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  • Title: Feasibility of hospital-based blood banking: a Tanzanian case study.
    Author: Jacobs B, Mercer A.
    Journal: Health Policy Plan; 1999 Dec; 14(4):354-62. PubMed ID: 10787651.
    Abstract:
    The demand for blood transfusion is high in sub-Saharan Africa because of the high prevalence of anaemia and pregnancy related complications, but the practice is estimated to account for 10% of HIV infections in some regions. The main response to this problem by the international donor community is to establish vertically implemented blood transfusion services producing suitable (safe) blood at a cost of US$25-40 per unit. However, the economic sustainability of such interventions is questionable and it is argued here that hospital-based blood transfusion services operating at a basic adequate level are sufficient for low-income African countries. The results of a project aimed at improving such services in Tanzania are presented. The main findings are: (1) the cost per suitable blood unit produced was US$12.4; (2) at an HIV test sensitivity of 93.5% during the study period, discounted financial benefits of the interventions exceeded costs by a factor of between 17.2 and 37.1; (3) the cost per undiscounted year of life saved by use of these interventions was US$2.7-2.8; and (4) safe blood transfusion practices can be assured at an annual cost of US$0.07 per capita. Recommendations are made to ensure safe blood transfusion practices at hospital-based blood banks in Tanzania. The demand for blood transfusion was high in sub-Saharan Africa because of the high prevalence rate of anemia and pregnancy related complications, but the practice was estimated to account for 10% of HIV infections in some regions. The most common response by the international donor community to the problem was to establish vertically implemented blood transfusion producing suitable safe blood units at a cost of US$25-40/unit. This paper presents an economic evaluation of the feasibility of a hospital-based blood banking in Tanzania. The project on which this study was based started in 1992 in Mwanza region with the aim of implementing the interventions required to assure safe blood-transfusion practices, as formulated by the Tanzanian Ministry of Health. The main findings of this study include: 1) the cost per suitable blood unit produced was US$12.4; 2) at an HIV test sensitivity of 93.5% during the study period, discounted financial benefits of the interventions exceeded costs by a factor of between 17.2 and 37.1; 3) the cost per undiscounted year of life saved by use of these interventions was US$2.7-2.8; and 4) safe blood transfusion practices can be assured at an annual cost of US$0.07 per capita. For a low-income country like Tanzania, provision of safe blood transfusion services through a hospital-based banking system was a feasible horizontal alternative to the more costly vertical approach.
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