Many people have a limited understanding of how the National Blood Service of Zimbabwe (NBSZ) is funded and sustains its operations.

NBSZ, the only provider of safe blood and blood products in Zimbabwe, is not a profit-making organisation. Its funding is based on cost-recovered fees.
Until the start of the economic meltdown in 2004/2005, NBSZ was almost entirely self-funding with minimal support for capital items from corporate and other international donors. The cost of blood remains a contentious issue among Zimbabweans, with the majority not affording the blood when in urgent need of it.

The most frequently asked question by Zimbabweans is: why do we need to pay for blood when it is donated for free? Blood is very expensive! As NBSZ we will continue to educate the public through our weekly column on how the service is run and how our user fees are costed.
NBSZ is mandated by the Government of Zimbabwe through the Ministry of Health and Child Welfare to collect blood, process it and distribute it to the various hospitals and health institutions throughout the country.  Did you know that NBSZ is currently operating on a cost recovery basis?

This means that all costs involved in the recruitment of blood donors, blood collection, laboratory tests, storage and distribution as well as general administration costs are passed on to the consumer.
Safe blood is critical otherwise we transfuse infected blood. Blood is tested in order to determine the blood groups (ABO Rhesus group) of the donor. It is also screened for Hepatitis B, Hepatitis C, HIV and syphilis. All tests are done in strict confidence by NBSZ laboratories.

The health of the person who receives the blood is paramount, hence the assessment of the suitability of the donor to donate a safe unit of blood and screening of all donated blood. Did you know that when a person donates blood, their blood sample is put through 10 tests? Safety considerations are a determining factor, which translates into blood user fees. If any additional transfusion transmissible infection is to be tested, this pushes the cost of production up and, in turn, the hospital user fees for blood.

Just imagine if these infections were not tested for because we want to keep the user fees to a bare minimum, would that be saving a life?
NBSZ distribute blood products for a fee to cover its operating expenses. Local hospitals work out contracts with NBSZ and NBSZ charges hospitals at cost.
Being a not-for-profit organisation, the fees it charges follow the cost of production. Personnel costs make up more than 30 percent of the fee hospitals pay “at the pump” — labour can be very expensive, since the staff is employed to recruit donors, collect blood, and then process it and test it for infections. The cost of the testing procedures themselves contributes about 25 percent to the final price of blood.

The rest goes to administrative overheads — rent payments for buildings that house the blood centres, for example. Hospitals also mark up an extra charge to cover their administrative costs.

User fees charged to hospitals
Mission Hospitals — $50
Government Hospitals — $65
Private Hospitals — $100

Blood safety in our setting has an immense contribution towards meeting the Millenium Development Goals No. 4, 5 and 6, which are as follows:
l Reduce child mortality;

l Improve maternal health; and
l Combating HIV, Aids, malaria and other diseases.
Safe blood also contributes significantly in reducing morbidity and mortality cases, particularly in children and maternal cases. To achieve all this there is a cost associated which eventually has a bearing on the final cost of blood and blood products.
Safety requirements constitute the single biggest factor affecting blood user fees over the long term. If any test is introduced, the added cost of those tests pushes prices up across the board. The total blood costs are largely driven by transfusion rate which includes factors such as the proportion of patients transfused and the number of units per patient transfused, and provide a unique understanding of both cost drivers and the opportunities for cost containment.

Reducing either or both factors has the potential to reduce costs dramatically. NBSZ’s costing model is activity-based and it provides a road map for institutional administrators to evaluate hospital processes and the impetus to initiate programmes to reduce and optimise blood usage.
Comparison of blood to water
running in a tap

A case scenario which we can relate the cost of blood to is that of water. Water through the rains comes for free and falls into the Mukuvisi River. However, it is not safe to drink as it has contaminants (Blood donor voluntarily donates blood but is not yet safe for transfusion until it is screened.). 
Water in the Mukuvisi or any dam is not safe to drink and therefore Government invested in equipment (bloodbank) to preserve and treat this water. 
Engineers and other personnel were hired to construct dam walls and treat the water so that it is safe to drink (donor clinic staff, stewards and laboratory staff).

Before the water is transferred to the taps, it goes through a chemical treatment process (laboratory processing of the blood) before it is pumped through the pipes to the taps.

The advantage of tap water is that it is safe to drink as it has been chemically processed (blood screened is safe blood ready for transfusion).
When the water is now in the taps it is safe to drink as it has been chemically tested and treated. The costs that the water authorities incur are passed on to the consumers (blood user fees). Blood, like water, is priceless but processing costs have to be recovered. The World Health Organisation (WHO) recommends that countries be self-sufficient and reliant on their needs for blood and blood products.

• To be continued