External Financial Aid to Blood Transfusion Services in Sub-Saharan Africa: A Need for Reflection

Abstract

Over the past ten years, high-income countries in the North have provided considerable financial aid to establish and support national blood transfusion services in low-income countries in sub-Saharan Africa. This action has largely been driven by concerns relating to the contribution of blood transfusion to the HIV epidemic in the region, leading to the overwhelming objective of ‘‘safe blood.’’ Whilst there have been definite benefits to transfusion services, we believe this aid has resulted in unintended but serious negative outcomes, which we describe here and argue should prompt a re-thinking of how to provide support to blood transfusion services in sub-Saharan Africa. Support has targeted either single countries such as Malawi, Rwanda, Burkina Faso, and Uganda [1,2] or multiple countries [3]. Funds, available only for limited periods, have been used to support a combination of infrastructure design and construction; purchase of equipment; screening for transfusion-transmitted infections and quality assurance; and the recruitment of blood donors. As a direct consequence of this funding, some of the underlying principles of transfusion services practised in the high-income donor countries have been applied in sub- Saharan Africa recipient countries (Box 1). These principles may be based on sound practice in wealthy countries but do not necessarily apply to sub-Saharan Africa at this time. We argue that considering the needs of sub-Saharan Africa, external aid was to some extent misdirected in the areas of donor recruitment, overall organisation, and availability of products.