In the simplest terms, the shortage of blood is a result of perceived high risk of donation, very low incentive for donation and increasing demand for blood.
Not only are people afraid of possible serious health ramifications (whether they are real or not) but the cost of travel and time is significant. I know diabetes patients who don’t go to pick up free medication because it is too expensive to get to the hospital. Interestingly enough they are also afraid of getting in accidents and dying on the way but that may just be a result of age and illness.
Cambodia currently does not pay for blood, unlike countries like China. They follow the same model that the US FDA advocates which requires that all blood used in hospitals needs to be obtained purely by donation. There is one overriding reason for this. Studies and common sense have shown that when money is offered for blood people are more willing to lie during screening (one example). While most diseases can easily be screened, some cannot, and many countries are not following correct screening procedures in the first place (source). Additionally, screening blood that ultimately cannot be used is costly. I can certainly see this being a problem in Cambodia and understand completely why they rely on donations.
There are problems however. Many people are also suspicious that doctors and hospitals are profiting off of their charity because blood needs to be paid for by patients. These costs are mostly due to the price of screening but accepting that requires trust in the medical system which does exist (and perhaps isn’t warranted). Furthermore, the shortage is so acute that when blood is not available for a patient, and family members are unwilling to supply blood themselves, the common recourse is to petition, and pay, anyone who is willing to fill the need. Doctors are left with no option but to request that their patients follow these measures. Ultimately all of the problems that you avoid by taking only donations are still in play, if not more so.
A quote from a recent article:
I have heard quite a few suggestions of measures that could be used to incentivize blood donations without increasing the frequency of risky donations. To do this effectively you would have to do two things. First, you would need to create an incentive that is not particularly attractive to at risk populations. I would not know where to begin to profile the type of donor that you want in Cambodia. Certainly you want to exclude drug using homeless children but beyond that many of these diseases are not necessarily demographic specific. Its possible that someone could argue further that more wealthy populations are more educated and therefore understand more clearly the implications of falsifying medical data but I don’t buy it. Not only is wealth not necessarily tied to education its also not particularly tied to morality. Suggestions such as tax exemptions or gym memberships that have been popular solutions in the United States do not seem entirely plausible. I do think that it may be worthwhile to create a partnership with the flurry of exercising groups that have overtaken almost every public park in Phnom Penh. These are health conscious people organized into neat social groups. Is there a more opportune population to target? Another possibility could be providing free physicals to blood donors. It is a clear incentive, but receiving a physical and lying about health information at the same time is somewhat counter productive. Not foolproof, but a possible solution.
Second, you would need to find a way to tie said incentive to the individual giving blood. This would be necessary to avoid creating tertiary markets which would negate any effect of the first requirement. In Cambodia in particular this would be difficult. National IDs could be used but they are not beyond forgery. Fingerprints or palmprints (hospitals in NYC have begun using technology that identifies individual vein patterns in palms) may be effective but the country may not have the infrastructure/man power to handle the data and unless some very complicated measures were put in place it could be a very serious breach of privacy.
Without financial incentive, the only real benefit to blood donation is the warm fuzzy feeling that comes from fulfilling moral or national obligations. This works for quite a few countries, including the US which currently has a surplus. Indeed, the book Freakonomics quotes a study which shows that paying for blood donation decreases the altruistic incentive and decreases blood donations. Unfortunately this hasn’t been working for Cambodia. I am preferential to the idea of only receiving donated blood but am forced to wonder if offering hard cash incentives under a more controlled environment would be a better option than allowing families to pay street children. Soft incentives (T-Shirts, buttons, cups, hats, physicals, subsidizing exercise, etc...) need to be explored but if they fail to produce results it may be necessary to take the lesser of the two evils.
Not only are people afraid of possible serious health ramifications (whether they are real or not) but the cost of travel and time is significant. I know diabetes patients who don’t go to pick up free medication because it is too expensive to get to the hospital. Interestingly enough they are also afraid of getting in accidents and dying on the way but that may just be a result of age and illness.
Cambodia currently does not pay for blood, unlike countries like China. They follow the same model that the US FDA advocates which requires that all blood used in hospitals needs to be obtained purely by donation. There is one overriding reason for this. Studies and common sense have shown that when money is offered for blood people are more willing to lie during screening (one example). While most diseases can easily be screened, some cannot, and many countries are not following correct screening procedures in the first place (source). Additionally, screening blood that ultimately cannot be used is costly. I can certainly see this being a problem in Cambodia and understand completely why they rely on donations.
There are problems however. Many people are also suspicious that doctors and hospitals are profiting off of their charity because blood needs to be paid for by patients. These costs are mostly due to the price of screening but accepting that requires trust in the medical system which does exist (and perhaps isn’t warranted). Furthermore, the shortage is so acute that when blood is not available for a patient, and family members are unwilling to supply blood themselves, the common recourse is to petition, and pay, anyone who is willing to fill the need. Doctors are left with no option but to request that their patients follow these measures. Ultimately all of the problems that you avoid by taking only donations are still in play, if not more so.
A quote from a recent article:
“Older street children...are selling blood sometimes, including drug users...They mostly hang around the hospitals, and if people need blood, they'll buy from them.” - Man Phally
I have heard quite a few suggestions of measures that could be used to incentivize blood donations without increasing the frequency of risky donations. To do this effectively you would have to do two things. First, you would need to create an incentive that is not particularly attractive to at risk populations. I would not know where to begin to profile the type of donor that you want in Cambodia. Certainly you want to exclude drug using homeless children but beyond that many of these diseases are not necessarily demographic specific. Its possible that someone could argue further that more wealthy populations are more educated and therefore understand more clearly the implications of falsifying medical data but I don’t buy it. Not only is wealth not necessarily tied to education its also not particularly tied to morality. Suggestions such as tax exemptions or gym memberships that have been popular solutions in the United States do not seem entirely plausible. I do think that it may be worthwhile to create a partnership with the flurry of exercising groups that have overtaken almost every public park in Phnom Penh. These are health conscious people organized into neat social groups. Is there a more opportune population to target? Another possibility could be providing free physicals to blood donors. It is a clear incentive, but receiving a physical and lying about health information at the same time is somewhat counter productive. Not foolproof, but a possible solution.
Second, you would need to find a way to tie said incentive to the individual giving blood. This would be necessary to avoid creating tertiary markets which would negate any effect of the first requirement. In Cambodia in particular this would be difficult. National IDs could be used but they are not beyond forgery. Fingerprints or palmprints (hospitals in NYC have begun using technology that identifies individual vein patterns in palms) may be effective but the country may not have the infrastructure/man power to handle the data and unless some very complicated measures were put in place it could be a very serious breach of privacy.
Without financial incentive, the only real benefit to blood donation is the warm fuzzy feeling that comes from fulfilling moral or national obligations. This works for quite a few countries, including the US which currently has a surplus. Indeed, the book Freakonomics quotes a study which shows that paying for blood donation decreases the altruistic incentive and decreases blood donations. Unfortunately this hasn’t been working for Cambodia. I am preferential to the idea of only receiving donated blood but am forced to wonder if offering hard cash incentives under a more controlled environment would be a better option than allowing families to pay street children. Soft incentives (T-Shirts, buttons, cups, hats, physicals, subsidizing exercise, etc...) need to be explored but if they fail to produce results it may be necessary to take the lesser of the two evils.
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