Botswana’s blood transfusion services are facing significant operational and structural challenges that require urgent reforms. This is according to the World Health Organization (WHO) Botswana Country Office Biennial Report 2024-2025.
The report highlights weaknesses ranging from fragmented coordination and outdated equipment to shortages of essential supplies, limited data systems and gaps in quality assurance – issues that could affect the country’s ability to provide safe and timely blood products to patients.
The WHO assessment found that Botswana’s National Blood Policy, introduced in 2018, remains in draft form and lacks a supporting strategic implementation plan.
It also noted the absence of a national advisory body responsible for providing oversight and guiding the development of the blood transfusion system.
‘Blood transfusion services coordination remains fragmented,’ the report states. It warns that many blood centres operate with ageing equipment, inadequate cold-chain systems and manual processes for preparing blood components.
The WHO said procurement challenges have contributed to periodic shortages of reagents and other essential consumables needed for blood processing and testing.
‘Critical shortages exist across donor recruitment, laboratory operations, quality management and data systems,’ the report said.
The global health agency warned that staff capacity also requires strengthening, with healthcare workers needing additional training in quality assurance, automation, regulatory compliance and international standards.
The report further raised concerns about Botswana’s blood information management systems noting that although the Integrated Patient Management System (IPMS) is expanding, the country still lacks a unified national blood information system.
According to WHO, inconsistent transmission of hospital data to the National Blood Transfusion Services (NBTS) limits real-time monitoring and weakens evidence-based decision-making.
The organisation also highlighted weaknesses in clinical transfusion practices, saying existing guidelines require updating to align with modern Patient Blood Management (PBM) principles.
‘Haemovigilance systems are weak, and most hospitals do not have functioning transfusion committees,’ the report stated, warning that this contributes to under-reporting of transfusion reactions and gaps in quality oversight.
To address the challenges, WHO has recommended a comprehensive reform programme covering governance, regulation, infrastructure, human resources and information systems.
The organisation called on Botswana to finalise and implement its revised National Blood Policy, establish a National Blood Advisory Group and strengthen the organisational structure of the NBTS.
It also recommended accelerating the enactment of the Medicines and Related Substances Bill and supporting accreditation of blood establishments through recognised bodies such as the Africa Society for Blood Transfusion (AfSBT).
On infrastructure, WHO called for investment in automated blood component production technologies, modern cold-chain systems and improved procurement mechanisms to prevent stockouts.
The report also recommends developing a national plasma strategy and recruiting specialised personnel to strengthen technical and managerial capacity.
WHO noted that despite significant government investment in health, the country continues to face financing inefficiencies, with 80-90 percent of the health budget allocated towards curative services, leaving prevention and health promotion underfunded.
‘Primary healthcare remains underfunded, despite being essential for achieving universal health coverage,’ the report noted.
The organisation also highlighted medicine shortages, supply chain weaknesses and disruptions affecting HIV/AIDS services following reductions in external funding.
Botswana’s maternal, newborn, child and adolescent health programmes also face persistent challenges, including shortages of health workers, vaccine stockouts, limited outreach services and gaps in reporting systems.
WHO further warned that Botswana’s ability to respond to public health emergencies remains constrained by regulatory and operational gaps.
The report noted that several emergency preparedness plans and standard operating procedures remain in draft form awaiting approval, while the absence of a fully operational Public Health Emergency Operations Centre (PHEOC) weakens coordination during outbreaks.
WHO said stronger multisectoral coordination, improved logistics systems and increased surge capacity in laboratories and healthcare staffing are needed to strengthen national emergency response.