Safe Blood

A timely and safe blood transfusion can be the difference between life and death in many health emergencies. Transfusions are integral to quality care in maternal child health, surgery, trauma care, oncology and malaria treatment. But building and maintaining strong systems for collecting, screening, storing, distributing, transfusing and monitoring safe blood is complex and requires unique expertise.

Multiple challenges hinder blood system performance in low- and middle-income countries including critical underfunding, over-reliance on donor funding, poor coordination between relevant stakeholders, health system fragmentation and a lack of technical assistance to strengthen safe blood within national health systems.

Many countries are requesting support to strengthen their ability to source adequate and safe blood, ensure availability in health facilities, and safely transfuse blood and blood products to patients for life-threatening conditions without adverse outcomes.

Postpartum hemorrhage, or excessive bleeding after childbirth, is a leading cause of maternal mortality worldwide, affecting 14 million women annually and resulting in about 70,000 deaths. It accounts for over a quarter of maternal deaths worldwide. For severe postpartum hemorrhage, a blood transfusion can be a life-saving intervention. Challenges in the blood systems of many low- and middle-income countries can undermine the provision of safe blood services when they are needed most.

Current country and global efforts to support national blood systems are inadequate, fragmented and untargeted. R4D sees country demand for technical assistance to improve this. Key opportunities include:

• Making safe blood a priority in national health planning and financing
• Improving coordination among stakeholders
• Mobilizing funding – especially from domestic sources
• Developing and disseminating policies, strategies, procedures and guidelines
• Improving quality assurance and safety monitoring practices
• Training health care workers on safe blood management and transfusion
• Collecting data on blood management, blood use, health conditions and adverse outcomes
• Transitioning procurement of equipment and consumables (like blood bags and lab items) away from donors or parallel supply chains to national systems
• Increasing blood supply by raising awareness and educating communities on voluntary blood donation to address stigma

There are also multiple opportunities for maternal child health (MCH)-focused funders, implementers and providers to contribute to wider blood system strengthening efforts in countries. While national systems for blood collection, processing, and supply are intended to be centralized, maternal child health programs are key customers of the blood system and can strengthen it in significant ways. MCH programs can:

• Lead advocacy and engagement to adequately resource the national blood system as a critical component of urgent and emergent clinical care
• Support integration of blood service supplies into national procurement and logistics management information systems, in partnership with national supply chains
• Capture more rigorous data on blood transfusions and outcomes to improve the evidence base
• Train health care workers on blood transfusion guidelines and protocols. National blood services typically do not exercise influence on clinical processes and quality assurance; MCH and other programs can help fill the gap with trainings and production and dissemination of job aids
• Raise awareness and reduce stigma around blood donations by leveraging the community health workforce, health promotion departments, and social and behavioral change interventions and partners to improve public perceptions

R4D’s approach aims to strengthen countries’ own abilities and resources to accelerate progress toward self-reliant blood systems and reduce dependence on donor assistance over time.

Our approach is responsive to country priorities and includes:

• Facilitating collaboration and engagement between relevant stakeholders within countries
• Facilitating opportunities for cross-country learning among peers
• Coaching and capacity building – leveraging local, regional, and where needed, global expertise to support change agents
• Co-creating policies, strategies and tools by translating global knowledge and evidence into locally feasible solutions
• Evidence generation, learning and adapting – conducting implementation research and other analytical support to discover what is and isn’t working and improve system design

The R4D-led Health Systems Strengthening Accelerator project funded by USAID is providing technical assistance in Liberia, Malawi and Rwanda to help strengthen national safe blood systems and improve access to safe blood transfusion services.

In partnership with change agents in each country and together with the USAID Market Access and Innovative Finance program, we applied the USAID Safe Blood Starter Kit — now developed into the WHO Blood System Self-Assessment tool — to understand the existing safe blood systems and country contexts, identify key challenges and opportunities, and co-create interventions to address challenges prioritized by each country. After completing the Safe Blood Starter Kit assessment in December 2022, R4D began providing technical assistance across a range of areas that aim to address both foundational and operational challenges in national blood systems.