Finding a solution to the cost of blood in Zimbabwe


NBSZ the only provider of safe blood and blood products in Zimbabwe is a not for profit making organization whose funding is based on cost recovery 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 user fees 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 and comments by many Zimbabweans; why do we need to pay for blood when it is donated for free? blood is very expensive!  
It is necessary to charge for the cost of blood in order to sustain the service. No profit is made.
Costs included in the production of blood include the following;
Donor recruitment
Blood collection
Blood processing
Capital Expenses

NBSZ distribute blood products for a fee to cover its operating expenses. Local hospitals work out contracts with NBSZ & NBSZ charges hospitals at cost.  Being a not for profit making organization, the fees it charges follow the cost of production.  Personnel costs make up  more than 30% of the fee hospitals pay "at the pump"—labor 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 centers, for example.  Hospitals also mark up an extra charge to cover their administrative costs.

Funding Model
Different countries apply different funding models;
100% financing through budgeted government support.
Combined budgeted government support, budgeted support from other programmes and partial cost recovery from hospitals.
Full cost recovery from charges to hospitals.
Model 1 is applied in most countries in Africa including our neighbours; Zambia and Botswana.
Model 2 is applied in Zimbabwe and Namibia.
Model 3 is applied in South Africa.
Whatever model is applied, there is full cost recovery. What differs is the source and level of funding.  Zimbabwe uses model 2.  The user fees depend on the contribution of budgeted government support and support from other programmes.  The more we get financial support from these services the less the user fees.  
The ideal situation is for the state to cover the cost of blood at state hospitals. Medical aid funds should cover the cost of blood products just like any other medical expense. One thing that everyone should understand is that blood is no sold but merely charge for the logistics of getting the much needed blood products to the patient on time.
In the case of the current fee structure, the support from other programmes was reduced and this led to the adjustment of the user fees so that NBSZ could break even.  With effect from 1 February 2014, user fees were reviewed as follows;
Government and Mission Hospitals    -    $135
Private Hospitals            -    $135
On top of these charges are fees for cross matching, and blood grouping.  These are charged whether the procedures are done by the hospital or NBSZ.  These are procedures that cannot be avoided.  

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 optimize blood usage.

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 the user fees 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.   

For NBSZ to maintain its operations, it is important that the Blood Service is funded adequately as the blood process is not only a vein to vein process but rather the process is safe blood from vein to vein.  The current cost to produce a unit of blood is pegged at $135.  It is important for the operations of the Blood Service to be sustained otherwise the Service will be crippled down.  
To the blood donors and public who are not aware, when blood donors personally need blood or their immediate family the blood is given to the blood donors at NO COST provided the blood donor has at least 10 donations.  This is a donor benefit given to all blood donors by NBSZ.  Such information will continuously be disseminated so that all blood donors and the general public are aware of such information.  Details of how to access this benefit is available through our Donor Clinics at all our centres throughout the country.  

Zimbabweans join hands with the Government of the Republic of Zimbabwe and NBSZ to find ways of financially supporting the NBSZ. The only way of reducing the user fees in Zimbabwe is to increase the level and sources of funding