Facilitators and barriers to blood and blood product accessibility and use in sub-Saharan Africa: a systematic review

Abstract

BACKGROUND: Access to safe blood and blood products is a global health priority, requiring concerted public health efforts to ensure universal access to reduce the global disease burden. However, there are inequities in access to safe and adequate blood and blood products in sub-Saharan Africa (SSA), leading to marked challenges in meeting the clinical needs of patients with diverse pathologies. This study used the WHO health system building blocks to systematically synthesize the literature to understand the barriers to blood and blood product usage in SSA. METHODS: We used the PRISMA guideline to systematically search relevant articles using six electronic databases: Web of Science, MEDLINE, PubMed, PscyInfo, Google Scholar, and Global Health databases between 2005 and 2023. The risk of bias for included studies was assessed using a modified Joanna Briggs Checklist. Inductive thematic analysis was performed to thematize the extracted data based on the WHO health system building blocks. RESULTS: Sixty-five studies representing eighteen countries in SSA were included for review. Barriers included transfusion delays, low transfusion rates, inappropriate practices, untimely referrals, blood stock-outs, poor adherence to guidelines, lack of standardized protocols, poor transfusion management systems, poor leadership/governance, and health workforce shortages. Facilitators included drone technology use, prompt referrals, appropriate transfusions, availability of skilled workforce, health information systems, and effective leadership and governance. CONCLUSIONS: Numerous barriers to blood and blood product access in SSA exist. Addressing service delivery barriers such as transfusion delays, product stock-outs, and ineffective governance of transfusion systems would be vital. Further, innovative technology, boosting referral systems, and practicing appropriate use of blood would engender sustainable access to safe blood services in SSA. Innovations such as the successful deployment of drone technology in Rwanda are worth emulating and scaling across the continent. Also, financing and effective leadership should be further researched as potential facilitators of safe blood accessibility and use in Africa. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD42023434335.