA/Government of Rajasthan project, only one blood bank was functioning in each of the three districts targeted. Infrastructure and laboratory facilities were poor, basic equipment and medicines were often unavailable and record keeping was weak. (i) Blood storage centres with blood transfusion facilities were set up in six first referral units (FRUs) and a training programme was drawn up and implemented for medical and laboratory staff. It was decided that “no woman will be referred to a higher centre or die for want of blood in this hospital”. (ii) A checklist for operationalising and guidelines for functioning of blood storage units were drafted. Guidelines were also translated into the local language. (iii) As per the guidelines, the CHC Medical Officer (MO) is responsible for blood storage units and returning unused blood units at least 10 days before expiry to district hospitals. (iv) CHC MO is responsible for providing the Principal Medical Officer (PMO) with a monthly requirement of blood units. The blood is supplied on a monthly basis. (v) Four-day training was organized for MOs and lab technicians in handling blood units. (vi) A room was earmarked within CHC for housing the blood storage equipments. It was seen that CHC has regular supply of electricity for the blood unit to be functional. (vii) Recruitment and maintenance of a panel of voluntary blood donors. This was intended to complement blood donated by family members (who are frequently resistant to the idea) for women relatives in urgent need. (viii) Voluntary blood donation camps on occasions such as International Women’s Day and Independence Day etc., with the support of local NGOs and influential members of the community. (ix) Activities were undertaken aimed at motivating people to participate in blood donation by dispelling myths and misconceptions and certificates of appreciation were distributed to voluntary donors on Independence and Republic Days. (x) A list of donors with rare groups was drawn up and maintained in the blood bank. Results: Under this programme, six FRUs now have fully functional blood storage units. Under further programmes which had the support of the European Commission Sector Investment Programme, nine more were made functional. All experienced delays in setting up functional units because of a delay in equipment procurement which was done at state level. Voluntary donations have almost doubled. Total collection of blood in the hospital has increased. Use of blood in the maternity departments has increased (by 70% and 150%) in two of the three hospitals (the other needs further work). Deaths due to haemorrhage have decreased by 70%.

Cost Cost information is not available – but after improving storage facilities, the cost of running the project is negligible
Place Rajasthan. 2000 – 2003. Initially in Jhalawar, Dholpur and Barra districts. Now being replicated in all districts.
Time Frame Three years.

SService delivery: Availability of blood storage facilities within the CHC premises improved the quality of services. Such as conducting C-section delivery, accident cases etc. Access: The availability of blood at lower administrative unit increase people’s access to emergency care.


Maintenance: Constant power supply is necessary to maintain optimum temperature for storing blood. Skills: Blood storage unit officer-in-charge and lab technician need regular training. Monitoring: Blood storage unit should be regularly monitored. Equipment procurement: Many FRUs have been held up waiting for equipment and supplies to be provided.


Availability of equipments. Regular supply of electricity to maintain the blood storage unit. Trained medical doctor to handle blood transfusions.

Who needs to be consulted

State government. MO in charge of FRUs District hospitals Local NGOs.



Once the initial expenditure to improve storage facilities has been undertaken, the cost of this action is negligible and local demand will ensure sustainability.

Chances of Replication

On condition that money can be found for the capital expenditure necessary to improve storage facilities, the action should be replicable. Following evaluation, the State Government of Rajasthan has now decided to implement the project throughout the state with funding from several development partners.


Even in very unpromising settings, such as in Empowered Action Group (EAG) states, significant progress can be made through low-cost interventions aimed at strengthening infrastructure.


Submitted By

Sara Joseph, Researcher, ECTA, New Delhi. September 2004. Updated Dr Nandini Roy, HS-PROD Research Consultant, NIMS, October 2005.

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