Transfusion in Sub-Saharan Africa- does a Western model fit?

Abstract

This review examines the current state of transfusion services in sub-Saharan Africa and presents the argument for and against the western model of a centralised blood service with 100% voluntary non-remunerated blood donors as advocated by the World Health Organisation. The current practice of family replacement donors in hospital-based blood service is the most economical option but in the face of high child and maternal mortality rates the blood supply has proved to be insufficient. With estimates of between five and 10% of HIV transmission in Sub- Saharan Africa being the result of contaminated blood transfusions there is a need to improve testing transfusion transmissible diseases and the selection of the blood donors. Of major concern with respect to testing, is the quality of kits being used and the continuity of supply. The need to produce components is discussed in the context of the transfusion needs in sub-Saharan Africa. The running costs of establishing and maintaining centralised blood services need careful consideration as such projects need to be sustainable in the future. It is concluded that both options are viable whilst centralised programmes are being developed and a pragmatic approach should be taken to ensure that the patients’ needs are met and that resources are suitably utilised to ensure sustainability.