Why Govt must act on cost of blood

The Herald (Zimbabwe) - - Opinion & Analysis - Itai Rusike is the ex­ec­u­tive di­rec­tor of Com­mu­nity Work­ing Group on Health (CWGH.) Itai Rusike Cor­re­spon­dent

Though the unit of blood, which is 250ml, was last year re­duced to $100 from $135 in Gov­ern­ment hos­pi­tals and costs $125 on av­er­age in pri­vate in­sti­tu­tions, it re­mains too high and un­af­ford­able to many Zim­bab­weans. What is, how­ever, baf­fling is that the same amount of blood costs far less in neigh­bour­ing coun­tries

THE high cost of blood re­mains one of the ma­jor bar­ri­ers to or­di­nary Zim­bab­weans ac­cess­ing and en­joy­ing their health en­ti­tle­ments and rights as en­shrined in the coun­try’s con­sti­tu­tion, which stip­u­lates that health is a right.

Faced by eco­nomic chal­lenges and high unem­ploy­ment, Zim­babwe con­tin­ues to lose pre­cious lives daily due to the steep cost of blood, which re­mains be­yond the reach of many peo­ple.

The in­creas­ing num­ber of peo­ple who are dy­ing in pub­lic hos­pi­tals be­cause they can­not af­ford to buy blood is wor­ry­ing.

Equally wor­ry­ing is that fam­i­lies have no choice, but to dis­pose of their priced pos­ses­sions for a song to save the lives of their loved ones.

Zim­babwe faces a high de­mand for blood trans­fu­sion due to bleed­ing re­lated to preg­nancy and child­birth, high traf­fic ac­ci­dents and other types of in­juries.

How­ever, the most af­fected are preg­nant women, who re­quire the life-sav­ing com­mod­ity.

About half a mil­lion preg­nan­cies are ex­pected in Zim­babwe and some of these come with ex­ces­sive blood loss, re­quir­ing trans­fu­sion of at least three pints. Timely blood trans­fu­sion pre­vents ma­ter­nal deaths which in Zim­babwe stands at 614 women per 100 000 live births.

For do­nat­ing blood, donors only en­joy a drink and bis­cuit. How­ever, it is also not a guar­an­tee that if you are a blood donor you get blood at no cost when you need it.

The Na­tional Blood Ser­vices Zim­babwe (NBSZ) and the Min­istry of Health and Child Care (MoHCC) should ur­gently de­vise sus­tain­able ways of en­sur­ing that the cost of blood is af­ford­able so that the or­di­nary per­son is not de­nied his/her ba­sic right to health.

This may in­clude lob­by­ing for sub­si­dies from gov­ern­ment and or invit­ing donors to chip in.

Though the unit of blood, which is 250ml, was last year re­duced to $100 from $135 in Gov­ern­ment hos­pi­tals and costs $125 on av­er­age in pri­vate in­sti­tu­tions, it re­mains too high and un­af­ford­able to many Zim­bab­weans.

What is, how­ever, baf­fling is that the same amount of blood costs far less in neigh­bour­ing coun­tries. For ex­am­ple, a pint of blood costs $50 in Zam­bia and $42 in Malawi, which is less than half of what it costs in Zim­babwe.

Other than af­ford­abil­ity, there is also a prob­lem with ac­ces­si­bil­ity. A bot­tle­neck anal­y­sis that was car­ried out by the Min­istry of Health and Child Care shows that 60 per­cent of sec­ondary fa­cil­i­ties were found to have no blood in their stocks.

Some fa­cil­i­ties could not stock blood be­cause of un­avail­abil­ity of fridges, elec­tric­ity and gen­eral poor in­fra­struc­ture. It is, there­fore, para­mount for the Gov­ern­ment to con­sider other al­ter­na­tives such as so­lar re­frig­er­a­tors for stor­ing blood prod­ucts.

To turn around the for­tunes of NBSZ, which cur­rently op­er­ates as a non-profit mak­ing com­pany and whose fund­ing is based on cost re­cov­ery fees, it should shed that status to be able to at­tract donors, a sit­u­a­tion that would re­sult in re­duced blood costs.

Blood short­age is a na­tional is­sue and should by all means at­tract the in­ter­est of donors, es­pe­cially at this point in time when the coun­try is ex­pe­ri­enc­ing eco­nomic chal­lenges.

It can­not be left to be man­aged by a non-profit mak­ing com­pany that has a board of di­rec­tors.

CWGH be­lieves in uni­ver­sal ac­cess to health ser­vices that in­cludes ac­ces­si­bil­ity of blood with­out re­strict­ing the prin­ci­ple of good gov­er­nance and ac­count­abil­ity, which we be­lieve must be the most im­por­tant cri­te­rion by which NBSZ per­for­mance is as­sessed.

How­ever, re­ports of al­leged poor gov­er­nance and al­leged poor ac­count­abil­ity within the in­sti­tu­tion of NBSZ, al­leged cor­po­rate tags that drive away po­ten­tial donors, are wor­ry­ing.

It is also wor­ry­ing that is­sues of gov­er­nance and ac­count­abil­ity con­tinue to crop up once the name NBSZ is men­tioned.

There is need to set lim­its of term of of­fice for board mem­bers as well as set out clear pa­ram­e­ters of their du­ties to avoid in­ter­fer­ence in the day-to-day op­er­a­tions of the in­sti­tu­tion, a move that pre­vents smooth ex­e­cu­tion of work by man­age­ment.

The board must have a func­tional con­sti­tu­tion and only peo­ple of pro­fes­sional in­tegrity must sit on the board.

It is un­ac­cept­able and un­heard of in the nor­mal cor­po­rate world that a per­son can chair the board for 38 years, as if he has mes­sianic abil­i­ties and the only com­pe­tent per­son that has lived on earth.

There is need for cur­ricu­lum vi­tae, em­ploy­ment and ser­vice his­tory of board mem­bers to be made pub­lic. No board mem­bers fired, or who re­sign from main­stream boards should be al­lowed to sit in the NBSZ board with­out due dili­gence be­ing made that they are clean.

Presently, there are no term lim­its, no skills mix, no di­rect elec­tion of board mem­bers from the blood donors; no clear poli­cies that de­fine board mem­bers’ du­ties and no board char­ter and the sit­ting al­lowances should be abol­ished and re­placed with a ba­sic to­ken of appreciation.

Rep­re­sen­ta­tion in the board must also re­flect the cur­rent gen­der and racial dy­nam­ics in the coun­try. Out of the 17 board mem­bers, there are no fe­males save for one fe­male CEO.

To at­tract donors to fund the in­sti­tu­tion, the fi­nan­cial books and ac­count­ing pro­ce­dures of NBSZ should be pub­lic mat­ter. Fur­ther­more, the au­di­tors should be changed at stip­u­lated in­ter­vals for ac­count­abil­ity rea­sons.

The grants that NBSZ re­ceives from the Gov­ern­ment should be ac­counted for to en­sure that po­ten­tial donors gain con­fi­dence in the in­sti­tu­tion.

Par­lia­ment and MoHCC should also play piv­otal over­sight roles to make sure that rec­om­men­da­tions of the Au­di­tor-Gen­eral are im­ple­mented for the im­prove­ment of gov­er­nance and ac­count­abil­ity pur­poses as well as for the ben­e­fit of or­di­nary Zim­bab­weans, who can­not af­ford the cost of blood.

The NBSZ ur­gently needs a struc­tural and op­er­a­tional over­haul, so that it can re­spond to the tenets of good gov­er­nance and ac­count­abil­ity for the ben­e­fit of or­di­nary Zim­bab­weans.

In this re­gard, the MoHCC should ur­gently in­sti­tute in­ves­ti­ga­tions into the op­er­a­tions of NBSZ and make rec­om­men­da­tions that pro­mote proper op­er­a­tions to avoid pre­ventable and un­nec­es­sary loss of lives.

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