Safe blood transfusions are an essential component of health care, particularly in low- and middle-income countries (LMICs), where access to safe blood is critical in treating leading causes of mortality, including malaria- and HIV/AIDS-associated anemia, hepatitis, trauma and postpartum hemorrhage.

The World Health Organization (WHO) recommends that national blood transfusion services collect data as part of a comprehensive quality management system. This data is crucial for decision-making, continuous improvement, and compliance with blood transfusion process standards.

However, blood systems in LMICs often lack the resources and capacity to track and analyze data on appropriate use and demand for blood products, inventory management, and blood transfusion reactions. This hinders their ability to optimize the use of available blood products, improve transfusion safety, and monitor blood donation trends, all of which are vital for improving overall health outcomes.

In Liberia and Malawi, two Sub-Saharan African countries with high burdens of malaria, HIV and post-partum hemorrhage requiring access to safe blood, national blood systems face significant challenges in their ability to collect, monitor and evaluate data. This includes the ability to collect indicators on the quantity of blood available at facilities, conditions for and number of blood transfusions, incidents of transfusion-transmitted infections, and occurrences of transfusion reactions along with their potential causes.

To address this gap, the USAID Health Systems Strengthening Accelerator (Accelerator) partnered with the national blood transfusion services of Liberia and Malawi to improve tools and systems for routine blood data collection, management, and utilization. This brief summarizes the approach and lessons learned from these efforts, offering insights that may be helpful for improving routine safe blood data management in other settings.

Challenges in routine safe blood data management

In Liberia, the Ministry of Health (MOH)’s National Blood Safety Program (NBSP) oversees provision of safe blood products. However, an assessment conducted in 2022 found that the lack of defined performance indicators and essential data tools hindered informed decision-making, allowing risks like adverse reactions and transfusion-transmitted infections to persist.

With support from the Accelerator, the NBSP worked with the MOH Health Information Systems to develop new Blood Transfusion Ledgers and Blood Safety Ledgers for all public health facilities providing blood transfusion services, as well as Regional Blood Centers. These ledgers include critical information, such as blood donor contact information, blood type, presence of transmissible infections, occurrence of transfusion reactions, to name a few. Developing these ledgers was a crucial first step to standardize facility data collection in Liberia for integration into the national health information system.

In Malawi, limited visibility into blood use at the facility level hinders the Malawi Blood Transfusion Service’s (MBTS) ability to effectively monitor and oversee access to quality, safe blood products in facilities. To address this challenge, the MBTS partnered with the Accelerator to implement a more advanced standardized blood data collection system in Malawi’s pilot at Queen Elizabeth Central Hospital (QECH) – the country’s largest public referral and teaching hospital.

The new data management system enables vein-to-vein blood tracking to improve visibility into blood utilization. This in turn will allow decision-makers to more accurately manage inventory and monitor appropriate use and handling of blood products, ultimately improving the overall quality management system.

Approach

In both Liberia and Malawi, the Accelerator worked with key blood system stakeholders to implement these improvements to the existing data management systems. This included first working with stakeholders to identify the precise needs, and then developing an improved tool responding to the specific blood system context.

For instance, in Liberia the Accelerator and NBSP reviewed and assessed previously deployed facility ledgers and their existence at facilities – only one in 15 facilities visited in a 2022 assessment was actively using the previous facility ledger. Next the team developed an improved ledger during a consultative convening of key blood system actors in March 2024, including representatives from the MOH HIS team and clinicians. The convening provided consensus on the precise indicators and format for the ledgers. Finally, the new ledgers were validated by MOH and printed for national dissemination in June 2024.

Similarly, in Malawi the Accelerator and MBTS conducted baseline a assessments of blood data collection at QECH to understand current blood data collection processes and tools. Next, they co-created blood indicators and revised existing data collection tools to be used in the facility wards and in the laboratory. The revised tools and approach were then piloted at QECH from March – May 2024. In total, 3,817 transfusions were conducted during this period.

Lessons learned from the pilot were synthesized and disseminated to MBTS, QECH, and national stakeholders through a series of meetings in June 2024 to guide the future nationwide scale-up of blood data collection, ensuring broader and more effective implementation.

Lessons learned and recommendations

Based on experiences from Liberia and Malawi, the following key recommendations for strengthening routine safe blood data management were identified:

• Build awareness on the importance of blood safety: In contexts where blood data tracking has been nonexistent or ad-hoc, advocate for the integration of blood-related indicators in standard facility data management systems to promote blood safety.
• Promote the value of blood data: Highlight the role of accurate blood data in informed decision-making and overall health system strengthening.
• Establish a cohesive blood data collection system: Engage strong leadership at all levels to collaboratively define and develop safe blood indicators and recording tools and standardize and formalize blood data collection processes.
• Sustain high-quality safe blood data management: Ensure that blood safety indicators are incorporated into routine health information systems and implement behavior change interventions to enhance blood data documentation at the facility level and for future national scale-up efforts.

Conclusion

The experiences of Liberia and Malawi demonstrate how data on blood, a neglected yet critical health area, can be strengthened as a part of national routine health and logistics management information systems.

These efforts have also highlighted the need for taking a collaborative, consultative approach to ensure improved tools and approaches responded to the needs of various stakeholders involved in the national blood system, e.g., both the clinicians providing blood transfusions and stakeholders within the national transfusion services overseeing national supply and quality assurance.

By taking an evidence-based, collaborative approach to strengthening data management systems, these countries are paving the way for more resilient and efficient national blood systems.

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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:

1. Consumption approach using historical blood usage data
2. Service delivery approach using the number of acute hospital beds
3. 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.

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The primary goal of the workshop was to discuss nutrition financing situations in Malawi and to agree on what a sustainable financing framework for nutrition should include. This work also complements the ongoing USAID Advancing Nutrition support to the Scaling Up Nutrition Movement to galvanize more and higher quality financing for nutrition in Malawi.

The workshop comprised four sessions including sessions on The National Multi-Sector Nutrition Strategic Plan and a review of its cost by Priority Areas and Nutrition Financing Trends in Malawi. The workshop also probed into district level annual and budget planning processes and ways to secure budget lines for multisectoral nutrition activities across various sectors including health, agriculture and education and discussed ways to advocate for increased nutrition funding within the district council development budgets.

We had participants from four districts in Malawi and from key nutrition stakeholders including the academia, development partners and civil society organizations.

The post Sustainable Financing for Nutrition in Malawi: Post Workshop Report appeared first on Results for Development.

The Government of Malawi has made nutrition and Early Childhood Development (ECD) a priority. In conjunction with the government’s commitment to improve nutrition through multisectoral approaches, there have been efforts to study how nutrition actions can be delivered through existing government ECD platforms, including preschools known as community-based childcare centers (CBCCs). For example, the Nutrition Embedded Evaluation Program Impact Evaluation (NEEP-IE), discussed in this case study, studied the impact of adding a set of integrated nutrition and agriculture interventions to Malawi’s ECD program delivered through CBCCs. Positive findings from the NEEP-IE helped inform the Government of Malawi’s commitment to scale up nutrition actions delivered through their ECD platform.

This case study, How Evidence Informs Decision-Making: The scale-up of nutrition actions through an early childhood development platform in Malawi, explores four enabling factors that led to the government’s decision, including:

1. Strong base of evidence on impacts and economic rationale.
2. Government leadership and multisectoral collaboration at all stages.
3. Strong partnerships between government and implementing organizations.
4. Community engagement as a driving force.

“This case study underscores the importance of generating policy-relevant evidence to support decision-making, particularly when thinking about how to scale-up nutrition actions through existing multisectoral platforms,” said Mary D’Alimonte, a senior program officer at Results for Development. “Research by IFPRI and implementation experience by Save the Children were critical to help inform the scale-up driven by the government.”

This case study was prepared as part of the Strengthening Economic Evaluation for Multisectoral Strategies for Nutrition (SEEMS-Nutrition) initiative, and benefited from input from colleagues at IFPRI and Save the Children.

SEEMS is a three-year initiative to strengthen evidence of the costs and benefits of multisectoral nutrition strategies. It is led by project director, Carol Levin, from the University of Washington Department of Global Health, with partners including IFPRI, Helen Keller International, and R4D. With new and emerging data coupled with a strong understanding of what information nutrition advocates, funders, policymakers and program planners need, we hope that this work will help generate improved evidence for scaling up multisectoral nutrition programs across countries. Read more here.

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About Results for Development
Results for Development (R4D) is a leading non-profit global development partner. We collaborate with change agents around the world — government officials, civil society leaders and social innovators — to create strong systems that support healthy, educated people. We help our partners move from knowing their goal to knowing how to reach it. We combine global expertise in health, education and nutrition with analytic rigor, practical support for decision-making and implementation and access to peer problem-solving networks. Together with our partners, we build self-sustaining systems that serve everyone and deliver lasting results. Then we share what we learn so others can achieve results for development, too. For more information, visit our website at: www.r4d.org.

Photo © 2008 Fletcher Gong’a, Courtesy of Photoshare

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In conjunction with the government’s commitment to improve nutrition through multisectoral approaches, there have been efforts to study how nutrition actions can be delivered through existing government ECD platforms including preschools known as community-based childcare centers (CBCCs) and parenting groups known as Care Groups. For example, the Nutrition Embedded Evaluation Program Impact Evaluation (NEEP-IE), discussed in this case study, studied the impact of adding an integrated agriculture-nutrition behavior change communication component to an ECD package delivered through CBCCs.

In late 2018, the Government of Malawi committed to scaling-up nutrition actions delivered through their ECD platform. With strong global attention focused on how to scale-up multisectoral actions in nutrition leveraging existing platforms, this case study looks at the enabling factors that informed and led to the government’s decision to scale-up nutrition-sensitive actions through Malawi’s ECD platform.

This case study was prepared as part of SEEMS-Nutrition (Strengthening Economic Evaluation for Multisectoral Strategies for Nutrition)

The post How Evidence Informs Decision-Making: The Scale-Up of Nutrition Actions Through an Early Childhood Development Platform in Malawi appeared first on Results for Development.

Community-based early childhood development centers in Malawi have been used as a platform to implement an integrated agriculture and nutrition behavior change intervention. Presentations will explore the findings of a rigorous evaluation on the impact, sustainability, costs, and returns on investment of this initiative. A case study will be also be presented by Research for Development (R4D) on the use of evidence in the policy processes that led to the scale-up of the program across the country.

Attend in person or follow online.

Opening Remarks
Dan Gilligan, Deputy Director of Poverty, Health, and Nutrition Division, IFPRI

Discussants
Julie Ruel Bergeron, Nutrition Specialist in the Human Development Network’s Health, Nutrition, and Population (HNP) Unit, World Bank Bank Group
Natalie Roschnik, Senior Nutrition Advisor, Save the Children

Presenters
Aisha Twalibu, IFPRI consultant, formerly Save the Children
Aulo Gelli, Research Fellow, IFPRI
Amy Margolies, Research Consultant, IFPRI
Mary D’Alimonte, Senior Program Officer, Results for Development (R4D)

Closing Remarks
Harold Alderman, Senior Research Fellow, IFPRI

The post Using Malawi’s Community-Based Childcare Centers to Implement an Agriculture and Nutrition Intervention appeared first on Results for Development.

In his role with EdTech Hub, Pilirani supports the design and delivery of evidence-based approaches to education technology. He builds and manages relationships with government, development partners and implementing organizations, and provides technical assistance tailored to Malawi’s context. He collaborates with EdTech Hub’s global network of specialists to connect research with national priorities and support improved learning outcomes.

Pilirani is also the founder of Padziwe, an education technology company focused on developing digital content and platforms that support teachers and learners with practical, tech-enabled education solutions. Through Padziwe, his work has impacted more than 10, 000 learners and earned several awards and recognitions, including selection as one of the African Union’s top 10 education innovations in Africa. He currently serves on the Board of Padziwe Digital Learning Limited.

Pilirani holds a Bachelor of Science in Library and Information Science from Mzuzu University in Malawi.

The post Pilirani Kumasewera appeared first on Results for Development.

A world free from malnutrition requires coordinated efforts across sectors, and the research suggests there is good reason to be enthusiastic about such interventions. However, assessments of their costs and cost-effectiveness are harder to come by.

One such study offers a promising way forward. Researchers at IFPRI and the University of Washington examined an integrated nutrition and agriculture intervention designed to improve the nutrition of meals offered through Malawi’s community-based childcare centers (CBCCs)—finding its estimated benefits (assessed as part of a related impact analysis) outweighed the intervention costs.

The economic evaluations used the framework and methods developed as part of the Strengthening Economic Evaluation for Multisectoral Nutrition Strategies (SEEMS-Nutrition) initiative. SEEMS-Nutrition aims to improve the comparability and use of economic evaluation findings across different multisectoral nutrition interventions through a standardized method, set of tools, and analysis.

To read the full blog, click here.

Photo © Melissa Cooperman/IFPRI

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