Liberia

Liberia Blood System Overview

The Liberia National Blood Safety Program (NBSP) was established in 2008 through the Clinton Health Access Initiative and National AIDS Coordinating Program partnership to oversee safe blood delivery throughout the country and support the transition to 100% voluntary, non-paid blood donations (VNPD). Liberia currently has two parallel blood systems that manage blood donation processes; however, both have been unable to meet national demand for safe blood:

1. A VNPD-based system run by the NBSP. The NBSP-coordinated system ideally should collect, screen, and distribute blood and products exclusively from VNPD through its regional blood centers (RBCs) to health facilities. Currently only two RBCs exist (located in Montserrado and Bong counties) and are intended to serve the needs of six counties. However, RBCs are unable to meet blood demand due to resource constraints and insufficient supply of VNPD. Compared to hospital-based blood banks (HBBs), RBCs have collected a small amount of blood—a maximum of about 1600 units since 2017 which accounts for only 4% of national blood needs.

2. A fragmented facility-based system reliant on family replacement and paid blood donors operated by HBBs. The HBB-based system emerged in the absence of a centralized system and collects nearly 100% of blood in-country compared to RBCs. HBBs are part of laboratories overseen by the National Diagnostic Division. This system relies on facility-based “just in time” collections. As a result, it also is unable to provide a consistent source of blood supply and is at a higher risk for safety concerns attributed to limited training and capacity of workers, as well as fragmented quality and availability of consumables.

Identified Challenges of Focus

When the HSS Accelerator began working with the NBSP in 2022, the following challenges were identified:

Coordination: Coordination across key actors and programs in the country should be strengthened
Policies & Regulations: National policies & regulations should be established
Funding: Significant funding gaps should be filled, where the NBSP had an annual operating budget of only $50k
Human Resources: Human resource gaps at the central and facility-level due to staffing and skill shortages should be addressed
Infrastructure & Supplies: The quality and availability of necessary infrastructure, equipment and supplies in blood centers and facilities should be improved to strengthen the system’s physical operations
Quality Concerns: Relevant policies, SOPs, and guidelines as well as training and monitoring to ensure quality throughout the value chain should be implemented
Tracking & Indicators: Blood and blood products indicators should be integrated within the national DHIS system to allow for data to be used for decision-making
Donor Mobilization: Stigma and limited awareness and donor mobilization should be addressed to improve insufficient and unsuccessful donation practices

Key Successes Through HSSA

The HSS Accelerator has been working with the NBSP to achieve several key successes to-date:

Coordination: Launched the country’s first Safe Blood TWG in 2023 to coordinate program priorities with government and development partners; the TWG meets quarterly
Policies & Regulations: For the first time, MOH approved a National Blood Service Policy and Strategic Plan, and included blood transfusion services in the national Standard Treatment Guidelines and Essential Package for Health Services
Funding: Mobilized additional resources through World Bank/GFF and USAID Mission bringing NBSP’s operating budget from $50k in 2022 to over $500k in 2024 (with additional opportunities in the pipeline); also ensured safe blood needs were included in annual county health budgets for the upcoming fiscal year for the first time
Human Resources: Routinized weekly NBSP staff meetings for the first time and capacitated NBSP with essential office supplies (e.g., laptops and internet)
Infrastructure & Supplies: Procured immediate operational needs to run the central blood bank and implement blood drives
Quality Concerns: Consolidated fragmented blood donor drive SOPs into a user-friendly toolkit for the first time
Donor Mobilization: Through 2 USAID-sponsored blood drives, NBSP acquired 163 units of blood from December 2023 – January 2024, surpassing its 2022 annual collection in just 1 month!

... Over the next 5-10 years, NBSP aims to expand its operations throughout Liberia and increase VNPD to transition Liberia towards achieving WHO’s recommendation for 100% VNPD.

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