Approaches to demand forecasting for safe blood in low-resource settings: Examples from Liberia and Malawi
Background
Quantifying the demand for safe blood products and related supplies in low-resource settings is essential for ensuring that health systems can meet critical blood needs, particularly during emergencies. According to USAID, accurate demand forecasting enables countries to allocate resources efficiently, plan supply, and minimize shortages or wastage. By leveraging data-driven insights, quantification helps strengthen supply chains and improve access to essential services, ultimately supporting better health outcomes.
In an ideal world, quantifications for any health system product — be it pharmaceuticals, consumables, medical devices or safe blood — would analyze together historical consumption, service delivery and demographic data to provide an accurate and comprehensive view of demand. However, particularly in low-resource settings, national blood systems lack the capacity and data to conduct robust quantifications.
Based on the data available in a specific setting, the World Health Organization (WHO) offers guidance for countries to estimate blood needs based on one of three approaches:
- Consumption approach using historical blood usage data
- Service delivery approach using the number of acute hospital beds
- Demographic approach using the country’s population
In 2022, Results for Development-led USAID’s Health Systems Strengthening Accelerator (Accelerator), in partnership with the National Blood Services Program (NBSP) in Liberia and Malawi Blood Transfusion Service (MBTS) in Malawi, identified that both countries faced clear gaps in their ability to quantify demand for safe blood.
This was hindering the health system’s ability to appropriately plan for resources and ensure the right amount of safe blood products and related supplies to safely collect, store and transfuse blood were available at the right place and the right time. While the two countries were at different levels of maturity in their ability to quantify safe blood demand, this blog details the specific methodology improvements implemented to strengthen accuracy of safe blood quantification exercises.
Approach
Liberia and Malawi’s national blood systems lie on two different sides of the spectrum in terms of a country’s capacity to quantify safe blood. Liberia is indicative of a data-scarce country which has not yet endeavored to quantify demand for safe blood and related supplies. Alternatively, Malawi has a quantification exercise in place but is keen to improve its accuracy to reduce persistent shortages in access to safe blood. Thus, two different approaches to quantification were taken in each country.
Liberia: data-scarce setting
As of the 2022 assessment, Liberia had not conducted a quantification exercise of safe blood or related supplies required to collect, store and transfuse. This in turn contributed to significant shortages in access to safe blood across the health system, as well as hindered the NBSP’s ability to effectively mobilize resources to meet the blood system’s needs. In partnership with the Accelerator and the National Quantification Technical Committee (NQTC), NBSP sought to conduct the country’s first quantification for safe blood products, reagents and supplies in 2024.
Furthermore, Liberia’s blood system did not have accurate data on blood donation rates, usage patterns, and shortages or wastage rates. As a result, experts opted to rely on a methodology consisting of both service delivery and demographic data. The demographic approach built on the WHO’s recommendation that 10-20 units of blood are required for every 1,000 people in a population.
The service delivery-based approach then combined (1) a review of data from the national Health Information System (HMIS) to identify conditions and estimate the percent of cases where blood transfusions were required with (2) treatment guidelines and expert clinical opinion to estimate the average quantity of blood units required for each condition.
In March 2024, NBSP, NQTC and the Accelerator organized a national quantification workshop consisting of key stakeholders and clinicians from across the country to review the methodology. Ultimately, the first national Blood Products, Reagents, and Supplies Quantification Report in Liberia was validated and finalized in July 2024. The findings of the report are now being used by NBSP to inform resource planning, donor mobilization and procurement decisions.
Malawi: strengthening accuracy
In Malawi, the MBTS sought to strengthen its quantification methodology to improve accuracy, and thus reduce persistent shortages in safe blood. In partnership with the Accelerator, the MBTS developed a quantification model to estimate the country’s overall blood requirement. The model analyzes together historical blood usage data from hospitals, population demographics, disease prevalence and service delivery data.
Both qualitative and quantitative data was collected to inform the model, i.e., key informant interviews at hospitals and blood banks, consumption data from the Laboratory Information Management System, demographic data from the Demographic and Health Survey, to name a few. Once data was collected, the quantification model was built using the Autoregressive Integrated Moving Average Model (ARIMA), which has been used to model blood needs in other countries.
In Malawi, the Blood Needs Quantification Model provides estimates from 2023-2030. The model provides MBTS with specificity to view estimated safe blood needs at both the national and facility-levels on a monthly and annual basis, as well as utilization trends and further details based on blood groups. The model is now being used by MBTS to monitor annual blood demand and utilization to provide MBTS with a more accurate view of access to safe blood within the national system.
Conclusion
The Accelerator’s work with NBSP in Liberia and MBTS in Malawi illustrates how global WHO guidance can be effectively translated into actionable improvements in countries, ultimately enhancing decision-making regardless of a country’s starting point. Liberia and Malawi offer two different examples of countries seeking to strengthen their abilities to quantifications to inform resource planning and supply planning for safe blood.
By exploring the different approaches available to countries, based on where they lie in the spectrum of access to data and capacity for conducting quantifications, it provides a pathway for other countries to follow when seeking to refine and improve their own efforts.
