The NIK audit of 2014 on the Polish blood donation and hemotherapy system translated into law changes in 2016. Nevertheless, signals about irregularities and the need for comprehensive changes in the law were still there.
In the audited period (2019–2022), solutions being an outcome of amended provisions of the Public Blood Service Act were in place. Also, two blood self-sufficiency programmes of the Minister of Health were implemented and a range of other projects were carried out, also with the support of EU funds. One of them was the long-awaited e-Blood project, not completed by the end of the audit, dealing with the digitisation of the blood donation system. Public blood service entities also had to face the challenge brought about by the COVID-19 pandemic and its consequences. The media also regularly reported blood shortages.
This audit was conducted on NIK’s initiative. It aimed to verify if the measures taken provided the state with blood and its components. It covered 7 auditees: the National Blood Centre and 6 regional blood donation and hemotherapy centres (further: blood centres). The audit findings were complemented with the results of the internet survey of blood donors and persons who wanted to donate blood but did not succeed and the ones who did not try to do it for various reasons. Over 16 thousand persons took part in NIK’s survey.
Key audit findings
In 2019–2022, the Polish state was provided with blood and its components. The number of produced blood components exceeded the number of blood units provided for treatment. In that way self-sufficiency was ensured and blood import was not necessary. Nevertheless, in individual regional blood centres periodic blood shortages occurred, mainly in summer, particularly in Rh-negative blood groups.
The year 2020 was particularly interesting. Because of the COVID-19 pandemic outbreak, the number of registered donors and persons willing to donate blood or its components went down considerably. As a consequence, donations plummeted by approx. 9%.
According to NIK the actions taken were sufficient only in stable periods when the whole blood donation ratio per 1000 residents remained at the level of highly developed states (31.5).
In 2020, the ratio went down to 29.16. It should be noted, though, that in 2020 the number of procedures, involving the use of blood and its components, decreased in that pandemic year. In crisis situations, such as the COVID-19 pandemic, the existing solutions proved insufficient. Part of the data on the number of donations or blood donors declined in 2020 against 2019, whereas some of them (e.g. the number of donors aged 18-24) even in 2022 did not reach the level from before the pandemic. In some periods, resources of red blood cell concentrate were lower than the restoration reserve.
In 2019–2022, the number of potential, registered blood donors reached approx. 10% of the Polish population but only every fifth of them reported in individual years to the Regional Blood Donation and Hemotherapy Centre to give blood. The number of donors (who reported to the centres) dropped significantly in 2020 against the previous year, which was mainly due to the COVID-19 pandemic. In the following years that number went up but it did not reach the level from before the pandemic (it was, respectively: 717.5 thousand in 2019, approx. 658 thousand in 2020, nearly 706 thousand in 2021 and over 711 thousand in 2022).
In the audited period, there were 21 Regional Blood Donation and Hemotherapy Centres, one or two in each province. Field branches were isolated in their structures (there were 128 of them at the end of 2022). Most donations were taken there and their percentage was growing year after year. Besides, the regional blood centres organised blood donation campaigns, e.g. using blood buses. The number of such campaigns declined considerably because of the pandemic and by the end of the audit it failed to reach the level reported in 2019. Donations could be made in the registered offices of the regional blood centres or in field branches on each working day. Field branches were sometimes closed because of staff shortages.
One of the solutions to encourage people to give blood was an extra day off for the donor, introduced in 2021. In NIK’s survey only every tenth donor or potential donor indicated that factor as a reason for giving blood. Nearly 70% of respondents said they donated blood because they wanted to help other people.
It is worth noting that over 40% of respondents said their employers were negative about their absence from work. Among other things, they indicated the need to finance at least every second day off from public funds.
According to NIK, blood collection stations should be easily accessible, reception times should be flexible and it should be possible to give blood on banking holidays. Every fourth respondent pointed out that working hours of blood collection stations were too short or improper and that the distance to reach the stations was too big. Over ⅓ of respondents of those who do not give blood regularly stated that they would be encouraged by better access to blood collection stations, i.e.: more stations, longer working hours or free car park.
The audited centres had accreditations and permits required. The premises and equipment of their registered offices, selected field branches and audited mobile stations (blood buses) met the technical as well as sanitary and hygienic requirements. In each of the audited regional blood centres at least periodic staff shortages were reported, though, mainly linked to the pandemic. In half of them the employment volume had impact on the working time levels in field branches or their temporary shutdown.
The charter of the National Blood Centre obliged that entity to supervise the organisation of blood collection, separation of its components and provision of blood by the regional blood donation and hemotherapy centres. In 2019–2022, in practical terms, that supervision mainly covered collecting and analysing data provided by the regional centres or initiating changes in the public blood service organisation. Although the supervision exercised by the National Blood Centre (NBC) helped provide required amounts of blood and supported safety, in the opinion of NIK it was unreliable and limited in scale. First of all, it did not help eliminate obvious mistakes and inaccuracies while collecting and analysing data. Consolidated reports provided to the Minister of Health contained unreliable data. The final number of donations and the number of liquidated branches were inaccurate. In particular, the whole blood donation per one thousand residents ratio was overrated.
Moreover, the NBC’s recommendations on converting the volume of blood components given by donors did not comply with the Act on Public Blood Service. That is why, an incorrect procedure was used in all the regional blood centres audited by NIK. By the time of the NIK audit, those inconsistencies went unnoticed and no measures were taken to implement adequate statutory changes.
Also, planning and monitoring of blood self-sufficiency programmes of the state were not adequate. According to NIK it was not possible to tell explicitly if all the planned activities were carried out on a full scale and also if and to what extent the programme objectives were met.
The audited regional blood centres and the National Blood Centre conducted and coordinated campaigns promoting honourable blood donation. In the audited period, the total of PLN 37 million funds from the NBC were spent on that promotion. Besides, the audited centre used their own funds of PLN 3 million for that purpose. The promotion of honourable blood donation was carried out on a broad scale. Effects of individual campaigns were not evaluated, though. The promotion activities were focused on the strategic goal, i.e. to ensure self-sufficiency and to intensify efforts in case of donation decline. According to NIK that approach made it more difficult to adjust proper tools, also to look for new forms, including system activities, tailored to individual groups of recipients.
The NBC and the audited centres took part in works on creating the e-Blood system. The project deadline was postponed several times. The repair programme from 2021 was not completed, either (the deadline was scheduled for 2023). The project cost nearly doubled, among others due to pays for IT experts. NIK points out that the e-Blood system was set up not only to meet the statutory objective. This is also an important and long-awaited tool to enhance the blood donation and hemotherapy system. However, long-term project works did not end in launching a fully-fledged system. Since the project was not closed, the NBC had to withdraw from another training project worth over PLN 2 million, supported with the EU funds.
Key recommendations
To the Minister of Health to:
- verify measures taken to ensure the state’s self-sufficiency in blood and its components, for the introduction of system solutions including emergencies, in particular those related to threats caused by armed conflicts;
- ensure that more inspections are carried out in the regional blood centre and use the results of these inspections to improve task performance in all entities;
- strengthen supervision over the implementation of the e-Blood system to make sure it is fully functional;
- adapt, in cooperation with the National Blood Centre and organisational units of the public blood service, the rules for converting the volume of individual blood components into whole blood to current needs, taking into account possible implementation of proper changes to the law;
- consider, in consultation with the Minister of Family, Labour and Social Policy, changes to the additional day off due to blood donation, considering its financing from public funds, and making this right dependent on factors such as the amount of blood donated, different groups of people (e.g. physical workers).
To the Head of the National Blood Centre to:
- ensure effective supervision over proper conversion of the volume of individual blood components into whole blood by blood donation and hemotherapy centres;
- ensure the programming of current and prospective tasks on the basis of documents, taking into account possible emergencies;
- develop rules to measure implemented goals, defined in self-sufficiency programs in a way enabling complete and objective assessment of effects achieved;
- evaluate promotional activities taken in relation to expected effects, in order to adapt them to the requirements of various groups of recipients;
- focus promotional activities on maintaining regular blood donors and acquiring new ones.
