MENDAMI 2 - Resilience of the Libyan Transfusion System through Quality Management

Libya continues to suffer from the impact of a protracted political crisis, which leads to outbreaks of violence, displacements and a general worsening of people’s living conditions. The 2011 conflict has caused a collapse in oil revenues with severe consequences to the capacity of the Libyan institutions to raise public revenues and deliver basic services. 

Despite several noticeable improvements in the past years, the Libyan health system remains severely weakened by the political situation and still does not allow to date the provision of sufficient public and therefore health services such as blood transfusion.
 

The Libyan blood transfusion system was facing two critical challenges that prevents it from adequately delivering its mission and providing the Libyan population with sufficient safe blood products:

• The first challenge was the fragmented nature of the blood transfusion system institutional organisation.
• The second one was the very low number of voluntary non-remunerated blood donors in the country.

Such fragile basis made the Libyan blood transfusion system ill-prepared to withstand sudden changes in its environment. The severe effects of the political and security situation as well as the COVID-19 pandemic showed this point: blood banks outside Tripoli or Benghazi faced regular shortages and some were even forced into temporary closure.

Moreover, the absence of a centralised and efficient national management of blood supply made it difficult for the system to reform and improve from within.

The appropriate tools, mechanisms and practices for blood banks are the backbone of a system whose robustness is anchored in the following logic: a rigorous top-down organization, an ability to document each step, to monitor and evaluate activities; and finally, to identify and solve the problems encountered. For the blood transfusion system, it is therefore essential to become resilient and improve its ability to cope with sudden changes or problems. The system gains strength through this cascade logic and systematic, structured documentation of all activities, including emergency planning.

The focus areas were:

• organizational management of blood transfusion services,
• implementation of standards with blood banks,
• documentation and data collection,
• training of technicians and management staff,
• quality standard assessments,
• blood donation awareness among the general Libyan population.

The European School of Transfusion Medicine provided technical assistance in transfusion medicine. No less than 5 international experts have been mobilized in blood banks and the National Authority of Blood Transfusion Services.

The programme was carried out in liaison with local authorities and public institutions at national and sub-national level, and in particular through the action of the National Blood Transfusion Services Authority, the direct beneficiary of the programme.

The capacity building strategy encouraged participants to take responsibility for ensuring sustainability of results over time. Thus, the migration of the e-learning platform developed during phase 1 of MENDAMI and the appropriation of its management at the level of the National Authority for Blood Transfusion Services contributes to this objective of sustainability of actions.

The project worked closely with the University of Tripoli to ensure that transfusion medicine was progressively integrated and institutionalized in the programmes.

The main written documents and publications produced during the program are distributed to all major stakeholders of the program as part of one of the missions of the National Blood Transfusion Services Authority.

Concretely, the implementation of the Mendami 2 project allowed:

• The creation and deployment of 14 strategic and technical quality management documents for the Libyan blood transfusion system (National Authority, blood banks, laboratories and hospitals);
• The validation of the National Authority’s document management system;
• The creation and transfer to the National Authority of a digital quality management training platform, available in Arabic and English, with an interface for monitoring training and data management;
• The training of IT staff dedicated to its use and maintenance;
• The training and certification of more than 550 technical staff (doctors, nurses and laboratory technicians) in quality management;
• The training of managers of the National Authority in WHO quality standards;
• The training of two blood bank inspectors;
• A complete analysis of the 8 partner blood banks:
• The international accreditation of two pilot blood banks;
• The organization of the first national conference on quality management in the blood transfusion sector;
• The creation and transfer to the national authority of a mobile application dedicated to blood donation;
• The implementation of a study and the first national awareness campaign on blood donation;
• The realization of 5 technical workshops on quality issues in blood transfusion in Libya.

The National Blood Transfusion Services Authority, which has been gradually anchored with the support of the Mendami 2 project, is now an autonomous entity serving the Libyan population. It develops its medium and long-term strategy to address systemic deficiencies in order to improve the quality and quantity of blood available across the country.