Cover Image
close this bookSafe Blood in Developing Countries - The Lessons from Uganda (EC, 1995, 151 p.)
View the document(introduction...)
View the documentQuotation
View the documentForeword by the Uganda Minister of Health
close this folderForeword by Commissioner Professor Pinheiro
View the document(introduction...)
View the documentWhat the blood transfusion service has done for Kabarole hospital
View the documentSome facts about Uganda
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
close this folderSection Two - Background: Uganda's history, health, and the HIV/AIDS epidemic
close this folderChapter Two - Uganda's political and physical health: A brief history
View the documentA. The political background
View the documentB. The health of the nation
View the documentC. Safe and unsafe blood in Uganda
close this folderChapter Three - AIDS in Uganda: A glimmer of hope?
View the document(introduction...)
View the documentExtent of aids in Uganda
View the documentMobilising to deal with HIV/AIDS
View the documentThe evidence for 'a glimmer of hope'
View the documentVoluntary mass HIV testing as a route to behaviour change
close this folderSection Three - The story of the Uganda blood transfusion service
close this folderChapter Four - How the European commission got involved
View the document(introduction...)
View the documentDr Lieve Fransen's report
View the documentThe 1987 plan
View the documentThe 1987 starting position
View the documentThe role of the Red Cross
close this folderChapter Five - Phase one of the project 1988-1990
View the document(introduction...)
View the documentA plan for blood donors
View the documentThe problem of laboratory space
View the documentThe problem of staffing
View the documentStaff structure and training
View the documentThe need for special skills
View the documentReconstruction of the Nakasero building
close this folderChapter Six - Phase two: Creation of a national service 1990-1991
View the document(introduction...)
View the documentRole of other donors
View the documentStaff recruitment
View the documentRegional blood banks
View the documentVoluntary testing for HIV
View the documentSupervision and quality control
close this folderSection Four - Evaluation: The view from Kampala
close this folderChapter Seven - The costs and benefits of safe blood in Uganda
View the documentA. The costs
View the documentB. The benefits to HIV prevention
View the documentC. Some other benefits
close this folderChapter Eight - Interview with Dr Peter Kataaha, Director, Uganda blood transfusion service
View the document(introduction...)
View the documentFlying to the rescue
View the documentChapter Nine - Interview with Dr Samuel Okware
close this folderSection Five - Key issues in blood transfusion: The Uganda experience
close this folderChapter Ten - The search for safer blood and the drive for voluntary, unpaid blood donors
View the document(introduction...)
View the documentCosts of relatives versus volunteers
View the documentFuture strategies: Donor clubs
close this folderChapter Eleven - The organisation of a blood transfusion service
View the document(introduction...)
View the document1. A centralised organisation
View the document2. A regional system
View the document3. A hospital-based system
View the document4. A mixed system
View the documentThe Zambian solution
close this folderChapter Twelve - Blood transfusion takes many skills: The importance of training
View the document(introduction...)
View the documentA. Training of Nakasero staff
View the documentB. Training of hospital staff
View the documentC. Residential courses for hospital staff
View the documentD. Training at schools for medical assistants
View the documentE. Training of senior professional staff
close this folderChapter Thirteen - Other issues, and their solutions
View the document(introduction...)
View the document1. Which diseases are screened against - and which are not? and why not?
View the document2. The special problem of malaria
View the document3. Adapting laboratory methods
View the document4. The start-up equipment - and computer
View the document5. Transport, for people, supplies, and blood
View the document6. Voice and data communications - or lack of
View the document7. Funding staff salaries in a time of inflation
View the document8. Keeping records, or trying to
View the document9. All or only some hospitals?
View the documentThe editor adds:
close this folderAppendices
View the documentAppendix 1: EC support for safe blood in developing countries
View the documentAppendix 2: Useful references

Dr John Watson-Williams enters the scene

Late in 1986, shortly before the EC became involved, the acting President of the Uganda Red Cross Society, Edward Mungati, via the American Red Cross invited Dr. John Watson-Williams, a British haematologist (i.e. an expert on blood) who had also worked in America, to visit Uganda and advise the URCS about how to revive the blood transfusion programme which the Red Cross had previously carried out before civil strife made it impossible. The visit was made in April 1987, the same month that Dr Lieve Fransen was in Kampala on behalf of the EC, and Dr Watson-Williams made recommendations on much the same lines as Dr Fransen, but independently.

Dr John Watson-Williams (right)

He suggested the construction of a blood bank in Kampala, a national volunteer donor programme, and a blood distribution system to deliver 30,000 units of blood a year. The American Red Cross Society agreed to designate Dr Watson-Williams as a volunteer delegate to the URCS, and the Carnegie Corporation of New York provided a $25,000 grant for a feasibility study.

This study was carried out from September 1987 until May 1988. During that time Dr Watson-Williams worked at the New Mulago Hospital, Kampala, and at the Virus Research Institute in Entebbe. He was able to report that a volunteer blood bank programme would probably be successful. He was also able to evaluate different ways of HIV testing and blood typing, and to select those which would be most cost-effective in a national programme.

The director of the AIDS Control Programme, Dr Sam Okware, and the Ministry of Health gave encouragement and invited Dr Watson-Williams to assist in the planning for the EC-sponsored Nakasero Blood Bank project, so bringing together the two parties interested simultaneously in much the same contribution to restoring Uganda's health system. So it came about that in July 1988 Dr. Watson-Williams was chosen to be the EC's technical assistant for the project, starting in September 1988.

Dr Watson-Williams came to the Uganda project with strong ideas about how best to organise blood transfusion services in Africa. He had already spent time in Nigeria and elsewhere studying the problem, and had already recognised that an efficient blood transfusion serice in Africa is a quite different proposition to a transfusion service in, say, Europe. In Europe, blood is needed for emergency operations, for example for adults after a car crash, and the electricity supply can be relied on for refrigerating stored blood. In Africa, both the need and the circumstances are different, with children and maternity cases being the main recipients, and electricity supplies often unreliable.

From his previous experience in Africa he had also concluded that one of the critical deficiencies in patient care was the scarcity of trained laboratory staff and the resulting low level of diagnostic testing at the peripheral hospitals where most of the patient care is given. If each hospital also expected the laboratory staff to recruit, screen and bleed blood donors, and to test the blood for markers of transmissible diseases, this would further reduce their ability to provide essential diagnostic testing.

However, if a centralised blood donor recruiting, blood collection and blood screening and testing service was available, the hospital technician would be provided with a constant and adequate supply of safe blood and would only need to perform compatibility testing for each transfusion. The benefits of this could then be maximised by the development of a high-level centre for training of blood transfusion staff, both for local programmes and for programmes in other developing countries, and a demonstration project could be set up that medical decision-makers from other countries could observe and learn from. So Uganda became, for Dr Watson-Williams, a chance to demonstrate that his theory would work in practice.

UBTS Blood Units Collected 1989-1994

Blood units Processed - UBTS 1994 - Anti-HIV+, Hepatitis+, Inadequate units

HIV Frequency of NBB Blood Donors - % positive for anti-HIV 1989-1994

HIV Frequency of NBB Blood Donors - % positive for anti-HIV 1989-1994