Govt blamed for blood supply crisis

Swaziland's national blood bank is on the brink of collapse following the government's failure to honour a partnership agreement with the International Committee of the Red Cross (ICRC), the Switzerland-based organisation has warned. "This couldn't happen at a worse time, with the AIDS crisis, which requires extremely vigilant monitoring of the blood supply for use in surgery and in emergency trauma situations," Sive Mdluli, a blood donor recruiter with the Swaziland chapter of the ICRC, known as the Baphalali Red Cross, told PlusNews. Sources with the ICRC told PlusNews that the organisation might have to pull out of the country because the government had not honoured a funding agreement. The Baphalali Red Cross collects 80 percent of Swaziland's blood supply. The Ministry of Health's blood collection service accounts for the remaining 20 percent. The Red Cross and the Swazi government signed an agreement in 1999 to combine their collection services into a single organisation, to be funded by the Swaziland government, with donor aid. An evaluation by David Mverel of the Blood Transfusion Service in Harare, Zimbabwe, had showed the economic and logistic benefits if Swaziland's two blood collection "teams" merged. Enabling legislation was supposed to have been drafted by the health ministry to establish the new unit, and release funding from the ministry's annual budget. In the four years since the agreement was struck between the Baphalali Red Cross and the government, no such legislation has been proposed by the health ministry. In keeping with the timetable of the agreement, the ICRC withdrew funding from its Swaziland branch's blood collection unit. By now, funding for the new blood collection service should have come from other international donor organisations assisting the Swazi government, but a lack of enabling legislation stands in the way of their financial support. A building to house a new Blood Transfusion Unit has been constructed in the central town of Manzini, 40 km east of the capital Mbabane, but remains unused. The Ministry of Health would not comment on when blood policy legislation would be promulgated. Swaziland currently has no health minister. Even if the new health minister, who has yet to be appointed by King Mswati, tables legislation in parliament as a priority, the newly-elected MPs would not be able to consider any legislation before March 2004. By then it might be too late. "We have no money to operate at all. Last year the National Emergency Response Committee on HIV-AIDS (NERCHA) carried us, but that money ran out in July. Since then we've survived by dipping into [our] national organisation's coffers - but we may have to shut down at any time," said Mdluli. Sources told PlusNews that Baphalali Red Cross director Kanya Mabuza and officials from NERCHA met with health ministry officials to press the government to fulfil its obligations, but to no avail. If the Red Cross withdraws, Swaziland will lose 80 percent of its blood collection capacity. In an interview with PlusNews, Dr Martin Weber of the International Cooperation Unit of the ICRC in Bern, Switzerland, said: "Historically, when the Red Cross withdraws from a country, the blood system in that country collapses. The issue of blood safety is paramount, because blood supplies have to meet international blood protocols. That is why blood is always associated with the Red Cross. Weber questioned the ability of the Swaziland government to meet 100 percent of the country's blood requirements, up from its current quota of 20 percent. "When it comes to the safety and security of blood, I have very great doubts. Donations would be down to 20 percent, and of the contributions that are now given in Swaziland, 50 percent are HIV-positive. The net supply of blood would then be 10 percent. Also, it is impossible to build up service from zero quickly. It takes years to build up a programme," he said. Health workers said if blood supplies dried up, there would be a dramatic humanitarian impact, with transfusions unavailable and surgical procedures threatened. Already, surgeons are being advised to eliminate the use of blood in some procedures. "There is also a matter of trust. Swazis don't like to donate blood, period. But when they do, they want to give to the Red Cross," said Mdluli. "They don't trust the government system." Weber praised Mdluli's team for enticing reluctant Swazis to donate blood. "It's to the credit of Sive's team that they get people to donate," he said. Pro-democracy activists have blamed the shortcomings of the monarchical system for the crisis. "This king appoints cabinet ministers to carry out palace policies. Under this system, a situation like a blood shortage gets neglected because there is pressure on ministers to spend money on other things the palace wants. There's no one to say, 'Your Majesty, the people need blood, not a new set of limousines for your family'," Samuel Lushaba, a member of the opposition Swaziland Democratic Alliance, said.