Profit can be thicker than blood, at least in Gujarat. A Comptroller and Auditor General report reveals a grim picture of state-governed blood banks in Gujarat, which sold blood components for profit, which overcharged HIV patients, and where government oversight was apparently so relaxed that it led to the loss of at least one life.

The CAG report on the general and social sector was tabled in the Gujarat legislative assembly in March during the monsoon session. It says that between 2011 and 2014, 10 blood banks sold 52,000 litres of “fresh frozen plasma” for Rs 6.17 crore in contravention of the national rules. The National Blood Policy clearly prohibits sale of blood in the country, yet these blood banks “traded in blood components”, vending plasma to three pharmaceutical companies for fractionation, a process whereby blood is separated into its component parts.

This wasn’t the only breach of the national policy. Violating rules that forbid accepting payment for blood or blood components for thalassaemia and haemophilia patients who need repeated life-saving blood transfusions, three “charitable” blood banks charged such patients exorbitant service charges totalling Rs 19.61 lakhs.

Furthermore, of the 32 blood banks CAG examined, seven overcharged HIV patients, even though the National Aids Control Organisation instructs not to do so. Together, these banks collected “excess... service charge of Rs 4.82 crore for 3.14 lakh units of blood or blood components” from HIV patients during 2011-'14.

Lack of equipment

The CAG said the director of the Gujarat State Council for Blood Transfusion, which oversees the blood banks, informed it in August 2014 that the guidelines for recovery of service charges had been issued to all blood banks. The council did not, however, explain what steps it had taken to refund the money to the HIV patients or crack down on the erring blood bank personnel.

It was this indifferent attitude of the council that led to the blood banks not always functioning satisfactorily, the auditor says. In one case, its report points out, a person died while donating blood at Prathama Blood Centre, Ahmedabad, due to “improper handling” of the donor.

The report takes serious note of the fact that there was a shortage of equipment in all 136 blood banks in Gujarat during 2013-'14, as a result of which the quality of blood distributed by them couldn’t always be checked. The banks also didn’t have equipment such Elisa Reader to conduct tests prescribed by the National Aids Control Organisation. Without ELISA Reader equipment, the chances of blood contamination increase. (Blood transfusion accounted for 1.20% of all new HIV infections in Gujarat in 2013-'14.) Yet, despite this, there was no action taken by the state council to provide Elisa Reader machines to the blood banks.

Blood gone to waste

The auditor observed that 23 blood banks in the state collected more than 10,000 units of blood every year in 2011-'14. However, none of these had Quality Assurance Managers as required under the National Blood Policy. Furthermore, while the Drugs and Cosmetics Act asks that every blood bank be granted a licence for five years after it satisfies requirements of infrastructure and qualified technicians, several banks in Gujarat were in the trade for over 10 years without proper licences.

It was also found that 73,000 units of blood had gone down the drain because the blood banks were not equipped with a computer network linking them to different hospitals. Had these banks – government and private – been interlinked, the scarce blood could have been given to poor patients who needed it most.

Contrary to these findings, former Health Minister Harsh Vardhan told the Lok Sabha on August 8 last year while responding to a query on blood banks in the country that all is well in Gujarat. He said that there was only one instance where Shri Shiradi Sai Seva Charitable Trust was prosecuted for operating blood bank activities despite expiry of licence. But on the whole, the minister assured that “constant monitoring is being carried out” of the blood banks in Gujarat.

He also stated that “periodic inspections by the central and state government officers are being undertaken before grant and/or renewal of licence as an effective monitoring mechanism” to streamline the functioning of blood banks. The CAG report doesn’t agree.