GAP Secretariat
Perth, WA, Australia

It has been almost one hundred years since the first Red Cross / Red Crescent (RC/RC) blood transfusion service was established by the British Red Cross in 1921. Today, more than 80% of all Red Cross / Crescent National Societies are operating a blood program as a core health and care activity—with 36 National Societies operating a full vein-to-vein blood service and 122 actively recruiting blood donors or advocating for voluntary blood donation.¹

The history of blood within the International Red Cross / Red Crescent Movement is described through a series of practical, legal, and (para) medical steps—all culminating from the battle of Solferino in Italy in 1859 where the vision of the Red Cross / Red Crescent movement was first realized.²

The international Red Cross humanitarian organization was founded by Henry Dunant in 1863 after he witnessed how little medical support there had been for injured soldiers during the Solferino battle four years earlier.³ From this, he advocated the need for a neutral organization of trained volunteers to provide aid and protection to affected soldiers, thus founding the Red Cross / Red Crescent Movement on both a legal (Geneva Conventions) and a (para)medical footing.

In 1921, the British Red Cross established the first blood transfusion service. Australia and the Netherlands followed shortly after.⁴ Identifying this growing interest in blood, in 1948 at the XVIIth International Red Cross Conference in Stockholm, the League of the Red Cross (later renamed the International Federation of Red Cross and Red Crescent Societies (IFRC) in 1991) adopted a resolution recommending that “National Societies take an active part in the matter of blood transfusion and co-operate with their respective governments in the establishment of blood transfusion centres or, if necessary, themselves organize such centres” (363).⁴ The resolution also endorsed the universal principle that blood should be provided and received free of charge, and that a standardization of supplies, equipment, and methods be applied globally.⁴

In 1975, at the World Health Assembly, major stakeholders urged the governments of all nations to adopt the highest standards for a safe blood service for their citizens, and to formulate those standards on the concept of voluntary non-remunerated blood donation (VNRBD).⁵ They also recommended that governments and their respective National Societies work together to build national blood services based on the broad voluntary participation of the people.

During this time, the number of Red Cross / Red Crescent blood programs had grown to reach around 95% of countries worldwide; with most of these involved in blood donor recruitment and education. This period also coincided with an increase in paid commercial blood donation globally, leading the International Conference of the Red Cross to adopt the position of VNRBD, affirming that this provided the safest and most effective way of meeting blood needs based on humanitarian principles. “The voluntary donor is the basis of all the blood transfusion services, just as he[/she] is an indispensable complement to the system of blood banks” (359).⁴

The reason the Red Cross / Red Crescent, as a volunteer-driven organization, became so heavily involved in blood donation is largely explained by this added safety (low transfusion transmissible disease rates) through voluntary non-remunerated blood donation as compared to paid or family replacement donations, and the ethics surrounding paying people for substances of human origin.⁶ Furthermore, with the largest humanitarian network of volunteers globally, the Movement is well placed to promote VNRBD and advocate for the safe provision of blood products and services.

The League of the Red Cross tasked itself with helping National Societies further develop their activities in safe blood transfusion. In order to be more familiar with local conditions and provide more effective assistance, it obtained the co-operation of blood transfusion consultants at the regional level, recommending sponsorship systems between sister Societies to promote the development of their respective transfusion programs.⁷

The role of the Red Cross / Red Crescent in each country is variable and largely depends on the specific circumstances in that country and, in particular, the relationship of the National Society with government. However, within blood, this role generally fits within the following areas (Figure 1 below):

Following a number of highly visible incidents and legal liabilities surrounding the arising HIV epidemic in the 1980s, The League was concerned about the potential risk posed by National Society’s participation in blood and the very threat to the existence of the organization as a whole. The decision was made to focus on the promotion of VNRBD recruitment, which supports the provision of a much safer and lower risk donor group than paid or family / replacement blood donation. A group of experts was set up to share knowledge and provide advice to National Societies on the proper management of the risks associated with blood programs; anticipating the group would share its results with Geneva from time to time.

During a G24 meeting in Sydney (1998), a session was organized for all National Societies actively involved in blood program activities, which provided the opportunity to share experiences and outline the ethical, social, legal, and financial fundamentals in the unique environment of blood operations. The following year in Bonn, it was agreed that any new program should focus heavily on effective blood governance and risk management as their core requirements.

Just over ten years later in Finland, the IFRC and the Finnish Red Cross hosted representatives from fourteen National Societies and the Federation, including speakers from Sanquin (Netherlands), National Blood Authority (England), and the European Plasma Fractionation Association (EPFA). In response to a specific seminar on blood program governance and management, a new expert group assembled, which included a small network of Red Cross Blood Service CEOs. The following year this new program was officially established as the “Global Advisory Panel on Corporate Governance and Risk Management of Blood Services in Red Cross / Red Crescent Societies” (GAP), with founding members from Australia, America, Finland, Switzerland, Japan, and Thailand.

GAP held their inaugural meeting in Vancouver and identified six critical issues of blood program governance and management. These formed the framework for a “GAP Self-assessment,” the fundamental guidance tool developed to support National Societies, and one that still remains a core GAP activity to this day.

In 2011 in Geneva, a policy “Promoting Safe and Sustainable National Blood Systems” was approved by the IFRC Governing Board.⁸ The policy acknowledges the critical role the Red Cross / Red Crescent plays in health care systems and in advancing health security through developing safe and sustainable blood systems based on VNRBD. The blood policy outlines the roles and responsibilities of National Societies, GAP, and the IFRC with respect to management and governance of blood programs.⁸ It states National Societies have a responsibility to implement the GAP Self-assessment and adhere to the GAP Manual, ensuring that appropriate risk management measures are implemented.⁸

GAP became a legal entity established under Swiss Law in 2012, with a purpose to provide “advice to National Red Cross and Red Crescent Societies, and their affiliated blood services, in matters concerning Corporate Governance and Risk Management of National Society blood programmes, as well as to the IFRC Secretariat and relevant IFRC bodies . . .”⁹

Today, GAP is devoted to blood banking and blood transfusion-related activities worldwide to help Red Cross / Red Crescent National Societies to improve their life-saving mission and adapt their practices to an ever evolving environment. With a current membership base of fifteen National Societies involved in blood donation, collection, and distribution, GAP continues to deliver and grow its program, which centers upon providing specialist assistance and risk management strategies to all RC / RC National Societies blood programs. What started as an effort to document activities and operational practice globally through questionnaires and global mapping, has now expanded to a more structural involvement in post-disaster aid for blood programs, as well as education. GAP also interfaces with the IFRC (with a Permanent Observer from Geneva on the GAP Executive Board), and is a critical component within the medical foundation of the Red Cross / Red Crescent Movement.

On reflection, Hantchef affirmed that “above all, every programme of transfusion requires, as a fundamental prerequisite, the active participation and support of the population. Experience has proved that such participation depends on how well the programme is understood by the public. . . . That is why the Red Cross, which has a very high moral influence with the public, is perhaps the ideal organization and the most logical, through which the recruitment of donors can be made all over the world (370).” ⁴

References

1. “Global Mapping,” Global Advisory Panel on Corporate Governance and Risk Management of Blood Services in Red Cross and Red Crescent Societies, accessed January 8, 2020. https://globaladvisorypanel.org/about-gap/activities/global-mapping
2. “Solferino and the International Committee of the Red Cross,” International Committee of the Red Cross, published 1 June 2010, accessed 15 January 2020. https://www.icrc.org/en/doc/resources/documents/feature/2010/solferino-feature-240609.htm#gs.s0b16n
3. “Founding and early years of the ICRC (1863-1914),” International Committee of the Red Cross, published 12 May 2010, accessed 15 January 2020. https://www.icrc.org/en/document/founding-and-early-years-icrc-1863-1914#gs.s094xe
4. Z. S. Hantchef, “The gift of blood and some international aspects of blood transfusion,” International Review of the Red Cross, 1 (1961) 355-370, doi:10.1017/S0020860400009724
5. “TWENTY-EIGHTH WORLD HEALTH ASSEMBLY, GENEVA, 13–30 MAY 1975”, World Health Organization
6. WHA28.72 Utilization and supply of human blood and blood products. https://www.who.int/bloodsafety/en/WHA28.72.pdf
7. “GAP Global Mapping Report,” Global Advisory Panel on Corporate Governance and Risk Management of Blood Services in Red Cross and Red Crescent Societies, published 2018, accessed January 8, 2020. https://globaladvisorypanel.org/system/files/resources/Global%20Mapping%202018_website_18072019%20FINAL_0.pdf
8. Z. S. Hantchef, “The Red Cross and new developments in blood transfusion,” International Review of the Red Cross,14 (1974), 337-343, doi:10.1017/S0020860400018994
9. “Promoting Safe and Sustainable National Blood Systems (2011),” IFRC Blood Policy.  https://globaladvisorypanel.org/system/files/resources/11.1%20Blood%20Policy%20approved%20by%20IFRC%20GB.pdf
10. “About GAP,” Global Advisory Panel on Corporate Governance and Risk Management of Blood Services in Red Cross and Red Crescent Societies.  https://globaladvisorypanel.org/about-gap1