The developed world has emergency response protocols where National Blood Services immediately increase blood supply from well-managed donor panels. These are largely non-existent in Africa.

What we take for granted

Failing Health Systems Strengthening initiatives can be traced back to inadequate supplies and poor access to tested, cross-matched blood. In well-resourced countries, no surgeon picks up a scalpel without assuming blood is available. No clinician deals with a malaria-induced, anemic two-year old, delivering mother or train-crash victim without assuming blood is available. The Eséka train derailment is a prime example of how national disasters become tragedies without safe blood.

For blood safety, Africa is the reciprocal of the developed world where over 75 percent of blood, donated by voluntary non-remunerated donors, is used for planned surgeries, oncology and trauma — car accidents, mostly. Sadly, the developing world uses over 70 percent of its inadequate blood supply to treat obstetric hemorrhage and acute anemia in children under age five suffering from advanced malaria, their mothers having walked tens of miles for treatment.

“In situations with wholly inadequate screening and testing, transmission of HIV and Hepatitis is inevitable.”

Paid donation’s risk

Readers familiar with blood safety practices will assume blood collected is made into the components of red cells, platelets and plasma. In fact, plasma is a global multi-billion dollar industry and contributors are routinely paid for their plasma. Some advocate that this industry should be dropped into Africa, providing incentives to donors, solving the problem.

In Africa, paid donation — disguised as Family Replacement Donation — is quite common. However, several studies by WHO have shown paid donations yield high-risk blood. In situations with wholly inadequate screening and testing, transmission of HIV and Hepatitis is inevitable. Voluntary donation systems allow for managed donor panels with a known risk profile and yield the safest blood.

In any event, there are few clinical indications for plasma in Africa, and those few countries making components discard an estimated $30 million. Given the decline in funding for blood safety, a way forward needs to be found to secure this resource, channeling all profits into improved blood safety based on voluntary donation.