John Patton Pitman, CDC Atlanta, GA , USA will publicly defend his PhD thesis on Wednesday 16 September at the University of Groningen, NL.
Title of the thesis: ‘The infuence and impact of the President’s Emergency Plan for AIDS Relief (PEPFAR) on blood transfusion in Africa. Case studies from Namibia.’
The research was done in Namibia between 2010 and 2014 and was academically guided and supervised by Prof. Cees Th. Smit Sibinga (IQM Consulting and University of Groningen, NL).
This thesis explores, beyond Namibia, the premise that challenges of unsafe and inadequate blood supplies in sub-Saharan Africa can be addressed through timely and adequate investments in the core technical, procurement and leadership elements recommended by WHO to strengthen national blood transfusion services. To explore how the introduction of external aid to achieve these ends may also create sustainability challenges for recipient countries, ten broad assumptions were made –
- Developing or strengthening healthcare services, whether a blood service, malaria prevention intervention or an antiretroviral drug program, requires governments and external donors to understand program costs, appreciate how current and future demand will influence costs, and develop policies and plans to ensure consistent (and sufficient) funding and human resources.
- In the context of sub-Saharan Africa, financial and human resources for health are generally scarce.
- Financing for healthcare in sub-Saharan Africa is usually achieved through a combination of domestic and external funding sources – with external donors often creating subsidies that recipient countries are unable to fully absorb.
- Functional cost-recovery systems are rare in African blood services, but are a potentially powerful solution to financing challenges faced by blood services in low-resource settings.
- Technology can (and probably must) play a role in achieving Africa’s blood collection goals – but the costs associated with introducing and sustaining the use of such technologies should be carefully considered to avoid creating sustainability gaps.
- Changing patterns of disease will influence how much blood is needed by African countries, and how available blood stocks will be used.
- Blood and blood components are unevenly distributed globally and within individual countries (e.g., urban areas tend to benefit more from scarce blood stocks than rural areas).
- Effective data systems are an essential prerequisite to document and evaluate progress and gaps.
- Investments made in the name of preventing the spread of a single pathogen or disease (HIV/AIDS) can have positive ripple effects across a country’s broader healthcare system – but single disease programs may also divert funds from other pressing healthcare issues (e.g., maternal mortality).
- The concept of ‘sustainability’ is dependent not only on a stable source of funds, but on adequate human capacity, political will, data to drive evidence-based decision-making, ownership and leadership.
As Namibia has demonstrated, successfully putting together all of the pieces described above – ownership and leadership, consistent domestic funding, a deepening pool of well-trained staff, effective use of technology, and the embrace of quality management systems across every department – is possible in a middle-income country, even one facing substantial development challenges.
Global data paint a less rosy picture of progress on structural issues, but some progress is nonetheless evident in the GDBS tables. Lessons learned in Namibia may be useful for countries and external donors seeking to invest in blood safety or sustainable blood system strengthening activities, especially those reflecting the critical importance of strong human capacity, routinely collected and easily accessible data for decision-making, and a solid grasp of financial data.
It is John P. Pitman’s hope that continued progress in this critical area of health systems development will occur in an environment marked by greater emphasis on equity and a continued evolution of donors’ and recipient countries’ understanding of the meaning and implications of the terms “ownership” and “sustainability.”