Financing blood transfusion services in sub-Saharan Africa: a role for user fees?

The provision of a secure and safe blood supply has taken on new importance in sub-Saharan Africa with the onset of the AIDS epidemic. Blood transfusi on services capable of providing safe blood are not cheap, however, and the re has been some debate on the desirability and sustainability of different financing mechanisms for blood transfusion services. This paper examines p atterns of financing blood transfusion in three countries - Cote d'lvoire, Zimbabwe and Mozambique. It goes on to consider the conceptual options for financing safe blood, and to examine in detail the possible role of user fe es for blood transfusion in Africa, developing a simple model of their like ly burden to patients based on data from Cote d'lvoire. The model indicates that, at best, there can only be a limited role for use r fees in the financing of safe blood transfusion services, due mainly to t he relatively high cost of producing a unit of safe blood. Charging individ uals for the blood they receive is likely to be administratively complex an d costly, could realistically recover only a fraction of the production cos ts involved, and is further complicated by the fact that the main recipient s of blood transfusion in sub-Saharan Africa are children and pregnant wome n. If cost-recovery for safe blood is to be attempted, the most viable opti on appears to be that of charging a collective fee, levied upon all inpatie nts, not just on those who receive blood. Such a mechanism is not without p roblems, not least in its failure to offer incentives for more appropriate blood use, and it is still likely to recover only a portion of the costs of producing safe blood. Whether or not cost-recovery is instituted, there wi ll remain an important role for public funding of blood transfusion service s, and, by implication, an important role for foreign donor support.