Despite blood being donated freely by thousands of Namibians every year, patients are still required to pay when it is transfused, a reality that often fuels public confusion and criticism.
The Namibia Blood Transfusion Service (NamBTS) says the explanation lies in the costly and highly regulated process that turns donated blood into safe, lifesaving medical products.
Namibia currently has 50 397 active blood donors, who donated a total of 32 533 units of blood.
This places the country at 17 units per 1 000 people, well above the African average of seven units and comparable to upper-middle-income countries such as South Africa, Brazil and China, according to the World Health Organisation (WHO).
However, NamBTS says supply remains fragile. The national blood stock currently stands at four days, far below the nine days regarded as a healthy and adequate reserve.
Barriers
NamBTS believes many eligible Namibians do not donate blood regularly due to fear of needles, myths and misconceptions, health concerns and personal circumstances. Others assume that enough people are already donating or say they are simply never approached.
“These fears and misconceptions contribute directly to blood shortages,” said Frieda Vatileni Asino, NamBTS spokesperson.
“Blood donation is safe, quick and essential, yet many people still hesitate even though the need is constant.”
Critical demand
Blood group O remains the most urgently needed, as it can be transfused to patients of any blood type in emergency situations. It is heavily used in trauma cases, surgeries, maternity complications and other medical emergencies.
Vatileni Asino said increasing awareness around the importance of blood group O could help stabilise national blood stocks and save lives.
While donors give blood voluntarily and without payment, the cost of processing a single unit of blood is substantial. NamBTS operates on a cost recovery model, as outlined in Namibia’s National Blood Policy.
Donor recruitment adds about N$82 to the cost of a unit of blood. Blood bags and consumables used during collection add approximately N$266, while travel costs for blood donation teams add N$95 per unit for short distances and N$214.43 for long distances.
Processing costs further increase the price. Blood group serology testing costs around N$275, while producing blood products from whole blood adds about N$273. Testing for transfusion-transmissible infections such as HIV, hepatitis B and C and syphilis adds N$692 per unit, with nucleic acid testing (NAT) being the single largest cost driver.
“Although blood is donated freely by selfless donors, the value chain process is costly and demands adequate funding to ensure safety and sustainability,” Asino said.
Why pay?
NamBTS explains that patients do not receive raw donated blood but carefully processed products tailored to their medical needs. These include concentrated red cells, platelet concentrate and fresh frozen plasma.
Before reaching a patient, blood must be collected using sterile equipment, transported, stored under strict cold chain conditions, tested, separated into components and distributed to blood banks nationwide.
“By the time the blood product reaches the patient, it is no longer the blood that was flowing in a donor’s veins,” Asino said. “It is a safe, regulated medical product designed to save lives.”
Funding
State hospitals consume about 76% of all blood products produced in Namibia, with NamBTS billing the Ministry of Health and Social Services. The remaining 24% are used by private patients and billed to medical aid schemes. Less than 1% of patients, mostly foreign nationals without medical cover, pay directly.
NamBTS receives no donor funding for blood transfusion services. All operational costs are covered through this cost recovery system.
As a nonprofit organisation, NamBTS generates only a limited surplus, typically between 10 and 15%, which is reinvested into blood safety, quality improvement and infrastructure expansion. Recent surpluses were used to establish regional blood banks in Onandjokwe and Rundu, improving access outside Windhoek.
Pro bono
Despite ongoing shortages, NamBTS has ruled out paying blood donors. The organisation follows the WHO-endorsed policy of voluntary non-remunerated blood donation, which is regarded internationally as the safest and most ethical approach.
Paid donation systems, NamBTS says, increase the risk of unsafe blood entering the supply, as financial incentives may encourage donors to conceal health risks.
“Voluntary donors donate out of care, not financial need,” said Asino. “That makes the blood supply safer and more sustainable.”
To grow the donor base, NamBTS continues to roll out awareness campaigns such as #NewYearNewHope, #OneArmThreeLives, #DareToCare and #DareToShare, with a strong focus on youth participation.
With demand rising due to maternity cases, trauma and cancer treatment, NamBTS says regular voluntary donors remain the backbone of Namibia’s blood transfusion system, even if the true cost of their contribution is only realised long after the donation is made.
