As mentioned by the World Health Organization (2021), "Multiple barriers to the safety and availability of blood components for transfusion were identified in the 2015 Global Database on Blood Safety, many of which derive from weak regulatory oversight, insufficient financing, and fragmentation of the national blood system." Blood systems that are decentralized and highly fragmented generally suffer from a number of drawbacks that can be remedied by centralizing crucial blood service operations within a small number of blood facilities, especially testing and processing of blood donations. The WHO has created a guide to help people who make important decisions, especially in countries with limited resources. The mentioned below are the guide that gives them a clear plan to think about whether it's a good idea to bring together the testing and processing of blood donations in one place. It also explains the steps they should take if they decide to do this in certain blood centers.

1. Assessing the current status

A complete understanding of the current situation is required before developing a centralized model and plan. A clear understanding of the need for centralization and the anticipated results must be present, along with the ability to gather and analyze current data. Additionally, any hazards must to be taken into account both during the project's planning and execution stages. Risks that have been identified need to be properly evaluated, disclosed, and dealt with.

2. Blood establishment development plan

A complete development plan should be created after the reasons for centralization have been thoroughly understood and the overarching high-level centralization plan, which specifies the number of Blood institutions and their location, has been approved. This plan should address each component needed to centralize activities, including the formation of the necessary working groups to address each component. Timelines and anticipated results for each time point must be included in the strategy.

3. Organizational structure

It is necessary to identify the organizational layout of the central blood establishment. Along with the necessary staffing levels, it is important to identify the specific departments and work areas as well as the qualifications needed for each position. To display the general organizational structure and the roles and duties, an organization chart should be created. The overall structure and organizational structure should meet the needs of the consolidated service in addition to the requirements of the national blood program.

4. Infrastructure

The proper infrastructure and systems must be established as part of the centralized blood establishment's architecture in order to support its facilities and machinery. This will include, among other things, the transportation of blood and blood samples, waste disposal, electricity, communications, sanitation, refrigerators and cold rooms for the storage of blood and components, blood testing and blood testing reagents, platelet incubators, freezers for frozen reagents and components. Infrastructure needs to be designed and specified, including human resources, purchasing, finances, and support services.

5. Finance and funding

The expenditures of the centralization must be included in a comprehensive budget. It's crucial to keep in mind that the current activities must continue while the centralized actions are being carried out. The finance and its sources must previously have been agreed upon in principle as part of the overall centralized planning process. For the total anticipated expenditure on all centralization operations, the budget should be able to provide precise numbers.

6. Partnerships and agreements

As stated by the WHO (2021), The centralized blood establishment should sign joint agreements like Memorandums of Understanding (MOUs) or contracts with the national blood programme authority, national government, local government, regional and local health services, and other relevant organizations like donor organizations, nongovernmental organizations (NGOs), and staff organizations in order to promote engagement, agreement, and effective collaborations. The blood establishments that are currently responsible for testing and processing ("customer" BEs) and the BEs that will take over those responsibilities as a centralized BE should sign an MOU. Customers BEs who have signed the MOU should agree that only the designated centralized BE would offer blood components.

7. Communication

The ability to communicate clearly, accurately, and frequently among all those participating in and impacted by the centralization is essential to its success. Communication's main goals are to enlighten and then solicit thoughts, opinions, and feedback. Despite the presence of high-level plants, communication with everyone involved or affected, whether directly or indirectly, is crucial, and they should be identified at the start of the centralization project. In order to promote appropriate blood donation, uniform national-level public communication is crucial.

8. Emergency preparedness

The central blood establishment needs to create emergency preparedness and action plans, as well as procedures and resources that are prepared to handle accidents, disasters, political instability, blockades, and epidemics. In order to handle the chance that a centralized BE would become completely unable of functioning in an extreme circumstance, a backup facility and network plan are required. Establishing contingency agreements with other organizations inside or outside the nation may be important in situations where it is not possible to guarantee a backup facility.

Source: World Health Organization. (2021.). Guidance on centralization of blood donation testing and processing. World Health Organization. https://www.who.int/publications/i/item/9789240020825