Operating framework for Safe blood for Africa using the Blood Safety Value Chain (BSVC)

Pete Zacharias

Chief Operations Officer

September 2015

The collection and availability of safe blood for all citizens is taken for granted in all developed countries.  Furthermore any programme, defined under Health Systems Strengthening (HSS) that is designed to uplift the skills of clinicians that require any surgical procedure, also assumes safe blood is available.  This assumption is especially so for international programmes to combat malaria which remains the biggest killer of children in Africa where a child dies every minute from malaria – but is a failed assumption.  In most cases, without safe blood for transfusions, these children will die due to acute anaemia caused by the parasite Plasmodium falciparum.  Blood Safety, therefore, is the foundation of the Health System!  Sadly, in Africa Blood Service are under resourced and developed.

Recognising this, the Safe Blood for Africa Foundation™ (SBFA) under the umbrella of Safe Blood International (SBI) is dedicated to the establishment of sustainable Blood Services according to the guidelines and recommendations of the World Health Organisation (WHO) for developing countries.  Our operational structure, based on the Blood Safety Value Chain (BSVC) (Figure 1), is a framework designed to demonstrate the connectedness between various components that are critical to making up a centrally coordinated National Blood Service (NBS) advocated by the WHO.  The Value Proposition is the safely transfused patient and all activities focus on achieving that value.  Irrespective of the country of operation, the model guides the coordination and project planning for Technical Assistance interventions in pursuit of the mission of SBFA to:

“Promote the health renewal of Africa through increased access to safe blood”

The model allows for the superimposition of a range of competencies and Blood Safety Performance Goals (PG)(Figure 1), which cover recognized areas of expertise and aspects, such as sustainability, Quality and Monitoring & Evaluation, training and infrastructure development, which are applicable to a number of accepted disciplines and competencies in Blood Safety.  It also provides for project coordination and definition of tasks as sub-chains (Figure 1) to show their interdependence.  As an example, the model shows very clearly

that there is little sense in ensuring large numbers of Voluntary Non-Remunerated Blood Donors (VNRBD) when phlebotomy skills are absent, cold chain management is inadequate, or indeed no attention has been paid to policy, leadership and a legal framework and human capital development.  If those working in Blood Safety understand this model, and their role in keeping the value proposition, the entire operation from the donor to patient will be more effective.  All operatives along the BSVC are dependent on each other.

This model then provides the basis for the organisation of the Safe Blood for Africa Foundation™ to regional teams with expertise covering the whole BSVC.  Our organisational model reflects this (Figure 2) demonstrating significant capacity serving the continent of Africa.

Using this organisational framework the Safe Blood for Africa Foundation™ (SBFA) provides expertise and Technical Assistance to guide and assist the National Blood Service of countries to develop the knowledge, skills and competencies to build a sustainable service supplying safe blood and blood components to all its citizens.  We rely on support and funding from national and international funding partners to achieve this.  Our role is to work within the policies and circumstances of any country to build fit-for-purpose and sustainable systems that are recognised and accredited by organisations such the Africa Society for Blood Transfusion (AfSBT) and the World Health Organisation.

Promoting the health renewal of Africa through increased access to Safe Blood