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Every year, millions of people in low- and middle-income countries face life-threatening situations, accidents, childbirth complications, or rare diseases, where access to safe blood and blood products can mean the difference between life and death. Yet, in many of these countries, these essential medicines are either unavailable, unregistered, or poorly regulated. This research set out to understand why this happens and how we can fix it.

We looked at how countries choose which blood products to prioritise in their national health systems, and whether those products are actually approved and available on the market. The results were striking: many countries, especially in Africa, don’t include the most essential blood products in their national list of essential medicines, and even fewer have these products officially registered for use. Surprisingly, less essential medicines were easier to find than the ones patients truly need.

Digging deeper, we examined how African countries regulate these products and how strong their systems are for monitoring safety and quality. The picture was mixed. While some progress has been made, especially for plasma-derived medicines (used to treat conditions like bleeding disorders, immune system problems and rare diseases), the systems for overseeing blood transfusions and for monitoring adverse reactions still have big gaps. It is clear that countries need more support, better tools, and strong leadership to build trust in their blood systems. By using global safety reporting tools and partnering with initiatives like BloodTrain, some African countries are already making big strides. This thesis shows that with smart investments, political will, and international collaboration, it is possible to create a future where every person, no matter where they live, has access to safe, effective blood when they need it most.