Challenges for developing sustainable blood transfusion services in the Caribbean

Abstract

Blood transfusion services are an essential part of healthcare. Timely availability of sufficient safe blood is a major problem in developing countries. Not surprisingly therefore that the Caribbean region faces stiff challenges in achieving a sustainable blood transfusion program. Several key issues requiring immediate attention can be delineated varying from effective donor programs, infrastructure to adequate legislation and protocols. Donor programs relying mainly (and in some countries even exclusively) on replacement donors are widely spread among most of the countries in the region. Although achieving complete donor program coverage by non-remunerated voluntary donors in the region seem still far away, some countries like Curacao and Aruba have shown such a program to be feasible. With support of external agencies like the PAHO, WHO and AABB several important reference and training documents have been developed in support of the regional programs like the Caribbean Regional Standards for Blood Banks and Transfusion services. A regional plan of action by the PAHO for 2006-2010 has also substantially contributed in further developing the transfusion services in the region. Furthermore this effort has also resulted in a unique compilation of relevant data regarding blood transfusion services for each country in the region. After evaluation of these data it seems clear that self-sufficiency remains a problem in most of the region. The lack of legislation and establishment of quality systems are other areas needing attention. Regarding human resources a distinct effort should be made to implement continuous education programs as indicated by the Regional Standards. Finally special attention should be given to the introduction of Haemovigilance programs to ensure proper data registration and improve patient safety. Notwithstanding some specific regional characteristics broadening of governmental support remains a key requirement for the region. The proposed inclusion of blood/ blood products in the WHO model list of essential medicines should serve to further accentuate the importance of a sustainable blood program and ensure necessary support. It seems also clear that next to improved national organization, commitment and allocated resources the Caribbean region should further explore the possibilities of horizontal collaboration between existing countries in order to pool resources and infrastructure and reach critical volume and expertise for blood transfusion services. Furthermore educational and training programs and costly testing for transfusion transmitted infectious agents could very well be centralized in order to further gain quality and cost-effectiveness.