Assessing the blood transfusion services across public and private sectors in Bangladesh: a nationwide cross-sectional survey

Abstract Background Blood transfusion services (BTS) are essential for timely and safe care in critical conditions. This study assessed the availability and functionality of BTS in Bangladesh to describe the operational landscape, identify gaps and inform recommendations. Methods A cross-sectional quantitative survey was conducted in 17 districts across eight administrative divisions of Bangladesh, selected on the highest concentration of blood transfusion (BT) centers. Of 402 centers nationwide, 201 were assessed: public tertiary, district and sub-district health facilities, private hospitals, standalone blood banks and Red Crescent centers. Specifically trained field investigators collected data on site using a standardized facility assessment instrument. Descriptive analysis used Stata 17. Results Dedicated BTS infrastructure was limited at sub-district health facilities: air-conditioned transfusion-transmissible infection (TTI) laboratories (27%), blood storage rooms (13%), and no professor or consultant, available in only 2 of 13 district hospitals (DHs). Median family replacement donations exceeded voluntary non-remunerated donations (774 vs. 404 units, April–June 2024). All centers used rapid diagnostic tests for TTIs. About 70% of public and 34% of private hospitals followed no standard operating procedures (SOPs). A valid license was reported by 84% of private for-profit facilities. Red cell concentrate, fresh frozen plasma and platelet concentrate were prepared most often by Red Crescent centers (6/7) and public tertiary hospitals (20/27). Maximum discards due to TTIs and expiry were 147 and 1,500 units. Functional BT committees were absent in 13 of 40 public tertiary hospitals and DHs, and hemovigilance in 37 of 126 applicable centers. Conclusion BTS in Bangladesh require strengthened regulatory oversight by the Directorate General of Health Services (DGHS) and its Safe Blood Transfusion Programme, particularly for licensing and SOP adherence. The services should be expanded to sub-district levels. Stock management, functional BT committees and a national hemovigilance system need strengthening to reduce wastage and monitor adverse events.