Somewhere in Africa tonight, a young mother is haemorrhaging after childbirth. The blood she needs may not be available. Whether she survives may depend not on the skill of the doctors around her, but on whether a stranger donated blood last week, whether the cold storage held overnight, whether the right type was screened and stored and ready. In too many hospitals across this continent, that chain breaks.
Every day, the same story repeats itself with different faces. Children weakened by severe malaria-related anaemia. Road accident survivors in emergency rooms. Cancer patients mid-treatment. People living with sickle cell disease managing a chronic, life-threatening condition. For all of them, the availability of safe, compatible blood is not a clinical detail. It is the difference between life and death.
Africa accounts for a disproportionate share of the world’s transfusion needs, however it consistently falls short of the supply required to meet them. The World Health Organization recommends that countries collect blood donations equivalent to at least one percent of their population annually to meet basic needs. [1] Most African countries remain well below that threshold. According to the WHO, sub-Saharan Africa collects roughly 5 donations per 1,000 people, compared to over 30 per 1,000 in high-income countries a gap that translates, every day, into preventable deaths. [2]
Where blood is available, questions of quality and safety persist. Cold chain failures, inadequate screening, and fragmented logistics mean that even when blood exists, it does not always reach the patient safely or on time. In many settings, patients’ families are still expected to find replacement donors themselves- an informal, unreliable system that places the burden of a structural failure onto grieving and frightened individuals.
The shortage is not, at its core, a matter of unwillingness. Many Africans would donate blood if asked in the right way, in the right setting, with the right information. The barrier is often misinformation. Widespread beliefs persist that donating blood causes permanent weakness, that donated blood is sold for profit, or that the process itself is unsafe. These are not fringe fears, they are deeply held community convictions that no single awareness campaign can dislodge.
Even where donor recruitment succeeds, the infrastructure required to turn a donation into a safe, usable product often does not exist. Blood must be screened for transfusion-transmissible infections including HIV, hepatitis B and C, and
syphilis. It must be stored at precise temperatures, typed and cross-matched, and administered correctly. Each step requires investment, training, and systems that are too often absent, underfunded, or unreliable.
The challenge is real, but it is not insurmountable. Several African countries have demonstrated what is possible when governments make blood systems a genuine priority. Rwanda has built a centralised, nationally coordinated blood service that has dramatically improved both supply and safety within a decade, working through community-based donor clubs and consistent public education. [3] [4] South Africa maintains one of the continent’s most sophisticated blood systems through its South African National Blood Service (SANBS) and has succeeded in transitioning to voluntary non-remunerated blood donation (VNRBD) models, in line with WHO recommendations. [3] These are not outliers made possible by exceptional resources. They are proof of concept. The knowledge is there. The models are there. What has been missing, in too many countries, is the political will and the coordinated investment to replicate them.
This is the challenge that the Coalition of Blood for Africa (CoBA) was established to help address in partnership with governments, civil society, and the broader health community. CoBA is the first private health sector-driven platform dedicated to advocating for safe and sustainable blood systems across the continent. It brings together stakeholders from across the blood ecosystem from donation and collection through to testing, processing, storage, and transfusion united by the belief that the private sector has a meaningful and complementary role to play alongside public institutions and community organisations in building the systems Africa needs.
Since its founding, CoBA has been encouraged by early progress made in collaboration with its partners: reaching over 100,000 people through advocacy and digital awareness campaigns, supporting partners through the collection of more than 11,500 pints of blood across multiple countries, and facilitating structured conversations on blood safety with over 100 young people. CoBA has also had the privilege of engaging with continental health institutions, including the Africa CDC and WHO, to ensure that Africa’s blood challenges remain visible on the broader health agenda.
These are meaningful early steps in what is understood to be a long journey. CoBA’s central conviction is that blood systems are health infrastructure deserving of the same sustained, strategic investment that African nations and their partners have rightly directed toward roads, electricity, and digital connectivity. Strengthening these systems is not a niche concern. It is a foundation upon which so much else in healthcare depends, and one that presents a genuine opportunity for collaborative action at every level.
Three things are needed, and they are not complicated to name, even if they are difficult to deliver.
Investment: National blood programmes deserve to be funded as core health infrastructure, recognition that reflects their true place within a functioning health system. This means working toward sustained, predictable government budget lines that allow for long-term planning and system building. International partners and donor organisations have played a valuable role in advancing blood safety across the continent, and that partnership remains important. The opportunity now is to complement that support with domestic financing commitments that endure beyond individual project cycles creating the stability that any critical health system requires to grow and be maintained.
Policy: Every African country should have a national blood policy with clear targets, accountability mechanisms, and cross-sector coordination. Where such policies exist on paper, implementation must follow. Where they do not exist, there is an opportunity to develop them with urgency and ambition. Beyond the national level, there is a compelling case for regional bodies such as the East African Community, ECOWAS, and the Southern African Development Community to develop harmonised frameworks that enable cross-border collaboration on blood supply, shared standards, and collective procurement, building on the cooperative spirit that already exists within these institutions. At the continental level, the African Union and Africa CDC are uniquely positioned to set a shared agenda, establishing benchmarks, tracking progress across member states, and ensuring that blood system strengthening finds its rightful place within the broader continental health vision embodied in the Africa Health Strategy and Agenda 2063.
Community trust: No blood system works without voluntary donors, and no voluntary donor base is built without sustained, honest, community-rooted communication. This work is often quieter than the policy conversations that surround it, and less visible than the infrastructure it supports. Yet it is equally foundational. Investing in community engagement , in the educators, health workers, and local champions who build trust one conversation at a time is not a soft complement to the technical work of blood system strengthening. It is the work itself.
Africa’s patients cannot wait for a more convenient moment. The mothers, the children, the accident survivors arriving at hospitals across the continent today need safe blood now. The continent has the knowledge and, increasingly, the institutions to close this gap. What it needs is the collective decision to treat blood supply as the emergency it is and to invest accordingly, before another preventable death becomes another quiet statistic.
[1] | World Health Organization, “Global database on blood safety summary report,” 2009. |
[2] | World Health Organization, “Blood safety and availability,” May 2025. |
[3] | E. I. Obeagu, “Blood transfusion practices in Africa: advances, barriers, and ways of overcoming the barriers |
[4] | R. B. Centre, “Intwari club 25: Donating blood to save more lives,” 2023. [Online]. |
