My interest in a fiction television film episode rapidly declines if no character gets murdered or if nothing mysterious happens within its first ten minutes.
I’m therefore an incurable fan of detective films and at the moment, I’m besotted with the whodunnit series, “Murdoch Mysteries” set in 19th century Toronto before the advent of advanced forensic techniques or medical technology. The lead characters are Inspector Brackenreid, who generally does more whisky-drinking than inspecting, and of course, the handsome razor-sharp and affable, Detective Murdoch.
In the last episode I watched, Murdoch’s sweetheart, Dr. Julia Ogden, suffered a gunshot assault and haemorrhaged. As she lay pale and frail in hospital, Murdoch was informed that Julia’s pulse was weak. With the alacrity of a man both desperate and smitten, Murdoch exclaimed, “She needs blood! Take mine! We are compatible.” He was immediately believed. No sooner had he said that did he find himself in a bed beside Julia’s. A metal contraption with a tube of a questionable level of cleanliness, connected the lovers’ veins and blood flowed from Murdoch straight into Julia.
Two centuries later, we’ve come a long way from the days of dubious medical practices and rudimentary healthcare tools. Blood transfusions are now preceded by a host of necessary and meticulous laboratory, clinical, logistical and administrative processes, to avoid, among other things, the paradoxical endangering of the very lives we endeavour to save with blood transfusions.
The announcement that a government subsidy will see blood become accessible free of charge at all Zimbabwe’s public health institutions that offer transfusion services from July 1, 2018 was largely met with positive commentary. Justifiably so. The price of blood, ranging between $50 and $140 per pint, was an access barrier to many in need of life-saving blood. At the risk of placing myself in the morally precarious position of appearing to criticize a life-saving intervention, I write here from a cautiously optimistic perspective, about my thoughts on the announcement that has made headline news.
Transfusion blood is not free. So, who pays for free blood and for how long?
To the naked eye, the relatively visible process of donors freely donating their blood may misrepresent the true cost of producing blood for transfusion. Because it is what we often see, I suspect that blood donation by unpaid volunteers is the dominant image emblazoned on our minds and tends to obscure the behind-the-scenes processes of converting donated blood (in essence, a raw material of unknown quality) into transfusion-ready blood (a safe medical product). As far back as 2013, research showed that the estimated cost of producing a pint of transfusion blood in Zimbabwe was between $118 and $131. This bill has to be met to sustain supplies.
The government has communicated that the subsidy that will enable free blood at the point of use comes from the Health Levy Fund, financed through mobile phone airtime taxation. $20 million has already been collected, it is reported. This deals with the question of the sustainability of the funding model. The sustainability of the political will to consistently allocate this fund to what it has been earmarked for however, is an entirely different kettle of fish. Sustainability of political will is a concern particularly to those on whom the curious timing of this policy is not lost. The proximity of the free blood policy announcement to the upcoming elections, has gotten some sceptics dismissing it as merely a short-lived campaigning ploy. It is hoped they are gravely mistaken.
Will access to blood be necessarily improved by a government subsidy?
Indeed, it is more than a perfectly reasonable assumption that a good number of lives will be preserved by the waiving of user-fees for blood products in Zimbabwe. However, affordability is only one of several enablers of access to quality healthcare products. Access is also affected by geographical accessibility of the health institution offering the product, the physical availability of the product at the point of care in a timely fashion, as well as the acceptability of the product to the user. Above all, access is enabled when a consumer is armed with information and knows that they are entitled to access. All these factors; affordability, accessibility, availability, acceptability and knowledge, must align for patients to benefit from our government’s new free blood initiative. This requires seamless or at least sufficiently efficient, logistics and supply chain systems to get blood timeously even to the remotest and/or underserved parts of the country. It requires transaction and opportunity costs incurred by patients eligible for blood transfusions to not be prohibitive enough to exclude them from benefitting from this noble intervention. Above all, it requires that patients (and healthcare providers too) be well informed of patients’ entitlement to free blood at public hospitals and its health benefits so that unnecessary red tape at hospital level does not undermine access.
For whom will access to blood be improved?
It is my understanding, that the motivation behind the new free blood policy is to facilitate access to blood transfusions for those who would have otherwise found the price beyond reach. Good governance and the cost-effective use of blood products will be imperative, if this goal is to be achieved. Will we not see moral hazard creep in, manifesting as clinicians over-prescribing blood and blood products due to the lowered price barrier to access? Will we not see free blood products meant for public institutions grow legs only to find themselves for sale elsewhere? Will access to blood be equitable, if consumers that have the ability to pay for blood at private facilities migrate to public hospitals and compete for free blood with those genuinely without the option of seeking care from private providers? Will proper diagnostic and treatment guidelines be followed, to ensure that those who survive a haemorrhage by obtaining a blood transfusion, do not ultimately succumb to the untreated underlying cause of bleeding or minor infection immediately after?
Whether one agrees with its politics or not, and whether one is cynical about its motives or not, our government needs to be commended for launching a high-impact intervention that has the great potential to alleviate the suffering of many of our people. Meaningful gains will be realised if the free blood policy is: implemented under adequate oversight, supported by functional logistics systems, complemented with interventions to address the concerns I have already highlighted, and above all, executed with a real commitment to sustained success.
If you’re wondering, Julia Ogden survived the gunshot attack- thanks to Detective Murdoch’s blood donation. Her shooter was eventually apprehended. All’s well that ends well, no?
Dudzai Mureyi is a pharmacist skilled in health policy analysis, currently pursuing doctoral studies in Global Health. Find her on Twitter: @BonnieDudzai or email her at: firstname.lastname@example.org.