World Blood Donor Day: WHO raises alarm over blood shortage in Africa

The World Health Organisation's recent alarm over persistent blood shortages in Africa, including Nigeria, underscores critical legal and regulatory challenges within the Nigerian healthcare system. This article examines the existing legal framework governing blood donation, collection, and transfusion in Nigeria, primarily focusing on the National Blood Service Commission (NBSC) Act 2021 and the National Health Act 2014. It delves into the operational deficiencies, such as reliance on commercial donors and inadequate infrastructure, which contribute to the severe supply gap. Furthermore, the article explores the human rights implications of insufficient access to safe blood and potential legal liabilities for healthcare providers, offering insights for legal practitioners navigating this complex and life-critical sector.

On World Blood Donor Day, the World Health Organisation (WHO) issued a stark warning regarding the critical and persistent shortages in blood supply across the African Region, highlighting that millions of patients remain at severe risk due to inadequate access to safe blood and blood products. This global concern resonates deeply within Nigeria, where the demand for blood significantly outstrips supply, posing profound ethical, public health, and legal dilemmas for the nation's healthcare system. The implications for patient care, medical ethics, and the enforcement of healthcare rights are substantial, necessitating a thorough examination of Nigeria's legal and regulatory landscape concerning blood services.

This article aims to provide legal professionals with a comprehensive overview of the Nigerian legal framework governing blood donation and transfusion, identifying key statutes, regulatory bodies, and operational challenges. It will analyse the intersection of these laws with the fundamental right to health and discuss potential areas of legal liability arising from blood shortages and safety concerns. By dissecting the current state of affairs, this analysis seeks to illuminate the legal responsibilities of various stakeholders and suggest pathways for strengthening the system to ensure universal access to safe and adequate blood supplies in Nigeria.

Nigeria's legal framework for blood services is primarily anchored in two key pieces of legislation: the National Health Act, 2014, and the more recent National Blood Service Commission (NBSC) Act, 2021 (Act No. 8). The National Health Act, 2014, in Part VI (Control of Use of Blood, Blood Products, Tissue and Gametes in Humans), initially mandated the Minister of Health to establish a National Blood Transfusion Service for the Federation. This Act also contains provisions regarding the removal, use, and payment for human tissue, blood, and blood products.

Building upon this, the National Blood Service Commission Act, 2021, established the National Blood Service Commission (NBSC) as a corporate body with perpetual succession, effectively replacing the erstwhile National Blood Transfusion Service. The NBSC is now the sole regulatory authority for all blood-related services nationwide. Its extensive mandate includes coordinating and controlling blood transfusion services within the national health plan, ensuring the delivery of safe blood and blood products, accrediting blood transfusion service facilities, establishing a National Strategic Blood Reserve for emergencies, and coordinating all public and private blood banks, requiring them to deliver 5% of their safe blood collections to the Commission's zonal centres. Furthermore, the NBSC is tasked with promoting public awareness for blood donation and ensuring compliance with National Blood Transfusion Guidelines and Standards. These statutory provisions are complemented by the Nigerian National Blood Policy (Revised November 2005) and the National Blood Safety Standards for Blood Establishments in Nigeria, which provide detailed operational guidelines for safe blood collection, testing, and transfusion practices.

Despite a robust legal and policy framework, Nigeria continues to grapple with a severe blood shortage, meeting only an estimated 25-30% of its annual blood requirement of 1.8 to 2 million units. A significant contributing factor to this deficit is the heavy reliance on family replacement donors and paid commercial donors, with only 17-20% of blood collected coming from voluntary, non-remunerated donors, despite international and national advocacy for the latter as the safest source. While the National Health Act, 2014, prohibits the sale of blood, it allows for reasonable payments for the procurement of tissues, blood, or blood products, creating a potential loophole that perpetuates commercial donation. The NBSC Act, 2021, aims to strengthen regulation and promote voluntary donation, but weak enforcement and inadequate funding remain critical impediments.

The right to health, while not explicitly justiciable under Chapter IV of the 1999 Constitution of the Federal Republic of Nigeria (as amended), is indirectly referenced in Chapter II (Fundamental Objectives and Directive Principles of State Policy) and can be inferred from the constitutionally guaranteed rights to life (Section 33) and dignity of the human person (Section 34). Nigeria's ratification and domestication of international instruments like the International Covenant on Economic, Social and Cultural Rights (ICESCR) and the African Charter on Human and Peoples' Rights further solidify the right to health as legally binding within its jurisdiction. The persistent blood shortage and challenges in ensuring blood safety thus raise serious questions about the state's fulfillment of its obligations under these instruments and the practical enforceability of the right to health for its citizens.

Legal practitioners must also consider potential liabilities arising from inadequate blood supply or unsafe blood transfusions. Medical negligence principles, as adopted by Nigerian courts, dictate that a healthcare provider owes a duty of care to patients, and a breach of this duty resulting in harm can lead to liability. Failure to cross-match blood before transfusion, for instance, is a recognised ground for medical negligence. While the Supreme Court in *Medical and Dental Practitioners Disciplinary Tribunal v. Okonkwo (2001) 7 NWLR (Pt. 711) 206* affirmed a doctor's right to respect a patient's informed refusal of blood transfusion on religious grounds, this precedent is distinguishable from situations where a doctor or institution fails to provide necessary blood due to systemic shortages or their own religious beliefs without patient consent. The lack of a centralised national blood database exacerbates coordination issues, potentially leading to delays and patient deaths, which could form the basis for claims of institutional negligence or breach of duty.

Furthermore, the challenges extend to inadequate infrastructure, equipment, and trained personnel in many blood banks, coupled with difficulties in comprehensive screening for transfusion-transmissible infections. These operational shortcomings not only compromise blood safety but also expose healthcare institutions to significant legal risks, including claims for damages arising from infections contracted through transfusions. The NBSC's mandate to accredit facilities and ensure quality assurance is crucial, but its effectiveness is undermined by weak enforcement and insufficient resources, creating a gap between statutory intent and practical implementation.

The WHO's warning serves as a critical reminder of the urgent need for Nigeria to address its systemic blood shortage and enhance blood safety protocols. For legal practitioners, this landscape presents multifaceted challenges and opportunities. Attorneys advising healthcare institutions must ensure rigorous compliance with the NBSC Act, 2021, the National Health Act, 2014, and associated standards, particularly concerning donor recruitment, screening, storage, and transfusion practices. Emphasis should be placed on transitioning towards a fully voluntary, non-remunerated blood donation system to mitigate safety risks associated with commercial donors.

Practitioners involved in human rights advocacy or public interest litigation may find grounds to challenge the state's inaction in fulfilling the right to health, particularly where inadequate blood supply leads to preventable deaths or severe health complications. Furthermore, the potential for medical negligence claims arising from unsafe transfusions or delays due to shortages necessitates heightened due diligence for healthcare providers and robust risk management strategies. Moving forward, sustained government investment, strengthened regulatory enforcement, and public awareness campaigns are crucial to transforming Nigeria's blood service landscape, ensuring that the legal framework translates into tangible improvements in patient outcomes and the protection of fundamental healthcare rights.