Proposed reforms to the blood transfusion sector in South African

 

In our earlier discussion on the activities of the blood banks in South Africa, it was clearly noted that while local blood banks have managed to generally acquire sufficient blood from donors to meet local requirements, several vexing problems have started to show that they require resolving with ever greater urgency. In particular, there have been indications that in future, there may be mounting difficulties in the collection of blood from new donors due to the negative effects imposed by the HIV epidemic on the blood banks in their recruitment activities, with new approaches to the acquisition of blood having to be considered. In this section, we examine ways in which blood supply could be increased in this country, with the discussion first looking at possible reforms to the altruistic systems already in place before moving on to look at the value of commercial blood donation in South Africa. 

The value of the newly organised SANBS in improving the operational efficiency of the blood banking system in South Africa has still to be fully determined. While supporters of this new system may be correct in assessing that costs could be decreased through the sharing of expertise and technical resources, as well as through the development of economies of scale, there are also some possible drawbacks to this system. First, each of the three largest regional blood services will continue to operate, to a large degree, independently of one another, which means that the problems they each had when they were individual organisations will continue to exist when they work in their new form [1]. Second, there is no guarantee that the formation of this new super blood bank will necessarily increase the volume of blood collected in South Africa, as there will still be no competition amongst the blood banks to ensure that collections of blood and the allocation of resources maximised. This is since these blood banks will continue to not only retain the monopoly on blood collection in their own area, but will possibly have even less of an incentive than before to collect blood from donors in a more efficient manner as they will know that their right to access the blood supplies of other regional services is now greater than it was before [2]. 

The increased use of autologous transfusion systems and other blood recycling mechanisms should be encouraged further, for while some of these systems are currently available in this country, they are still not used as frequently as they could be [3]. While this lack of use is partly because there may be a lack of knowledge as to their medical value, another factor could be that since blood is not priced according to its real social value, hospitals may find that using donated blood, which has an artificially low private price, is cheaper than using systems that really indicate all relevant social and private costs associated with their use. If blood was to be properly traded and priced, then we could expect to see a greater demand for these alternatives, as they would appear far more cost-effective and convenient than they do at present. Greater use of substitute blood products should also be encouraged as a means of allowing for the pressure imposed on the national blood banks to be relaxed when dealing with the problem of acquiring large volumes of safe blood for transfusion. Here, one positive measure was taken in April 2001, when the Medicines Control Council, the regulatory agency that licenses the use of pharmaceutical products in South Africa, granted approval for the use of a previously examined haemoglobin substitute, Hemopure, as a blood substitute [4]. With this, South Africa became the first country in the world to allow this product to be used on human patients during normal medical activities. 

One extremely important requirement is that significantly more attention should be placed on recruiting black donors, as the quantity of blood collected from black South Africans is minimal even though they have the potential to constitute the majority of the donor pool in this country. Here though, it might be appropriate to utilise a different strategy in the marketing of blood donation to members of this population group, especially to younger individuals, who have the best prospects of becoming repeat blood donors. Rather than concentrate primarily on the medical and moral aspects of blood donation, where people are informed of how their righteous gift of blood can help others, consideration should also be given to explaining the social benefits that could be offered to blood donors. For example, being a blood donor could be described as being an opportunity for young people to make a new circle of friends that would otherwise not exist. It might also be worthwhile to consider linking the blood services more intimately with anti-HIV campaigns, given the dependence of the blood banks on safe blood – becoming a blood donor might be encouraged as being a way for people to assume responsibility for themselves (and others), and thereby avoid engaging in activities that could compromise their health.

If a lack of knowledge is seen to be the problem with collecting greater quantities of blood from non-whites, then more effort may be need to be spent in order provide information and clarity on this type of activity. For example, articles could be commissioned to appear in publications with a mass black readership, such as Drum or Bona magazines (or even The Sowetan newspaper). While campaigns showing the actual drawing of blood have appeared on TV before, one strategy that has probably not been carried out, except in documentaries, is to include a review on blood donation in the script of a television series. In South Africa, a couple of television shows that discuss general health issues in a melodramatic manner are regularly aired on national television. Of these, the best known has been Soul City, which is a highly popular soap opera that receives some degree of support from the Department of Health as its central theme concerns HIV. While it would be impossible to introduce a soap opera with blood donation as its central theme, it may, however, be possible to include details relating to the importance of blood in television shows such as Soul City, in the hope that these shows could inform the public of the importance of this activity. Black role models could also be recruited as possible donors in order to demonstrate to the public that donation is a safe activity that is worth undertaking. In particular, celebrities who are likely to inspire the youth, such as entertainers and beauty queens, could be recruited as the public image of the blood service, with those celebrities who donate blood regularly (rather than in once-off public displays) being especially valuable as they can demonstrate that there are no negative long-term effects from donation.

Commercial blood donation should also be considered for introduction in South Africa as a means of both increasing the national supply of blood and as a method of earning income from foreign states. While South Africa has aspirations of becoming a developed first world country, if we are to review the socio-economic evidence that is available, it would not be difficult to see that to all intents and purposes, this country remains largely a developing state. While the current unpaid system is ideal for most local blood donors, who come from relatively well off backgrounds, to the majority of the population, who are poor, it may be deemed irrelevant, as they might be more likely to express a preference for giving blood only if they were to be paid to do so. Thus, there can be no doubt that commercial blood donation could be used in this country, where wealthier people would remain under the current unpaid system of free giving, while poorer people could be registered as paid donors.

Given that the mechanisms and potential problems that could face a commercial blood service were examined in the previous section, there would be no use in repeating how these issues could affect the formation of such a service in South Africa. The only important point worth mentioning is that even if no effort is made to collect whole blood from paid donors, the collection of plasma for commercial processing may prove to be a highly lucrative business. This is because although the demand for products derived from this blood component have increased substantially in recent years, supply has not increased by as fast a rate, with supply problems likely to be exacerbated further in future if more countries join the UK in destroying all their domestically acquired plasma due to fears of infection with CJD. Under such circumstances, countries that do not have such fears of CJD infection could benefit quite significantly from the provision of plasma products to those wealthy states that have concerns over their domestic blood donors.

In summary, it has been clearly shown that commercial blood donation is a feasible proposition that could significantly increase the amount of blood collected without seriously compromising the health of recipients. In addition to being able to provide safe blood, commercial blood banks can also provide blood efficiently compared to altruistic blood banks, which is highly desirable as this can reduce some of the negative economic effects associated with “free” blood.