Access to a safe and sufficient supply of blood and related products and services, including blood transfusion, is a critical element of any health system. Unfortunately, many people who need transfusions — especially those who live in low- and middle-income countries around the world — do not have timely access to safe blood.
According to the World Health Organization (WHO), activities related to blood collection, testing, processing, storage, and distribution should be coordinated at the national level through effective organization and integrated blood supply networks. Furthermore, national blood systems should be governed by national blood policies and legislative framework to promote uniform implementation of standards and consistency in the quality and safety of blood and blood products.
WHO reports that in 2012, 70 percent of all countries had a national blood policy, which represented a 10 percent increase from 2004. Additionally, some 62 percent of countries have specific legislation on safety and quality standards for blood transfusion, ranging from 81 percent of high-income countries down to just 44 percent of low-income countries. There is also a marked difference in the level of access to blood between low- and high-income countries, as evidenced by the whole blood donation rate, which ranges from a median of 36.8 donations per 1,000 population in high-income countries to 11.7 in middle-income countries and 3.9 in low-income countries. And, while WHO reports an increase of 8.6 million blood donations from voluntary unpaid donors between 2004 and 2012, 72 countries collect more than half of their blood supply from family, replacement, or paid donors rather than voluntary unpaid blood donors.
Clearly, there is a need in many low- and middle-income countries for expert technical assistance to strengthen the rapid implementation of safe blood programs and precautions against the transmission of HIV, hepatitis, malaria, and other blood-borne infections.
AIHA’s Blood Safety Program
In December 2012, AIHA launched a new project designed to improve access to a safe supply of blood in selected countries in Asia and Eurasia. This five-year technical assistance project is supported through a cooperative agreement with the United States Centers for Disease Control and Prevention (CDC) with funding from the US President’s Emergency Plan for AIDS Relief (PEPFAR).
Working closely with each country’s Ministry of Health and blood transfusion services, AIHA’s team of international blood safety experts are supporting the establishment of national systems based on WHO guidelines, including effective strategies for attracting non-remunerated blood donors and screening of all donated blood for transfusion-transmitted infections. The AIHA team is also working with national stakeholders to develop and implement evidence-based blood utilization guidelines and to strengthen systems to support the quality, safety, and adequacy of national blood supplies.
Through this project, AIHA is contributing to the critical development of indigenous human resource capacity related to blood safety. Currently, we are providing technical guidance, clinical training and mentoring, and expert advice to enhance blood safety and improve transfusion practices in Cambodia, Kazakhstan, Kyrgyzstan, and Ukraine, with activities slated to commence in Tajikistan this year. These countries all face a broad range of challenges meeting or maintaining acceptable standards for blood safety.
In some of the countries, transfusion of infected blood or blood products is a serious concern because the prevalence of HIV and hepatitis B and C in the blood donor populations is higher than the prevalence in the global donor population. Screened blood units have higher rates of most transfusion transmitted infections (TTIs) than the general global donor population and, according to CDC reports, the presence of TTIs remains the primary reason for discarding donated blood. Lack of safe blood has also been directly implicated in HIV transmission in Central Asia and other countries.
Safe Blood Is a Priority
Selected Program Results
- In Cambodia, AIHA is supporting an ongoing collaboration between the Ministry of Health and the National Blood Transfusion Centre and technical experts from the Australian Red Cross. Together, they are strengthening Cambodia’s blood safety infrastructure, including development of national blood policies and clinical guidelines for transfusion in Phnom Penh, as well as providing laboratory training in the capital region, with the expectation of rolling the project out to the provinces in the coming year.
- In Kazakhstan, AIHA provided technical assistance supporting the development of user requirement specifications for bidding a national computer system; delivered a quality management training curriculum; provided technical assistance on cost-accounting and financial management systems; and reviewed national prikaz on clinical use of blood, making recommendations for revisions. We also worked with leading national experts to develop a postgraduate course on the clinical use of blood, which — once finalized and officially approved — will be introduced to medical school faculty and clinicians across in the country during a two-week training workshop. Similar work is underway for a postgraduate quality management course for specialists from the national blood service.
- AIHA’s work in Kyrgyzstan commenced with a national needs assessment and resulting recommendations for blood service reform. We conducted a series of quality management trainings with follow-up mentoring in all six oblasts and are currently working with local stakeholders to develop quality and technical standards that will be submitted to the Ministry of Health for approval and issuance of a national prikaz. In addition, the AIHA team is in the process of developing national clinical guidelines for the use of blood components that will also become national policy once completed and approved by the Ministry. We’ve provided technical assistance on blood service financing and are implementing donor recruitment training for partners from the Republican Blood Center, the Red Crescent Society, and Club 25, as well as to representatives of the mass media. The project will also support a national blood safety conference in October 2014.
- In Ukraine, the AIHA team provided two quality management trainings and a financial workshop to address costing of blood. We also participated in a scientific conference sponsored by the Association of Blood Services in Ukraine and are working with State Services to develop a plan for a new computer information management system for which we are coordinating training and development of user requirement specifications. Through the project, AIHA is collaborating with the National Medical Academy of Postgraduate Education to develop a transfusiology curriculum and is assisting with harmonization of local policies with European Union directives for blood services. Future plans are to provide trainings in proper venipuncture techniques, donor care, component preparation, and validation of equipment.