Evidence-based approaches to tackling Zambia’s blood shortage

For years, Zambia has faced persistent blood shortages, with serious consequences for maternal health, emergency care, and patients with conditions like anaemia. In response, the Zambia National Blood Transfusion Service (ZNBTS) set an ambitious target in 2024: to triple its annual blood collections from 130,000 to 400,000 units. Achieving this goal requires more than just increasing the number of ZNBTS blood drives.  It also requires a deeper understanding of donor characteristics and behaviour, and improvements across the entire blood collection system.

With support from the Presidential Delivery Unit (PDU), ZNBTS, the Ministry of Health and IDinsight partnered to unpack a set of complex questions at the heart of Zambia’s blood supply challenge: Why are people donating blood? What motivates them to donate? Why do so many eligible Zambians choose not to donate? And what would encourage both donors and non-donors to give more often? To answer these questions, we conducted a mixed-methods study that surveyed over 1,500 donors and non-donors, conducted focus group discussions, analyzed ZNBTS administrative records, and interviewed key leaders across the blood system.

Our findings point to a clear path forward: Dispel common myths and misconceptions, educate at the grassroots level, strengthen data systems and foster a culture of data and evidence to support these efforts.

Who donates (and who doesn’t)?

Donors in Zambia are typically young males, with an average age of 30. Students are also a key donor demographic, and school blood drives are a staple of the ZNBTS blood collection strategy. From December 2018 to February 2024, over 30% of donations were from secondary students. While this group is a reliable source of donations, it also introduces volatility and dependency. Zambia’s blood supply drops sharply during school holidays, leading to seasonal shortages that strain the health system. 

Donors tend to have higher levels of education and report higher household incomes than non-donors. We found that the donation rate among older adults is low. Only 10% of non-student donors in our sample were aged 45-65, despite being eligible to donate. Yet our survey data revealed no significant logistic or attitudinal barriers that are unique to this demographic, and their altruistic motivations were similar to those of younger respondents. Discovering this age gap presents an important opportunity. With tailored outreach and follow-up, older adults could move from being an untapped resource to a stable source of repeat donations.

Donation locations

A steady blood supply depends on having donation sites that are both efficient and accessible. ZNBTS runs a network of mobile teams that travel to rural communities, schools, malls, and offices nationwide to collect blood. This has worked well, especially in rural areas, but many potential donors prefer permanent sites like clinics or hospitals, which offer more privacy than mobile tents. In Lusaka, 68% of surveyed donors said they would rather give blood at a fixed site. While mobile sites remain crucial for rural areas and schools, ZNBTS could boost donations by making fixed sites more accessible, either by adding more clinics or extending hours at existing ones.

Fear, misinformation, and community sensitisation

Many Zambians are willing to help others, yet fear, uncertainty, and persistent myths keep people from donating blood. Nearly half of the non-donors surveyed cited fear of needles, fainting, or contracting a disease as their reason for never donating. Others voiced doubts about what happens to donated blood, with concerns that it may be sold by hospitals, misused, or even linked to satanic rituals. These beliefs are not rare. More than a quarter of non-donors (27.6 percent) did not disagree with the myth that collected blood is used for satanism. Countering these myths may be most effective when paired with messaging that reinforces the positive impact of blood donation on others.

Beyond fear and mistrust, limited access to accurate information remains a significant barrier. Many Zambians are unaware of ZNBTS sensitisation talks, and even fewer have attended them. Instead, most people hear about blood donation informally through friends and family. Word-of-mouth can be a powerful way to mobilise communities, especially when trusted local figures share these messages. However, it also has the potential to spread misinformation, reinforcing fears and misconceptions that discourage people from donating. 

The role of data in strengthening blood donation systems

ZNBTS has made meaningful strides in collecting and managing donor data, but there is still work to do to ensure these systems fully support a resilient blood supply. In many provinces, donor information is recorded and kept in paper books, and then later digitized. This system leads to inconsistencies in digitisation rates, missing data, or duplicated records. These limitations make it more challenging to follow up with past donors, monitor donation patterns, and coordinate efforts across provinces. 

More complete and standardised records would help ZNBTS identify gaps in donor outreach, plan more targeted sensitization campaigns, and track repeat donations. Investing in stronger digital infrastructure, consistent data practices, and integration with broader health information systems will help ZNBTS and other national services respond more effectively to blood supply needs. 

A path forward

Our work identifies five data-driven strategies that ZNBTS and partners can act on:

1. Partner with trusted public figures to strengthen sensitisation campaigns. Religious leaders and health professionals were consistently viewed as credible messengers across the regions we studied. For student populations, the voices of teachers also matter. Identifying and training community “blood donation champions” to spread positive messaging could be valuable to dispel fears, myths, and misconceptions that prevent some from donating.
2. Refocus communication on altruism and blood use. Many Zambians report donating blood to help their community and country. Using campaign messaging that highlights how donations help mothers in childbirth or accident victims not only resonates with potential donors but also shows how blood is used around the country.
3. Improve accessibility and privacy. Many donors prefer donating at hospitals or clinics instead of the tents that come with mobile drives due to better privacy. Extending the hours of existing blood banks and investing more in private mobile setups can help meet this demand. 
4. Embrace a tailored approach for different target demographics. Men and women experience different barriers to blood donation. While women are slightly more likely to fear fainting or needles, men often report not knowing where or how to donate. Higher-income individuals living in Lusaka are more likely to hear about blood donation via television. In contrast, lower-income individuals and those living in rural areas are more likely to hear via word-of-mouth and the radio.
5. Build a strong data foundation. Inconsistent donor records limit ZNBTS’ ability to track and retain donors. Standardising data systems, adopting national donor IDs, and integrating them with health sector monitoring and evaluation tools would unlock efficiency gains.

A call to funders and policy makers

This blog draws from a pivotal study focused on Zambia, but the challenges it highlights are not unique. Many countries across sub-Saharan Africa face obstacles in building and maintaining a reliable blood supply. Myths and misinformation are common; people don’t know where, when, or how to donate if they feel compelled to, and health facilities continue to struggle with rationing the limited blood supply.

Our work with ZNBTS has shown that data can help us better understand the barriers to blood donation and design smarter, more targeted solutions. However, solving this problem requires more than one study. We need increased attention to the issue, more research to build the evidence base, and greater investment in building resilient blood donation systems across the region.

There is no one-size-fits-all approach, but many of Zambia’s lessons on donor education, trusted messaging, site accessibility, and data system reform can inform efforts elsewhere. Strengthening blood donation data systems is not just a technical challenge. It is a critical public health priority that deserves focus, funding, and collaboration.

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To learn more about blood supply in Zambia, you can find our Desk Review here, containing a review of ZNBTS administrative data and literature review of blood donation in Sub-saharan Africa. To read more about our primary research and the motivations, barriers, and opportunities regarding blood donation in Zambia, you can find our final report here.