Cover Image
close this bookSafe Blood in Developing Countries - The Lessons from Uganda (EC, 1995, 151 p.)
close this folderSection One - Introduction and summary
close this folderChapter One - Safe blood and HIV/AIDS: The Uganda achievement
View the document(introduction...)
View the documentThe tragedy of the haemophiliacs
View the documentInfections carried by blood
View the documentThe unique features of Africa
View the documentThe global blood safety initiative
View the documentThe Uganda blood transfusion service: A portrait
View the documentThe wider contribution of the UBTS
View the documentThe view from an up-country hospital
View the documentThe matter of costs
View the documentThe dynamics of the project
View the documentA complex organisation
View the documentA view from Mulago hospital, Kampala
View the documentFour questions about AID
View the documentThe first visit for the EC
View the documentDr John Watson-Williams enters the scene

The global blood safety initiative

In 1988, a year or so after the European Commission began its safe blood project in Uganda, the Global Blood Safety Initiative (GBSI) was launched. Its aim was an ambitious one, no less than to set universally applicable standards for the collection and use of blood. The GBSI (recently replaced by the WHO Blood Safety Unit, with a different mandate) was a collaboration between the World Health Organisation, the Global Programme on AIDS, the League of Red Cross and Red Crescent Societies, the UNDP (United Nations Development Programme) and the International Society of Blood Transfusion. A meeting of representatives from these organisations and from the World Federation of Haemophilia, the EC, and other bi- and multilateral agencies and NGOs was held in May 1988, at which it was agreed to launch the GBSI.

The practical purpose of the GBSI was to support the setting-up of integrated blood transfusion services in all countries, services which could provide adequate, safe, accessible, affordable and appropriately used supplies of blood. The key words here are 'integrated', 'safe', 'accessible', 'affordable', and 'appropriately used: These concepts drew upon the principles already established by the EC for achieving safe blood, such as voluntary blood donation, systematic screening for all relevant infections, and rational use of blood to reduce unnecessary blood transfusions. The EC has made a point of operating at both technical level and, through such efforts as collaboration with the GBSI, at worldwide policy level.

The GBSI believed that safe blood would only be guaranteed in the con- text of a sustained world-wide co-operative effort - an effort which, sadly, has yet to come to full fruition. Although HIV/AIDS triggered this new and urgent concern for the safety of the world's blood supplies, it quickly embraced a broader objective of reducing morbidity and mortality both from failure to transfuse and from the many complications of transfusion, including transmission of HIV and also other infectious agents, depending for example on the region.

The GBSI worked out and published clear and comprehensive guidelines for operating blood transfusion services, with particular attention to:

- recruitment of blood donors
- HIV-testing of blood donated
- training of blood transfusion staff
- appropriate use of blood.

The main principles guiding the GBSI were that:

1. development of integrated blood transfusion services should occur within the broader context of national health plans as well as within the context of national plans for AIDS prevention and control.

2. a country's supply of safe blood and blood products should be sufficient to meet patients' needs.

3. steps should be taken to encourage appropriate clinical use of blood.

4. safety of blood supply depends on careful selection of blood donors, and voluntary non-remunerated donors best fulfil the criteria for 'safe donors'.

5. to ensure quantity and safety, blood transfusion services need to be regulated and co-ordinated, a task for which governments bear the ultimate responsibility.

Therefore the GBSI tried to persuade both governments and donors that blood transfusion should be a component of all AIDS programmes, with a separate budget even if it could not be a separate unit, with adequate government support and funding. Realistically, it recognised that most developing countries would need financial aid from international donors to achieve a safe blood supply. Such was the case in Uganda, where the European Commission had already stepped in as the major support agency. The GBSI and the Uganda blood transfusion project interacted. The GBSI drew on the Uganda experience in formulating its policies and guidelines. The managers of the Uganda project were able to use the principles laid down by the GBSI to demonstrate to government and other officials that their objectives and ambitions were in accordance with the best practices laid down by the World Health Organisation. Also, the GBSI funded a short-term consultant, Judith Goddard, to help develop transfusion services in the districts of Uganda, so helping a truly national service to come about. After Dr John Watson-Williams had completed his task as EC technical assistant for the rehabilitation of the UBTS, Miss Goddard joined the main Nakasero blood bank in Kampala as technical assistant.