BMAU BRIEFING PAPER (24/17) May 2017
Challenges facing Uganda Blood Transfusion Services (UBTS)
Key Issues
Overview
Blood shortages in most health facilities
The mission of Uganda Blood Transfusion
due to inadequate donations.
Services (UBTS) is to provide sufficient and
efficacious blood, and blood components Limited budget for blood processing.
through voluntary donations for appropriate
Introduction:
use in health care service delivery. The UBTS` Staffing gap at the regional blood banks
main objective is focusing on increasing and at UBTS headquarters. A total of 390
annual blood collection necessary to meet the posts were approved, however, 231 are
transfusion needs for all patients in the country filled and 159 vacant.
who need it. This is to be achieved through
Limited infrastructure for blood
increased advocacy and mobilization for blood
collection and processing. Performance is
donation, strengthened strategic collaboration
affected by power outages and limited
with the Uganda Red Cross Society and
storage equipment.
improved care and retention of safe blood
(Ministry of Health, FY2016/17).
Despite the increase in collection, the UBTS
still falls short of official hospital blood unit
demands. According to the World Health Introduction
Organisation (WHO), a country is supposed to The UBTS was established as an autonomous
collect units of blood equivalent to 1% of the institute in 1989 and commissioned in January
total population. Thus in Uganda, 350,000 2003. It operates within the framework of the
units of blood per Financial Year (FY) should National Health Policy (NHPI) and the Health
be collected. Sector Development Plan (HSDP). The
headquarters at Nakasero Blood Bank act as a
This Briefing Paper examines the extent and reference centre for the regional blood banks and
the key challenges faced by UBTS. The other public and private hospitals. Blood is
information used is based on field findings of collected from healthy volunteer donors with least
the Budget Monitoring and Accountability risk for Transfusion Transmissible Infections
Unit (BMAU) and other relevant literature. (TTIs).
The UBTS has grown from supplying blood in
Central Uganda within a radius of 100km to a
network of seven regional blood banks namely;
Arua, FortPortal, Mbarara, Mbale, Gulu, Kitovu
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BMAU BRIEFING PAPER (24/17) May 2017
and Nakasero, and six collection centres; Hoima, gap. PEPFAR closure left a funding-gap of Ug shs
Jinja, Kabale, Rukungiri, Lira and Soroti. 5.4billion.
The core aim of UBTS is to collect and provide
safe blood and blood components in the Table 1: Financial performance of UBTS from
prevention and treatment of Malaria, Anemia; FY2014/15 to 31st December, 2016
morbidity and mortality reduction; prevention of
HIV/AIDS and other TTIs, promotion of Maternal Financial Approved Budget Expenditure
Year Budget Release (billion)
and Child Health; and provision of blood for
(billion) (billion)
victims of accidents and emergencies. The UBTS
has a target of offering Blood Transfusion 2016/17(Half 8.934 5,597 4.135
Services at all HCIVs, however, blood collection year)
has not always met the targets as shown in figure
1. 2015/16 8.703 8.811 8.673
Figure 1: Blood collected versus targets 2014/15 6.807 6.090 5.655
(Financial Year 2013/14 to 31st December,
Source: Approved Budget Estimates
2016)
Challenges facing UBTS
300,000
250,000 1) Blood shortages in most health centers
blood units
200,000
150,000 UBTS FortPortal achieved 70% of the targeted
100,000 collection in Q1 and Q2. Blood shortages were
50,000
also registered in Mityana General Hospital
0
2013- 2014 - 2015- 2016 - despite the fact that it was a newly rehabilitated
2014 2015 2016 31 dec and renovated hospital which has attracted a great
blood units number of patients. The number of deliveries
210,502 235,407 247,711 119,691
collected
increased from 500 to 600 per month by 31st
targets 242,000 242,000 266,804 266,804 December, 2016 with an increase in transfusions.
Source: UBTS Unfortunately, the blood supplied was not enough
to cater for the increase.
Funding for the UBTS improved between FY
2014/15 and FY2015/16 (Table 1), however, The overall blood shortage was occasioned by the
currently the Government budget is highly long school holidays. Students while in school,
constrained following the closure of the Presidents contribute over 70% of the blood collected as their
Emergency Program for AIDS Relief (PEPFAR) blood is usually healthier and safer.
on 3rd March, 2016. The Government has provided
2) Limited budget for blood processing
funds for salaries for PEPFAR staff but no
The unit cost of processing blood is USD 29
additional funds for blood collection and field
translating into Ug shs 98,600 per unit. To that
allowances have been provided to fill the funding-
effect, Ug shs 27billion is required to process at
least 280,000 units of blood in FY2016/17. The
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BMAU BRIEFING PAPER (24/17) May 2017
annual allocation of Ug shs 7.8billion for FY Post Title Approved Filled Vacant
2016/17 to National Medical Stores (NMS is in- post post post
charge of procuring blood kits and reagents for Technologist
UBTS) from UBTS was far below the required Senior 8 6 2
Laboratory
funding. By February 2017, UBTS had registered
Technician
stock outs of blood screening supplies and NMS Blood Donor 16 14 2
could not supply as their budget had been Recruiter
exhausted. Systems 7 1 6
Administrator/
3) Staffing Gaps Data Officer
Another challenge is human resource shortages. Stores Officer 1 0 1
The UBTS has 390 approved vacancies of which Biomedical 1 0 1
Engineer
231 were filled and 159 vacant by 31st December,
Engineering 1 0 1
2016/17. The staffing levels were at 60% by Assistant
2016/17 with most critical cadres missing (Table Laboratory 14 11 3
2). For example there are seven vacant posts for Technologist
Principal Blood Donor Recruiters which has Laboratory 14 12 2
partially led to UBTS’s failure to meet the Technician
required collection targets. In addition, Fort Portal Nursing Officer 37 15 22
Medical 16 9 7
regional blood bank also had a challenge of
Records
understaffing due to failure to replace retired staff. Assistant
Enrolled Nurse 37 28 9
Table 2: Staffing status of UBTS by 31st Laboratory 28 23 5
December, 2016 Assistant
Post Title Approved Filled Vacant Source: UBTS
post post post
Principal 6 5 1 4) Inadequate infrastructure for collection
Medical Officer and distribution of blood
Senior Principal 1 0 1
Laboratory I. Blood transfusion infrastructure (buildings
Technologist and power supplies like generators) is still
Principal 1 0 1 inadequate with some of the centres
Systems
operating from a few borrowed rooms within
Administrator
Principal 1 0 1 the Regional Referral Hospitals (RRHs). The
Laboratory UBTS Arua operates within Arua Regional
Technician Referral Hospital. Other inadequately
Senior Blood 7 0 7 furnished smaller centres were in Hoima,
Donor Recruiter Kabale, Jinja, Soroti and Masaka. These
Senior Nursing 23 16 7 currently collect and distribute blood but
Officer
require more appropriate structures.
Senior 8 5 3
laboratory
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BMAU BRIEFING PAPER (24/17) May 2017
II. Lack of proper storage and power outages 3. The UBTS should plan for hi-tech
for blood collected at the regional centers; equipment and standby generators at every
some centers lack enough fridges to store blood bank to avoid power shortages
blood. For example Mbarara RRH reported a which destroy already processed blood.
poor blood storage system and lack of
reagents making it difficult to provide 4. The UBTS and Health Service
transfusion services to patients. The West Commission should fill the vacant
Nile region also had power shortages positions.
because most rivers had dried up due to the
weather changes. References
III. Limited blood banks, regional collection Ministry of Finance, Planning and
centres and transportation means making it Economic Development (MFPED) 2017.
difficult for some transfusing entities to Semi-Annual Budget Monitoring Report
undertake timely blood transfusions. FY 2016/17
Mubende and Hoima RRHs lack regional
blood banks; their collection center is Uganda Blood Transfusion Services
(UBTS)
Nakasero Blood Bank which is very costly in
terms of transportation. FortPortal UBTS MFPED Approval Estimates of Revenue
also faces transportation inadequacy and and Expenditure (Recurrent and
operates mainly in FortPortal town, whereas Development) 2015, 2016, 2017
they could provide outreach services to
Kibaale, Kagadi, Bwere and other areas. Ministerial Policy Statement Ministry of
Health FY2016/17
Conclusion
MFPED, 2015 Public Investment Plan
There has been an increase in blood collection by
2015/2016-2016/2017
the UBTS from 187,000 units in 2010 to 266,800
units in 2016 but this is still inadequate. The
blood shortages are largely due to funding gaps,
inadequate human resources and infrastructure.
These constraints are not insurmountable.
Recommendations
For more information contact
1. The Ministry of Health (MoH) should Budget Monitoring and Accountability Unit
work with UBTS to establish blood banks Ministry of Finance, Planning and Economic
and collection centers at every RRH and Development
General Hospital. P.O. Box 8147, Kampala
www.finance.go.ug
2. The MoH should reprioritize blood
transfusion services and provide more
funding to UBTS.
4 Ministry of Finance, Planning and Economic Development
