With the support of the Coopération luxembourgeoise (Luxembourg Agency for Development Cooperation), four CRTS (centres régionaux de transfusion - regional blood transfusion centers) dependent upon the CNTS have been set up: one in the capital and three in the country’s major cities (Figure 1). Medical and paramedical staff who received their training in blood transfusion overseas (in France, Belgium and Tunisia) now run the CRTS, where quality control and reference material systems have been set up to meet international norms and standards. The CNTS supplies the three CHU (centres hospitaliers universitaires - university hospital centers), two of the nine CHR (Centres hospitaliers régionaux - regional hospital centers) and 20 of the 60 CMA (Centre médicaux avec antennes chirurgicales -medical centers with surgical units). These four CRTS produce about 53% of the country’s blood products but only cover a part of the nation. The health agencies not supplied by the CRTS continue to collect, test and distribute the blood that they need on their own.

We do note one positive point: all the health agencies in Burkina Faso carried out HIV and viral hepatitis B screening. This is a significant advance in the prevention of transfusion-transmitted infections in the country since according to WHO, blood products are not yet 100% screened for HIV throughout the African continent [6]. In Burkina Faso, this screening is all the more important because the prevalence of infection remains high in the general population [7,8]. On the other hand, a number of health agencies do not carry out reverse ABO typing for cross-matching. The difficulty of preparing red cell reagents was noted by half of these centers. In order to resolve this situation, the inclusion of all health agencies under the aegis of the CNTS could allow them to receive red cell reagents prepared by the mother organization and the health agencies could in turn supply the local medical analysis laboratories. It is true that making labile reagents so regularly available would impose certain logistical and budgetary constraints on the CNTS.

Be that as it may, observation and analysis of the health agencies’ blood transfusion practices indicated three main areas of departure from good blood transfusion practices.

The first area concerns regulations. Blood transfusion seems to have remained on the margins of the health systems of numerous sub-Saharan African countries, despite the fact that it has been practiced there for many years. Initiatives to modernize this sector of health, under the leadership of WHO which has recommended the creation of national blood transfusion services, are relatively recent [1,9], and the regulations which would have been needed to support practical implementation of these reforms have not always been promulgated. In Burkina Faso, the CNTS was created under a Public Health Law which does little to tackle blood transfusion questions. Just before this, a “national policy document” for blood transfusion had been drawn up, but it was not distributed widely enough and therefore did not have an effect on all stakeholders. After the CNTS was created, the responsibility for suggesting the regulations needed for proper operation of the whole blood transfusion system fell to this national organization. Two pieces of reference material were drafted and adopted by ministerial decree in 2007: the “National Directives for good Blood Transfusion practice” and the “Document concerning Blood Product standards in Burkina Faso”. Although each health organization collecting and distributing blood units had received these guides, a number of these organizations did not apply them, and the CNTS truly did not have the resources to compel them. One of the reasons for which the health agencies not covered by the CRTS did not feel that they were really covered by these documents (which nonetheless had a national scope) may have been the lack of instruction, awareness-raising and training for health officers following the distribution of these reference materials. Because of a lack of financial resources to organize such training, the CNTS had to be content with sending these documents to the organizations concerned, where they often remained unheeded. Such a situation conveyed both the difficulties for public authorities to apply the rules established by them – whether this was a question of a weakness of ministerial authority or professional authority – and the persistent and growing need for training and awareness-raising of blood transfusion stakeholders.

The second area, which follows partly from the last one, relates to funding, as the CNTS’s lack of financial resources plays a significant role. As it was not able to supply the health agencies with blood transfusions reagents or consumables, and not being in a position to provide training for stakeholders on the ground, the CNTS could only leave each center to conduct its blood transfusion policy as it intended with the resources at its disposal. Such resources were often very scarce, as blood transfusion is considered to be unprofitable by hospital administrations because blood products are given free-of-charge to recipients. In effect, for-profit and even non-profit health organizations tend to put blood transfusion in the background in favor of sectors of activity which are more “profitable”. When there are financial difficulties, they feel at liberty to stop blood transfusion activity for a while, or to impose certain restrictions, like the suspension of screening for one or another infection marker. This particularly pernicious situation could be ameliorated by a centralized supply of reagents and blood transfusion consumables from the national CNTS.

The third area, which is equally crucial, is that of training. In industrialized countries such as France, government decrees have defined the training needed to carry out professional blood transfusion activities [10], based on initial training programs which have been modified from time to time to take account of developments in the discipline. Furthermore, according to the principles of quality assurance which are widely applied in industrialized nations, blood transfusion organizations and their stakeholders are obliged to provide continuous training and to provide proof that this has been carried out. In Burkina Faso, initial training of prescribing physicians does not take the subject of blood transfusion into consideration. The same applies for nurses, who receive just four hours of teaching on blood transfusion practices, as well as for laboratory technicians who are called on to be responsible for blood testing laboratories. In order to remedy this situation, Burkina Faso’s CNTS has undertaken a review, in partnership with the École nationale de santé publique (National School of Public Health), concerning the creation of a nurse’s course specializing in blood transfusion, similar to those already given in anesthesia, pediatrics or surgery.

The deficiency of blood transfusion safety in sub-Saharan Africa is multifactorial: almost all of the countries in this part of the continent have shortfalls in blood transfusion practices [11], and Burkina Faso has not escaped this reality. However, this country can count on some assets: it is one of the rare countries in sub-Saharan Africa where numerous personnel have received high-level training in blood transfusion in first-class institutes, and the aim of its CNTS is in the medium term to become truly the only blood transfusion operator, by extending its activity progressively until all national activity is covered. Under a strategic plan for 2010–2015 drawn up for this purpose, this will put an end to the current “two-tier” situation of the country’s blood transfusion system. This plan includes negotiations with universities and nurses’ and laboratory technicians’ colleges for training the future stakeholders in the country’s blood transfusion.