Preface.

A recent United Nations Development Program (UNDP) study concluded that the spread of communicable diseases is one of the most critical health problems facing Central Asia, and that unless action is taken, the toll of HIV/AIDS and Tuberculosis alone will seriously further compromise the region's economic and social well-being. (1) Unsafe blood transfusions and medical practices may contribute, and in some cases have already contributed, to the spread of communicable diseases, particularly HIV, hepatitis B and C, (2) and syphilis. (30 Blood supply shortages are also a concern, as reported herein.

This report provides an overview of the challenge posed by the deteriorated blood transfusion services in Central Asian health systems, a situation that presents a clear and present danger to the populations of these countries. The results of a 2007 assessment conducted by the Central Asia Regional Office of the United States Centers for Disease Control and Prevention (CDC/CAR), under a co-financing arrangement with the World Bank, are discussed. In addition, the World Bank team took into account the technical recommendations put forward in this field by the World Health Organization (WHO) and the Joint United Nations Program on AIDS (UNAIDS), and reviewed other published and unpublished sources, including online sources, contributing to the evaluation of the CDC/CAR evidence.

Efforts to identify and document systemic deficiencies of blood transfusion services in Central Asia are fully consistent with the Bank's health improvement and poverty alleviation objectives in the health sector. (4) Indeed, well organized and well financed health systems are necessary to ensure equitable access to effective health care services. These efforts are also consistent with the new strategic directions guiding the Bank's overall work, (5) particularly those of fostering regional and global public goods that transcend national boundaries and of working in close cooperation with other agencies that have special expertise.

This is an initial attempt to collect empirical evidence on and evaluate the functioning of blood transfusion services in Central Asia. Information concerning these services in most former Soviet Union (FSU) countries generally remains unavailable. The evaluation was performed only after the CDC/CAR and World Bank teams gained permission from the governments to retest blood samples for markers of blood-transmitted infections and agreed to engage national specialists in the effort. Furthermore, the assessment of the safety of blood transfusion services in Central Asia is preliminary. Further research is needed to more precisely hone this understanding and to support the informed implementation of related policy and institutional reforms. Nevertheless, the need to act on the basis of available evidence is urgent. This report should foster continued efforts to improve these services.

In fact, as country-specific findings became available during the course of its 2007 investigation, as was done in previous investigations in 2004 and 2005, the CDC/CAR team shared them with high-level authorities of the Ministries of Health of the assessed countries. Initial measures addressed some of the more urgent and readily corrected problems. Thus, one of the main objectives of this work--raising awareness at the highest government level of the nature of problems in the blood services and fostering action to address them with the support of the international community--began to be met before the drafting of this report.

How this report is organized

To explain the results of the CDC/CAR investigation and their implications for policy making and action, the report begins by providing information on the growing burden of communicable diseases in Central Asia, particularly HIV/AIDS. Next are discussions on the importance of safe blood transfusion services and practices. The state of these services in Central Asia is then described, followed by recommendations.

It is expected that the results of this assessment will help the governments of the Central Asian countries develop measures necessary to prevent the transmission of communicable diseases, particularly HIV/AIDS, hepatitis B and C, and syphilis, due to contaminated blood and blood products administered in the health care system. It is also intended to help mobilize international support to help the countries in this region block this source of communicable disease transmission as part of broader health system restructuring efforts.