All countries face challenges in making sufficient supplies of blood and blood products available and sustainable, while also ensuring the quality and safety of these products in the face of known and emerging threats to public health. Since 1975, the World Health Assembly (WHA) has highlighted the global need for blood safety and availability. WHA resolutions 63AE12, 58AE13 and 28AE72, The Melbourne Declaration on 100% Voluntary Non-Remunerated Donation of Blood and Blood Components and WHO Global Blood Safety Network recommendations have reaffirmed the achievement of 'Self-sufficiency in blood and blood products based on voluntary non-remunerated blood donation (VNRBD)' as the important national policy direction for ensuring a safe, secure and sufficient supply of blood and blood products, including labile blood components and plasma-derived medicinal products. Despite some successes, self-sufficiency is not yet a reality in many countries. A consultation of experts, convened by the World Health Organization (WHO) in September 2011 in Geneva, Switzerland, addressed the urgent need to establish strategies and mechanisms for achieving self-sufficiency. Information on the current situation, and country perspectives and experiences were shared. Factors influencing the global implementation of self-sufficiency, including safety, ethics, security and sustainability of supply, trade and its potential impact on public health, availability and access for patients, were analysed to define strategies and mechanisms and provide practical guidance on achieving self-sufficiency. Experts developed a consensus statement outlining the rationale and definition of selfsufficiency in safe blood and blood products based on VNRBD and made recommendations to national health authorities and WHO.

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To face known and emerging threats to public health, all countries have to overcome the challenges of providing sufficient supplies of blood and blood products of the highest quality and safety. Unfortunately, self-sufficiency is not yet a reality in many countries. In 2011, experts from WHO addressed the urgent need to establish strategies and mechanisms for achieving this goal. A summary of these recommendations is further discussed.

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TATM 2003;5(1):277-284 • Safe blood • Scarce resources • Quality systems • Hemovigilance • HIV/AIDS In many parts of the world, people continue to die due to shortage of blood and blood products. The safety of blood transfusion therapy remains a continuing concern, particularly where resources are scarce.The different stages of economic and social development are reflected in the existing status of the countries health care systems and that of their national blood transfusion services. The lack of quality systems, standardization and traceability of collected blood along the blood transfusion chain are the major contributing factors to the undesired outcomes of transfusion and increased risk of transfusion-transmissible infections, namely HIV/AIDS and hepatitis. Hemovigilance as a concept and developed operational system, supports the continuous improvement of quality and safety of transfusion practices. Once the minimum safety requirements are in place, implementation of quality systems in the blood transfusion service throughout the entire blood transfusion chain has to be considered the first mandatory step for establishing hemovigilance systems. The challenge awaiting countries with scarce resources is the implementation of their own hemovigilance system in a sustainable way. The integrated approach for a safer blood supply developed by WHO is aimed at building capacities at a national level, through advocacy, infrastructure development, technical support, training and documentation, and it creates the necessary grounds for establishment of hemovigilance systems. By further increasing its commitment in this area, WHO fulfils its leadership role in preventing risk factors for major disease burden and in organizing equitable health services, in line with its strategic directions. Based on existing data and locally gained experience, joint programs and related expertise can be developed, strengthening inter-country, regional and global collaboration for a safer, adequate blood supply. ( Pa ge 27 7 ) Hemovigilance in Countries with Scarce Resources-A WHO Perspective NEELAM DHINGRA et al.