According to a group of 20 international authors from high, middle and low-income countries writing in this week's PLOS Medicine
, ''flexibility and pragmatism are necessary to reduce the unacceptably high rates of unnecessary deaths in Africa because blood for transfusion is lacking".
Over the past ten years, high-income countries have provided considerable financial aid to establish and support national blood transfusion services in sub-Saharan Africa, largely driven by concerns over the contribution of blood transfusion to the HIV epidemic in the region. However, the authors argue that whilst there have been definite benefits to transfusion services, this aid has resulted in unintended but serious negative outcomes, which should prompt a re-thinking of how to provide support to blood transfusion services in sub-Saharan Africa.
The authors argue: "Policies and practices from funding countries, particularly exclusive use of volunteer non-remunerated donors, centralization, and systematic preparation of blood components, are not necessarily appropriate for sub-Saharan Africa where the vast majority of transfusions are done as emergencies."
They continue: "Implementation of these policies and practices adds significantly to the cost of a unit of blood, making the transfusion services unaffordable in resource poor settings and creating long term reliance on external funding."
The authors suggest that on the basis of current evidence, leading funding organizations should focus on achieving adequate blood supply in order to save lives in the context of emergency blood transfusion in sub-Saharan Africa.
The authors conclude: "Externally funded initiatives for strengthening transfusion services in sub-Saharan Africa should be based on appropriate evidence and adapted to take account of the local context, available resources, and long term sustainability."