BERLIN, Germany — In emergency situations, a blood transfusion is often the only way to save a patient’s life. The lack of an adequate blood supply is one of the greatest global challenges facing health care systems in low-income countries. Due to rising demand, the situation is expected to become even more critical. A study published in Lancet Haematology notes that 10 to 20 blood donations per 1,000 residents are needed to meet global demand.

Modern technological solutions can overcome infrastructure barriers and reduce costs by ensuring blood transfusion security in affected areas during times of crisis. The mobile-based platform known as the Blood Information System for Crisis Intervention and Management (BISKIT) aims to ensure the quality of blood donations and optimize supply chains to strengthen the region’s blood supply.

Blood Transfusion Security in Africa

Countries with a high number of people living in extreme poverty are disproportionately affected by rising demand and the resulting supply shortages. Young children and pregnant women in sub-Saharan Africa, in particular, are driving up mortality rates, which also leads to high health care costs at the national level. The quantity of blood donations collected in Africa falls far short of the estimated need. The World Health Organization (WHO) recorded a median of only about five donations per 1,000 people in low-income countries, compared with 31.5 per 1,000 in high-income countries.

The sub-Saharan region accounts for the highest number of maternal and child deaths worldwide. WHO estimates that approximately 178,000 mothers and one million newborns die in Africa each year; the region accounts for 70% of global maternal deaths. Patients in the region predominantly suffer from severe anemia or perinatal hemorrhage—that is, heavy bleeding during childbirth. In most cases, children and women were unable to receive the life-saving treatment due to a lack of proper blood transfusion security.

“Blood Desert”

Blood, as a medical supply, is subject to very strict requirements. As living tissue, some of its components—such as granulocytes or platelets—can only be stored outside the body for a few days and only at constant temperatures. Even a slight change in temperature can cause transported blood to become unusable.

In addition, blood donations require strict testing and safety measures that are costly. However, there is a lack of suitable cold-chain logistics in the region. Processing blood into its components—such as concentrating red blood cells—also significantly increases the success rate in treating critically ill patients, yet the necessary medical infrastructure with the appropriate equipment is missing.

Sub-Saharan Africa suffers disproportionately from what is known as a “blood desert”—predominantly rural areas without blood banks and with inadequate road infrastructure, where blood supply cannot be guaranteed due to a lack of timely and affordable access.

An analysis published in the American Journal of Clinical Pathology found that only 380 accredited laboratories in sub-Saharan Africa met international standards. Thirty-seven of the region’s 49 countries had no laboratories accredited to international quality standards. Furthermore, 91% of the laboratories were concentrated in South Africa.

Decentralized Donation Systems

Diseases such as human immunodeficiency syndrome (HIV), hepatitis and syphilis are widespread in sub-Saharan Africa, as two-thirds of the world’s people living with HIV reside in this region. As the blood donation system is largely decentralized—meaning that donations are often collected by family members at local hospitals—the risk of transfusion-transmitted infections is higher.

A meta-analysis by the University of Ghana found that approximately 10% of blood units collected in sub-Saharan Africa carry the risk of a transfusion-transmitted infection. Based on data from 45 countries south of the Sahara, scientists using WHO data have calculated that the median overall risk of HIV infection is one per 1,000 units, 4.3 for the hepatitis B virus and 2.5 for the hepatitis C virus.

Cost-Effective Blood Transfusion Security

To manage and monitor the blood supply quickly and cost-effectively, eHealth Africa, in collaboration with the Paul-Ehrlich-Institut, has developed a blood supply system that enables health care professionals in sub-Saharan Africa to collect, manage and access reliable data on donors.

BISKIT operates on the following basis:

  • End-to-End Tracking: Monitoring blood collection, laboratory testing, transport, storage temperature and final delivery.
  • Geographic Information System (GIS): Tracking and mapping the location and movement of blood bags, donor locations, mobile reserves across regions, transit routes, regional blood banks and hospital demands.
  • Cloud and Mobile Databases: Centralized, accessible data on donors, real-time inventory records, and blood collection volumes, types, components and screening data.
  • Supply Chain Simulation Models: A discrete-event simulation predicts shortages by combining geographic data with donor behavior.

In 2025, 6,000 donor records were digitized using the BISKIT workflow, and an additional 5,300 individuals were certified as eligible to donate. This enabled medical professionals to track more than 500 successful blood transfusions. In addition, BISKIT is capable of automatically matching blood types, which increases the chances of successful transfusions in crisis and emergency situations.

Outlook

In sub-Saharan Africa, BISKIT has the potential to establish a resilient blood supply chain for emergency situations. Funded by Germany’s Federal Ministry of Education and Research, the BISKIT consortium—coordinated by the Paul-Ehrlich-Institut—has piloted the system in South Africa, and eHealth Africa is implementing it in Nigeria, at Aminu Kano Teaching Hospital in Kano. However, significant constraints on health care budgets are hindering the rollout and optimization of these systems. In the future, organizations will rely extensively on foreign aid and support to train health care workers and optimize workflows for better blood transfusion security.

– Oliwia Kowalak

Oliwia is based in Berlin, Germany and focuses on Technology and Solutions for The Borgen Project.

Photo: Flickr