No Woman Should Die During Childbirth: Blood Safety and Maternal Health Issues in Sub-Saharan Africa

Op-ed co-authored with Philana Mugyenyi, Manager SSA – Government Affairs & Public Policy at Terumo Blood and Cell Technologies
and Kaushal Shah, Head of Health Strategy, Africa Health Business

A study published in 2021, suggests that in Kenya, Ghana and Ivory Coast, there is an absolute shortage of safe blood originating from weaknesses in blood supply chains, despite the considerable efforts to improve access to safe and adequate blood supplies. In the context of maternal deaths, the shortage of blood directly contributes to high maternal mortality from postpartum haemorrhage (PPH) in these countries. Furthermore, an expansion of the investment in the blood safety value chain in these countries is likely to provide large positive economic returns in terms of preventing fatal postpartum haemorrhage in less than two years.

The African community has achieved significant gains in maternal and newborn health. However, every year, thousands of babies die within days or weeks after birth, and thousands of women die during pregnancy and delivery. Almost all these deaths are due to preventable causes such as poor access to care, fragile delivery systems, complications of being born too small or too soon, and infection.

Although facility births are increasing, the quality of care remains a critical challenge. Primary healthcare facilities are often ill-equipped to prevent or address underlying causes of illness or other complications. Furthermore, resourcing for health is often insufficient or fragmented and accountability for policy implementation is lacking in many settings.

Blood transfusion is an essential component of the healthcare system of every country.

In 2013, the most recent year for which global data are available, an estimated 112.5 million blood units were donated worldwide. Of these, 5.6 million blood units were collected in 46 African countries, accounting for only 4% of global donations, although these countries are inhabited by approximately 13% of the global population [1].

Maintaining access to and availability of safe blood is crucial for patients requiring blood transfusion and can be lifesaving. In developing countries, blood is frequently needed for the management of complications of pregnancy and childbirth. In the sub-Saharan region of Africa, severe bleeding is estimated to account for up to 44% of maternal deaths, and the need for blood products far outstrips supply.

Of all maternal deaths, over 90% occur in low-resourced countries and the leading cause of death is PPH. Worldwide, an estimated 800 women die every day from preventable causes related to pregnancy or childbirth, among which untreated haemorrhage is a major contributor.

Health Economic Value of Blood in Kenya, Ghana and Ivory Coast: The Case of Maternal Bleeding

Although the link between the blood supply and morbidity and mortality within a country is well understood, to date, there is not enough data regarding the impact of increased blood supply on healthcare performance in countries in Africa. More specifically, only a few studies in the African region have evaluated predictors of survival of patients requiring acute massive transfusion (e.g. due to maternal bleeding) or regular transfusion (e.g. due to chronic anaemia). To address this data gap, a review was conducted to understand the impact of blood availability on the health outcomes of patients in three African countries: Kenya, Ghana and Ivory Coast [2].

To address this data gap, a review was conducted to understand the impact of blood availability on the health outcomes of patients in three African countries: Kenya, Ghana and Ivory Coast [2].

Failure throughout the entire blood supply chain

The gap between blood demand and blood availability in Africa can be attributed to the fact that the local blood value chain fails to meet international guidelines across-the-board [2]. This includes: insufficient financial resources, missing healthcare infrastructure, poor local guidelines, weak blood registries, supply chain and logistics issues, shortage of blood donors and blood types.

Blood shortage: The case of maternal bleeding and lives lost in numbers

Shortages of blood supplies in Kenya, Ghana and Ivory Coast directly contribute to the overall mortality and morbidity figures. In the three countries[2]:
• Nearly 30% of deaths are attributable to the blood shortage.
• Up to approximately 40% of maternal mortality could be attributed to severe PPH.
• Of the maternal deaths attributed to PPH, more than 85% are potentially avoidable with blood transfusions.

Partnerships are key

Blood collections in Sub-Saharan Africa do not meet the international recommendations for the supply of blood and blood components. Due to these shortages, common clinical indications such as severe maternal bleeding cannot be treated effectively. Increased investments in safe blood supply chains across Africa are likely to provide large positive economic and societal returns. Even considering the relatively low-income levels, the cost of saved lives outweighs the investments in the supply of blood with cost savings. Local governments and authorities have taken the initiatives within the last decades to improve the availability of safe blood on the continent; however, there is still room for improvement. The magnitude of filling the gap in the availability of safe blood on the African content in the coming months and years will require collective action from both the public and private sector. With regards to the private sector, organisations can engage with governments and nongovernmental organisations to enter public-private partnerships that ensure the strengthening of blood supply chains. The private sector also can assist in healthcare workforce training, asset sharing (private facilities can be used for blood collection and storage and private hospitals and healthcare workers can be utilised for blood drives), public education regarding the importance of blood donation and managing and monitoring blood collection programs, including prioritising target populations and maintaining donation/collection registries using digital technologies that may not be readily available to the public health authorities. Digitised, up-to-date data will also enable real-time situation monitoring and swift issue mitigation.

In 2019, Terumo Blood and Cell Technologies led a series of high-level discussions on the sidelines of the United Nations General Assembly to explore solutions to blood safety and maternal health issues in sub-Saharan Africa (SSA). One outcome was the formation of a working group to drive the agenda for adequate, safe, sustainable blood in SSA now referred to as the Coalition of Blood for Africa (CoBA). CoBA was launched in 2020 with the goal of finding solutions to the perennial challenges of blood in the continent. The coalition brings together an unprecedented array of health experts, including public-sector research institutes, ministries of health, academia, not-for-profit research and development organisations, NGOs, international organizations and private sector organisations all committed to one goal: access to safe, sustainable blood in Africa.

www.cobaafrica.org

Specifically, partnerships can focus on [3]:

• Policy and program development: nationwide situation analysis of existing blood services and assessment of current and future needs, development of national blood policy and strategic plan, establishment of legislative framework and regulatory mechanism, national coordination of blood transfusion services and establishment of systems for financial sustainability.

• Infrastructure development: to ensure adequate and suitable facilities for blood collection, testing, processing, storage and distribution.

• National data collection and information management system: to ensure the traceability of donors, donated blood and transfusion recipients.

• Strengthening of blood donor programs: to increase the total number of donations by voluntary blood donors, reduce family and paid donation and implement strict criteria for assessing the suitability of donors.

• Testing and processing: centralized/regionalized testing of all donated blood in accordance with quality standards.

• Quality systems: in blood transfusion services and at the clinical interface.

• Training: of all staff in blood transfusion services and hospital staff involved in the clinical transfusion process.

• Blood utilization: prescribing of blood in accordance with national transfusion guidelines and the safe clinical transfusion procedures.

• Monitoring and evaluation: of all activities related to blood transfusion to assess progress, monitor trends and impact, and replan, as necessary.

[1] WHO. Global Status Report on Blood Safety and Availability. 2016. Available from:https://apps.who.int/iris/bitstream/handle/10665/254987/9789241565431
[2] Owusu-Ofori SPO, Sekongo YM, Rajab JA, Asamoah-Akuoko L, Magutu V, Lamotte M, Bah A, Dierick K. Health Economic Value of Blood in Sub-Saharan Africa: The Case of Maternal Bleeding. Value in Health. 22. S773. 10.1016/j.jval.2019.09.1964.
[3] Making Safe Blood Available in Africa. Committee on International Relations, Subcommittee on Africa, Global Human Rights and International Operations, U.S. House of Representatives. 27 June 2006

About Terumo Blood and Cell Technologies

Terumo Blood and Cell Technologies is a medical technology company. The company’s products, software and services enable customers to collect and prepare blood and cells to help treat challenging diseases and conditions. Terumo Blood and Cell Technologies customers include blood centres, hospitals, therapeutic apheresis clinics, cell collection and processing organizations, researchers and private medical practices. The company’s customers are based in over 130 countries. Terumo Blood and Cell Technologies is a subsidiary of Terumo Corporation, a global leader in medical technology.

Learn more at: www.terumobct.com

About Africa Health Business

Africa Health Business (AHB) is a pan African boutique consulting firm, headquartered in Nairobi, Kenya, that aims to improve access to equitable healthcare in Africa. Our expert team provides clients with effective, evidence-based solutions for today’s complex healthcare challenges. Clients in government, the development space and the private sector rely on our research and advisory to inform and transform interactions with and use of healthcare systems.

Learn more: Our solutions

About AHBS- Africa Women’s Health: The Role of the Private Sector in Advancing Women’s Health in Africa

AHB curated the Africa Health Business Symposium (AHBS) under the theme: The role of the private sector in advancing women’s health in Africa with the objective to prioritise, explore and strengthen the role of the private sector in advancing women’s health on the continent.

Learn more at: www.africahealthbusiness.com