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INVESTIGATION: How persistent blood shortages, poverty drive blood black-market in Nigeria

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The World Health Organisation (WHO) says Nigeria needs at least two million pints of blood annually, a far cry from the 25, 000 it currently generates.

Three months ago, a Federal Civil Servant residing in Abuja Louis Obafemi, was in search of blood for his wife who was due to have their baby in March.

Obafemi’s wife had received a list from the Government General Hospital Kubwa where she had registered for her antenatal care, containing items she was required to provide during delivery, including blood, which is standard procedure across major hospitals in Nigeria.

As an O positive blood type recipient, she could only receive blood from O positive and O negative donors, making her husband of the B positive blood type, ineligible to donate blood to her.

The fact that her O positive blood type tops the chart of donated blood in Nigeria should have made their search less challenging, but it did not. The situation compelled them to expand the scope of their search to include friends, and finally strangers.

“My fear was that I wanted to know the person that owns the blood before transfusion. I wasn’t just comfortable taking blood from someone I don’t know. I wanted to know the character of the person that owns the blood. It’s just my personal belief,” Obafemi told our reporter.

Through the help of a colleague who directed him to the Nigerian Red Cross, he was able to get a matching voluntary donor, and only had to pay N8,000 for blood screening and storage.

The story was different for an insurance staff Yetunde Afolabi, who underwent a myomectomy procedure in 2021 at a private health facility in Isolo, Lagos State.

Afolabi who has the B positive blood type, said she was asked provide two pints of blood before her surgery, which she admitted was sourced from the blood black-market at the cost of N25,000 per pint.

“I don’t have close family or relatives here in Lagos so I had to get it (the blood) through an agent. Altogether, I paid N50, 000 for two pints of blood,” she disclosed.

The need for blood is universal, but access to safe blood and safe blood products for all those who need it is not. Shortages of safe blood are particularly acute in many developing countries like Nigeria.

In the wake of the recent attack on a church in Owo, blood donors where sourced from various states to meet the demand of victims, after those donated by friends and relatives proved insufficient.

Head of Information and Advocacy for the Nigerian Red Cross in Owo Ibrahim Laide, confirmed to TNG that blood donations were received from Akure the Ondo state capital, as well as other states like Edo, Ekiti, Osun and Port-Harcourt, until the blood banks at the Federal Medical Centre and St. Louis Catholic Specialist Hospital Owo reached their maximum capacities.

“People donated from the University of Benin Teaching Hospital, University of Port-Harcourt then from Ayo Babalola University teaching Hospital too,” he told our reporter.

As the world mark the World Blood Donor Day today, the WHO used to opportunity to opportunity to thank voluntary, unpaid blood donors for their life-saving gifts of blood and also raise awareness on the need for safe blood and blood products to save more lives.

This year, the World Blood Donor Day slogan “Donating blood is an act of solidarity. Join the effort and save lives”, aims to draw attention to the roles that voluntary blood donations play in saving lives and enhancing solidarity within communities.

“We don’t sell blood” – Hospitals

Humans have 35 major groups or families of blood group antigens, as well as other minor groups, but to ensure that a transfusion recipient receives compatible blood, only two antigens are considered – the ABO (which has A, B, O, and AB categories) and RhD (which has negative and positive categories) groups.

A spokesperson in the Servicom unit of the National Hospital Abuja simply identified as Jacob said emphatically, that the hospital does not sell blood to patients, but that he is aware some patients enter into private arrangements with paid donors.

“We don’t sell blood, it’s not possible. If there is anyone who has a case where blood was sold to them at the hospital, they should let us know. I want to know.

“There are certain sensitive blood groups such as O positive that we may not get on time and patients would have to source for donors and pay them. So patients bring people to come and donate blood and they would give them money on their own. We’re not involved, we only ask them to pay for screening the blood,” he informed TNG.

Jacob added that before any procedure is carried out, patients usually sign a form consenting to donate any unused blood to anyone that requires it within the hospital.

Head of Laboratory at Nisa Premier Hospital Abuja Emmanuel Enejoh, explained that it is a world health standard practice to require patients to provide blood prior to a delivery or surgical procedure.

Here too, patients give consent that the blood supplied is non-refundable and where the blood is not transfused to the patient, it is used to cater to emergency situations that may arise.

“We have the emergency wing of our hospital. We have sickle-cell clinic. When these crisis or emergencies come up, we don’t ask these people to go and look for blood, provided we still have blood that are within the expiration date of 27-30 days.

“How do we refund screening please? So if I now buy Enzyme Linked Immuno-Sorbent Assay (ELISA) kit to screen blood for somebody, I will now return the screening fee back to the patient?” he queried.

Enejoh, further explained to our reporter that although, the hospital’s first line practice is to use relative donor, its sometimes recruits paid donors for patients who do not have and charges only a screening fee afterwards.

“If you don’t have your donor, that is where the remunerated donor comes in. Some of them will tell you they don’t even want to know these people. In this part of our world, because of the level of poverty, people have not woken up to the reality that you should come and donate blood free.

“Once we recruit a donor for a patient, we allow them reach an agreement on pricing. We don’t charge patients any fee outside screening fee,” he stressed.

However, corroborating Afolabi’s claim about the blood black-market, Operations Manager at Haima Health Initiative Ayobami Bakare, during an interview with our reporter, disclosed that Nigeria has an active blood black-market which charges very exorbitant fees.

“At Haima Health Initiative, we organise blood drive for the NBSC (National Blood Service Commission) and we screen those blood and issue them out at N6, 000. Where the discrepancies come from is that there are a lot of private blood banks, especially in Lagos and Abuja, where people pay donors to get blood.

“There is also an active blood black-market in Nigeria which is very exorbitant. The price of a negative blood can cost between N25, 000 – N30, 000, depending on the location (Abuja or Lagos). So they just extort patients because of the deficit. At every point in time, Nigeria needs between 1.8 million to 2 million pints of blood,” Bakare said.

Inability to fractionate whole blood still a major challenge – Commission

The National Blood Service Commission is in charge of coordinating, regulating and ensuring the provision of safe, quality blood transfusion services in Nigeria.

Nigeria established a national blood transfusion policy through a published set of guidelines in December 2006, essentially made up of sets of action plans geared toward the provision of safe, available, and affordable blood donor units, where and when they might be needed in the country through.

The policy guideline provides five main structures – the National Blood Service Commission (formerly called the national blood transfusion service), the zonal blood service centers, state and local government areas blood service centers, the armed forces blood service, as well as private and other nongovernmental health establishments – to ensure universal coverage of the country, right to local government councils.

The Commission has disclosed that most hospitals in Nigeria transfuse whole blood to patients even when only specific components of the blood is required because the equipment for blood fractionation are expensive and not readily available.

Technical Assistant to the Director-General of the NBSC Uneku Offor, disclosed this during an interview with our reporter as a major challenge the commission is working to surmount in the near furture.

Offor revealed that only eight percent of Nigeria’s population donate blood voluntarily, the most of which come from relatives and that the Commission has rolled out an initiative that targets to grow voluntary blood donation from 25, 000 per annum to one million, as part of its 10-year strategic plan launched last year.

An individual can only donate blood a maximum of three times a year and in Nigeria, the highest voluntary blood donor is Benjamin Aghoro, who as at May 2022 has donated 106 pints of blood.

“There should be a reserve such that when such emergencies, mass casualties are encountered, such as the Owo church attack, we can easily mobilise those units of blood to the area that they may need it. That is what the one million safe blood units’ initiative is all about.

“Through the one million safe blood units’ initiative, we will start diversifying into components like red blood concentrates and the plasma, once we get a substantial amount of donated blood.

“Because the equipment used for this fractionation is not readily available and is really expensive, most hospitals, especially in Nigeria just give whole blood, whether the person has need for whole blood or not,” Offor said.

She further stated that some of the 11 state centres of the NBSC already have component platelet machines through which they are able to extract just the platelet concentrate and distribute to those that need them per time.

The NBCS has six zonal centres which in addition to the 11 state centres make a total of 17 centres across the country.

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