Rwanda

Funding and staff gaps stall progress: BTD is reliant on Global Fund for a majority of its budget, has limited clinical training and clinical guidelines for health care workers, and limited number of staff in transfusing facilities.

Lack of coordination within Blood Transfusion Department (BTD), Blood centers and transfusing facilities. This leads to limited oversight resulting in difficulties in enforcing clinical and data protocols.

The System is centralized but there has not been a standardized adoption of roles and responsibilities to its regional offices.

BTD's organizational structure changed with Zipline and centralization, but there hasn't been standardized adoption of new responsibilities/roles.

Hemovigilance at the facility level is nascent, as clinical guidelines have not been updated since 2018.

Adverse transfusion reactions are not reported to BTD possibly because of a lack of knowledge on identification, treatment, and reporting standards.

The national inventory management system does not allow unit traceability from donor to patients through one platform and is a combination of electronic (at central facilities) and paper registrars (at facility level)

Data collection is a combination of electronic (central facilities) and paper at the facility level.​

Knowledge at the provider level varies resulting in inappropriate use of blood. As a result, there are lower stocks of certain blood types (e.g., O+ and O), wastage of blood and reagents, cross-matching issues, and shortages.

Blood supply is not always able to meet demand: in addition to inappropriate use, there is a limited blood supply and donor pool of Rh-negative blood, occasionally resulting in stockouts and limited availability for emergency use.​