05 March 1992
ADMINISTRATIVE ORDER
No. 118–A series 1992
THE
NATIONAL BLOOD SERVICES PROGRAM (NBSP)
1. BACKGROUND
Blood
for transfusion is needed in the emergency treatment of patients with acute
blood loss, during major operations and to replace deficient blood components.
There is a shortage of blood as demonstrated by the disparity between 600,000
units (1% of population) compared to 500,000 units collected in 1990. More
significantly, only 30% of blood is collected from
voluntary of replacement donors. The Department of Health has been entrusted
with the task of safe guarding the quality of the blood supply through the
Blood Bank Law (R.A 1517). However, to stimulate more voluntary blood donation
to alleviate the blood shortage, the Department of Health, Philippine National
Red Cross and Philippine Blood Coordinating Council formulated the National
Blood Services Program.
2. POLICY
In
consonance with the Department Circular No. 99 series 1987 (Declaring Basic
Policies on Blood and describing measures in support of such policies) and Department
Order No. 339–K series 1988 (Creation of the Committee on National Blood Services
Program), it is the policy of the Department of Health to plan, organize
and implement the National Blood Services Program in the Philippine to provide
an adequate, equitable and safe supply of blood and blood products. The Bureau
of Research and Laboratories (BRL) under the Office of Standards and Regulation
is the Central Office primarily responsible for NBSP. All DOH agencies, the
PNRC and its Blood Centers, the PBCC, hospitals, professional associations,
schools and other cooperating organizations shall be responsible for the
implementation of the program activities.
3. NATIONAL BLOOD SERVICES PROGRAM
a. Vision
Blood and its components shall be
available, accessible and affordable to all patients
who need them by motivating enough people
who are willing and able to donate
blood voluntarily to facilities, to blood
centers with the capabilities of recruiting and
screening donors, collecting and
processing blood and distributing them equitably all
over the country.
b. General
Objective
To
ensure an adequate and equitable supply of safe blood and blood products to
patients who need them.
c. Specific
Objectives
(1) To increase the number of blood donation through the
promotion of voluntary blood donation.
(2) To provide facilities for the recruitment, screening
and collection of blood from the regional to the district level.
(3) To upgrade laboratory facilities at national and
regional levels for the processing, distribution and transfusion of blood.
(4) To provide training to health personnel for the proper
screening and selection of donors, collection and processing of blood.
(5) To promote the maximum utilization of limited blood
resources.
(6) To encourage research in various aspects of blood
donation, processing and utilization.
d. Policies
(1) The National Blood Services Program shall be
undertaken by the DOH, PNRC, PBCC, hospitals and other organizations interested
in blood donation.
(2) All blood transfusion shall be medically indicated and
shall utilize blood component therapy.
(3) Voluntary blood donation shall be prompted through an
organized and sustained public education program.
(4) The welfare of donors shall be protected by regulating
the frequency of donation.
(5) The provision of blood is a medical service and should
be made available on a non–profit basis.
(6) The cost of providing blood should be reimbursed to
the institution providing the service, either by the family, government or non–governmental
organization.
(7) The education and training of health professionals
shall consist of the proper selection of donors and the optimal utilization of
blood products.
(8) Each tertiary hospital shall have a written policy for
the provision of blood for its patients to be monitored by a blood transfusion
committee.
(9) The establishment and operation of blood banks and
centers shall be regulated by the DOH through the BRL pursuant to the Blood
Bank Law (R.A. 1517) and its Rules and Regulations.
(10)
Data on the
quantity and distribution of the blood supply and its usage shall be collected
nationwide.
(11)
Research on donor
recruitment, processing of blood and its components, resolution of
immunohematologic problems, the clinical and public health effects of blood
transfusion and administrative aspect of blood banking shall be promoted in
academic institutions, hospitals and blood banks.
e. Strategies
(1)
Blood
Supply
(a) An organized and sustained public for the promotion of
voluntary blood donation shall be planned and implemented by the DOH, PNRC,
PBCC, mass media and other interested organizations.
(b) Blood replacement programs shall be promoted in
hospitals.
(c) Blood collection facilities shall be established in
regional hospitals, medical centers, provincial, district and municipal
hospitals.
(d) Blood collecting facilities of the PNRC shall be
upgraded at regional and provincial levels.
(e) Mobile blood collection units shall be deployed in
each region.
(f) Donor registries for donors with rare blood types
shall be established.
(2)
Blood
Processing, Distribution and Utilization
(a) Blood centers shall be established in regional
hospitals and medical centers and provincial hospitals of the DOH.
(b) Blood processing facilities of the PNRC shall be
upgraded at regional and provincial levels.
(c) Cold chain facilities shall be made available for the
transport of blood and blood products.
(d) An immunohematology referral center for blood banking
problems shall be established in the BRL.
(e) Plasma fractionating facilities shall be made
available to be supported by plasma collection centers to provide blood
products.
(3)
Integration
(a) The National Blood Services Program shall be an
integral part of the Laboratory Services Program and shall be in support of the
Hospital Development Program.
(b) A Committee on National Blood Services Program shall
be formed under the Office for Standards and Regulation consisting of
representative s of the DOH, PNRC, PBCC, government agencies, professional
associations and other interested organizations.
(c) Regional Blood Councils shall be established in each
region to plan and implement regional blood programs. When feasible
provincial/city blood councils should be established in provinces/cities for
the same purpose.
(d) Blood Bank facilities (government, private and PNRC)
shall be linked in a network in each region/province/city to maximally utilize
blood resources.
(4)
Regulation
(a) The minimum requirements for the establishment and operation
of blood banks/centers shall be promulgated by the Bureau of Research and
Laboratories through the Rules and Regulations and Technical Standards issued
pursuant to the Blood Bank Law (R.A. 1517).
(b) Blood bank facilities and laboratories shall be monitories
by the BRL through periodic inspection and quality control tests.
(c) Annual reports on the quantity of blood and blood
products collected, processed, dispensed and discarded shall be submitted by
blood banks and hospital laboratories to the BRL.
(d) The maximum rates for blood and its products shall be
prescribed by the BRL in consultation with appropriate professional societies.
The fees shall be based on actual cost including expenses for recruitment of
donors, collection, processing, storage and transport of blood with reasonable
allowance for spoilage and professional service rendered.
(e) Commercial blood bank outlets shall be phased out.
(5)
Training
and Education
(a)
Information on
the benefits of blood donation shall be included in the curriculum of schools
at the primary, secondary and college levels.
(b)
The training of
medical, technical and other health professionals shall be done in cooperation
with professional societies, medical and other health professional schools and
hospitals.
(c)
Blood bank seminars
shall be conducted by the PBCC in cooperation with the BRL and PNRC on the
following topics:
i. Donor
recruitment, screening and selection;
ii. Blood donation,
processing and compatibility testing;
iii. Blood storage
distribution and inventory control;
iv. The appropriate
use of blood transfusion including blood component therapy
v. The collection
and utilization of autologous blood; and
vi. Investigation of
suspected transfusion reactions.
(6)
Research
(a) Funds shall be requested from the DOH, PCHRD and other
donor agencies to be allocated for blood bank research.
(b) Blood Banks, hospital laboratories, medical schools
and other institutions, shall be encouraged to formulate and implement research
projects on technical, clinical and administrative aspects of blood donation
and transfusion.
(7)
Legislation
Legislation
on the following shall be obtained:
(a) Promotion of voluntary blood donation and collection
in the community.
(b) The inclusion of voluntary blood donation, its
rationale and benefits, in the education curricula.
(c) A policy that the provision of blood is a medical
service and not the sale of a commodity.
(d) The provision of facilities and logistics for blood
donation and transfusion.
(e) The operation of blood bank facilities on a
professional and non–profit basis.
(8)
Monitoring
and Evaluation
(a) Reports on the quantity of blood and blood products
collected, processed and dispensed by blood banks/centers and hospitals shall
be collated by Bureau of Research and Laboratories.
(b) The agencies of the Department of Health and
Philippine National Red Cross shall submit reports on the upgrading of their
facilities and training activities of health personnel on blood donation and
transfusion to the Bureau of Research and Laboratories.
(c) Data on public education activities shall be submitted
by the PBCC, PNRC and other concerned organizations to the Bureau of Research
and Laboratories.
(d) The Committee on National Blood Services Program shall
evaluate the accomplishments of the Program summarized by the BRL in comparison
to the targets set as input into the next planning cycle.
f. Implementing
Agencies
The
roles of the different agencies involved in the program:
(a) The Bureau of Research & Laboratories, within the
Office for Standards and Regulation, shall be the Department of Health unit
primarily involved in policy formulation, program planning, monitoring and
coordination in the area of blood supply and usage.
The
BRL shall:
i. Promulgate a set
of standards that will apply to all the blood banks/centers in the country,
both for the collection, processing and utilization of blood.
ii. Monitor both the
supply and distribution of blood products to ensure national self–sufficiency
and prevent exploitation by commercial interest.
iii. Determine the
true need of a certain region for blood and blood products on the advice of the
Regional Blood Center Chief.
(b) The Philippine National Red Cross Blood Program will
coordinate closely with the regional blood councils with regard to the
provision of the blood supply of the different regions and mapping out of
operational plans. This will prevent competition for the same donor population
and ensure proper and equitable distribution of blood and blood products.
Furthermore, the PNRC shall send its surplus plasma to the Bureau of Research
and Laboratories for fractionation and shall have access to plasma derivatives
whenever needed.
(c) The Regional Health Director/Provincial and City
Health Officers and Chiefs of Regional/Provincial/City Hospitals shall support
the formation of Regional/Provincial/City Blood Councils in their respective
areas. They shall assist in the planning, implementation and coordination of
local blood programs through contributions of manpower, facilities, logistics
and funds as appropriate to provide an adequate supply of safe blood in the
community.
(d) The Regional/Provincial/City Blood councils shall plan
and implement a program of donor recruitment and selection, collection and the
processing and distribution of blood and blood products in their respective
areas.
The
different provincial and district hospitals through their stationary and mobile
blood collecting stations shall augment the main supply obtained by the
regional blood center to ensure the blood supply of the whole region on a
regular basis.
The
local blood councils together with community and political leaders, civic and
religious organizations, cause–oriented and consumer groups, business sector
and mass media will hold regular and sustained educational campaigns on a
national, regional and local scale utilizing government and private facilities
such as press, radio, television, films, etc., to communicate with the public
at all levels including children.
(e) The Philippine Blood Coordinating Council will assist
in the training activities and proper dissemination of accurate information
regarding voluntary donation and utilization of blood.
The
Council will assist in setting–up collaborating educational programs on good
transfusion practice for undergraduate and post–graduate medical and
paramedical students, as well as for physicians–users.
(f) The Bureau of Research and Laboratories (BRL), shall
receive the excess plasma collected by the DOH Regional and Philippine National
Red Cross blood centers. The BRL shall arrange for the fractionation of such
plasma locally or overseas. Blood products are then made available to the
different regions for distribution according to medical needs.
(g) The Philippine Society of Pathologists, Philippine
Society of Hematology and Blood Transfusion, Philippine Association of Medical
Technologists and other professional societies shall assist in the recruitment
and training of blood bank physicians and other health personnel.
(h) Training and continuing education seminars for health
professionals shall be held in cooperation with the Philippine Medical
Association, medical specialty societies, Philippine Hospital Association and
private hospitals, Philippine Nursing Association, Philippine Pharmaceutical
Association and other health professional associations.
(i) The assistance of government agencies such as the
Department of Education, Culture and Sports, Department of Social Welfare and
Development, Department of Interior and Local Government, Department of
National Defense and the Philippine Information Agency shall be obtained in the
education of the public regarding the benefits and advantages of voluntary
blood donation.
4. ORGANIZATION
OF THE NATIONAL BLOOD SERVICES PROGRAM
The
National Blood Services Program shall be implemented by the Committee on
National Blood Services Program which shall be under the Office for the
Undersecretary of Health for Standards and Regulation. The Committee shall
consist of representatives of Bureau and Services in the Department of Health,
the Philippine Blood Coordinating Council, professional associations and non–governmental
organizations which are concerned with blood donation and blood transfusion.
A
secretariat shall be designated to support the Committee. Committees on various
aspects of blood donation and transfusion shall be formed.
A
Regional Blood Council consisting of representatives of various sectors, both
government and private shall be formed in each region. It shall plan and implement
a Regional Blood Program supported by Regional Health Office and Regional
Hospital / Medical Center. The Chief of Regional Health Laboratory shall act as
the action officer of the Regional Blood Program. Various committees on public
education, professional education and blood collection and replacement programs
shall be formed to undertake the projects.
Similarly,
multisectoral provincial blood councils and city blood councils shall be formed
in each province and city. This local council shall plan the local blood
program in the community.
These
local blood councils formed in the context Administrative Order No. 122 series
1991 (Departmental Policy on Collaboration between Public and Private Sectors
on Health Policies and Programs) and being multisectoral in character shall be
considered as non–governmental organizations (NGOs).
5. FUNDING
(a)
Budgetary
appropriations for the National Blood Services Program shall be included in the
regular annual budget of the Bureau of Research and Laboratories.
(b)
Other funds
allocated for the National Blood Services Program from the DOH and other
national agencies shall be sub–allotted to the Bureau of Research and
Laboratories.
(c)
Grants and
donations from national or international institutions both government and
private shall be placed in a trust fund that shall be administered by the BRL.
(d)
Funds for the
NBSP may be disbursed to agencies both government and private participating in
the NBSP in accordance to the work and financial plan previously approved.
(e)
Regional and
other local councils, as non–governmental organizations, shall maintain their
own financial records and report to their respective donor agencies as
requires. They shall render an accounting of the utilization of funds that have
been contributed by government agencies to the agencies concerned.
6.
REPEALING
CLAUSE
All
Orders, Circulars and Administrative issuances which are inconsistent with this
Order are hereby repealed or amended accordingly.
7.
EFFECTIVITY
This
Order shall take effect immediately.
ANTONIO O. PERIQUET,
M.D.
Secretary of Health
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