Uganda: Uganda Struggles to Close Gaps in Blood Supply As Maternal Deaths Persist

As Uganda marked World Blood Donor Day on June 14, health officials turned attention from donor recruitment drives to a harder problem, the structural inability to deliver safe blood quickly enough to women bleeding after childbirth.

The national theme, "From Donor to Delivery: Blood Availability for Postpartum Hemorrhage Deaths Elimination", reflected a growing recognition that maternal survival depends less on individual generosity than on a functioning logistics chain.

That chain includes donor mobilisation, laboratory screening, cold storage, transport networks, referral systems and emergency obstetric care. Without every link in that chain functioning properly, experts warn, even the most well-intentioned blood donation campaigns will fail to translate into lives saved.

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Uganda has lowered maternal mortality over the past decade. According to the World Health Organization (WHO), the ratio now stands at 189 deaths per 100,000 live births, a significant improvement from earlier figures. Yet postpartum haemorrhage (PPH) remains one of the leading killers of mothers in the country.

Local studies attribute between 25% and 35% of maternal deaths to severe bleeding after childbirth. Ministry of Health reviews consistently list haemorrhage as the primary direct cause. For context, that means hundreds of Ugandan women die each year from a condition that is largely treatable, provided blood is available within a narrow clinical window.

Dr Richard Mugahi, Commissioner for Reproductive and Child Health at the Ministry of Health, described access to blood as non-negotiable.

"Blood equals life. Without blood there is no life," he said.

The government has established nearly ten regional blood banks across the country, a decentralised system intended to improve access and reduce transport times. "These are not banks with money," Mugahi added. "These are banks with life."

The facilities are responsible for receiving donations; screening for transfusion-transmissible infections including HIV, hepatitis B, hepatitis C and syphilis; maintaining cold chain integrity; and distributing blood to hundreds of health facilities nationwide.

But officials acknowledge persistent gaps. Kabale in the southwest and Yumbe in the northwest remain among the regional referral hospitals that still lack fully functional blood banking capacity. Collection levels also fall below national demand, leading to periodic shortages that ripple through the health system.

A logistics race against time

To address delays, the ministry has adopted a principle now being integrated into emergency obstetric protocols: "Don't move the patient; move the blood."

The model prioritises rapid transport of blood from regional banks to facilities facing shortages, using dedicated couriers and, where possible, motorcycle riders trained in cold chain maintenance.

Uganda is one of the few countries in the region that conducts detailed maternal death reviews, known as MPDR or Maternal and Perinatal Death Surveillance and Response.

Findings consistently show that delays in blood access contribute to preventable deaths. These delays occur at multiple levels, including failure to recognise bleeding early, delays in ordering blood, transport breakdowns, or simply empty shelves at the blood bank.

"Many women die because blood does not arrive on time," Mugahi said. Postpartum haemorrhage can kill within two hours without timely intervention, he warned, a window too narrow for many rural facilities to manage without reliable pre positioned supplies.

At Kawempe National Referral Hospital, Uganda's largest specialised maternity unit, the consequences of these systemic gaps are felt daily.

Dr Lawrence Kazibwe, Deputy Executive Director, said the hospital receives mothers from about ten districts in the central region, plus complex referrals from public and private facilities across the country.

The facility handles between 60 and 100 deliveries per day. Approximately half are Caesarean sections, a rate that reflects both the referral nature of the hospital and broader trends in obstetric care.

Primary postpartum haemorrhage affects between 10% and 15% of all deliveries within the first 24 hours after birth, according to Kazibwe. For many of these mothers, survival depends on immediate blood replacement. Yet health workers frequently find themselves contacting blood custodians at all hours - midnight, 2am, 4am - scrambling to secure urgently needed products.

"The challenge of obtaining blood products for those in need remains significant, making prevention and mitigation crucial," Kazibwe said.

The Ministry has introduced early detection measures in response. These include calibrated blood collection drapes, simple plastic sheets with graduated measurement pouches that enable health workers to measure blood loss accurately after childbirth.

When loss reaches critical thresholds, typically 500 millilitres for vaginal delivery or 1000 millilitres for Caesarean section, treatment protocols are activated immediately. These protocols include uterine massage, uterotonic drugs, and if bleeding continues, blood transfusion.

Supply constraints persist

Blood collection agencies face a parallel challenge, maintaining adequate stocks during lean seasons, holidays and periods of low donor turnout.

According to WHO data, African countries collected nearly seven million units of blood in 2023, up from about 2.2 million in the early 2000s. Nearly seven in ten donations now come from voluntary unpaid donors, a shift away from family replacement donation that improves both safety and sustainability.

Nevertheless, the region collects only about half the blood required to meet healthcare needs. Africa averages roughly six donations per 1,000 people, far below the recommended level of 10 to 20 donations per 1,000 people needed for reliable transfusion services. By comparison, high income countries often exceed 30 donations per 1,000 people.

Dr Aggrey Ngobi, speaking on behalf of WHO, noted that blood transfusions are essential for far more than maternal care. They are required for children with severe anaemia caused by malaria, trauma victims from road crashes, which are rising across Uganda, and patients living with chronic conditions such as kidney disease or blood disorders.

He praised Uganda's screening standards for transfusion transmissible infections, which meet international benchmarks. But he warned that misinformation, cultural beliefs, limited infrastructure and an inadequate number of regular donors continue to constrain supply. Some communities harbour unfounded fears about blood donation causing weakness or infertility, while others have religious or traditional reservations.

Regular donors: the missing link

Dr Dorothy Kyeyune Byabazaire, Executive Director of the Uganda Blood Transfusion Service (UBTS), framed the problem as one of donor frequency rather than donor potential. Uganda has millions of eligible people within the recommended age group of 17 to 65 years, yet shortages persist.

"Every unit of blood donated represents hope for a patient in need," she said. But donation, she emphasised, is not a single act. It sustains an entire system of recruitment, testing, processing, storage and distribution.

She described frequent midnight calls from doctors managing severe bleeding. "We receive calls at midnight, at 2am, when women are bleeding and need blood immediately. Those are the moments when the absence of a regular donor becomes a matter of life or death."

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UBTS maintains that a fully voluntary, unpaid donor system is essential for both safety and sustainability. Voluntary donors, who give without family pressure or financial incentive, have been shown in multiple studies to have lower rates of transfusion transmissible infections. They are also more likely to return regularly, creating a predictable supply.

The challenge now is converting first time donors into repeat donors. UBTS is piloting mobile based reminder systems, donor loyalty programmes and school based education campaigns aimed at building a generation of committed voluntary donors.

Health experts argue that eliminating preventable PPH deaths will require more than blood service investments alone. Improvements in emergency transport, referral networks, skilled birth attendance and maternal healthcare infrastructure are equally necessary.

A mother who begins bleeding at a rural health centre level II, which lacks surgical capacity, must be stabilised and transferred to a facility that can perform a blood transfusion or surgical intervention. Each transfer introduces delays and risks. The Ministry is working to upgrade select facilities to emergency obstetric and newborn care centres, but progress remains uneven across districts.

Mugahi added that the solution ultimately rests on collective responsibility across government, health workers, community leaders and citizens. Blood, he said, transcends religion, tribe, race and geography.

"It is the true bank of the people," he said.

World Blood Donor Day is observed annually on June 14 to raise awareness of the need for safe blood and to recognise voluntary unpaid donors. The day also underscores the importance of sustained blood systems, particularly in low and middle income countries where demand routinely exceeds supply.