Apheresis in Ethiopia: Availability, challenges, and opportunities.

Belonging to the Brethren of Blood: An Autobiography

This study aimed to analyse and predict emerging trends in transfusion medicine using complex network analysis of high-impact global scholar rankings. Network analysis was employed to uncover research trends, identify central research directions and map knowledge networks. The analytical hierarchy process was used to evaluate potential future research trajectories. The Kolmogorov-Smirnov test assessed network centrality differences, with cross-validation performed using the Association for the Advancement of Blood & Biotherapies (AABB) and the International Society of Blood Transfusion (ISBT) conference themes. Clinical transfusion is the central theme, with transfusion management, evaluation and specific transfusions like platelet and plasma gaining prominence. Blood safety evolved into a standalone domain, while immunohaematology and cell therapy represent emerging trends. Innovations in blood storage, transfusion technology and omics insights are shaping future directions. Notably, despite global healthcare impacts, COVID-19 has not significantly redirected transfusion medicine research. The transfusion medicine landscape demonstrates stability in its core framework while increasingly focusing on emerging areas such as personalized therapies, platelet transfusion and cell-based treatments.

Organ Trafficking: Global Solutions for a Global Problem

Guest Editor’s Bio

Jean-Pierre Soulier, 1915–2003

Quality monitoring is a key component of the quality management system, closely related to the concept of quality improvement. The implementation of quality indicators (QIs), as a valuable quality monitoring tool, contributes to the achievement of quality objectives. During 2010, discussions about the importance and use of QIs in transfusion medicine intensified, and 3 years later, the Quality Management Working Party (QM-WP) of the International Society of Blood Transfusion (ISBT) published a set of QIs for blood establishments and hospital blood banks. QIs defined by ISBT QM-WP were further developed and revised considering data obtained from an international survey on QIs, targeted consultations with members of the ISBT QM-WP and individual expert opinions. Several revisions of quality indicators proposed by ISBT QM-WP have been published. The latest version from 2023 is presented in this paper and contains data on 50 QIs. Each indicator is defined, its importance is explained and the numerator and denominator required for its calculation are defined. The indicators are divided into seven groups according to areas of activity in the transfusion chain. This paper underlines the importance of QIs and provides resources for their selection, implementation and monitoring.

Extended RBC antigens typing is very valuable in transfusion immunology since it is highly recommended to ensure better transfusion practices and avoid transfusion-related complications and to establish registries for rare blood donors as recommended by the International Society of Blood Transfusion and World Health Organization. A group of 236 Tunisian blood donors were genotyped for 19 common blood loci using the Sequence-specific primers polymerase chain reaction (SSP-PCR) method. The statistical analysis was done using the HaploView Software. The study showed the dominance of the loci: RHCE*e, KEL*02, FY*02 and CO*01; and the absence of the homozygous state of the CO*02 allele. Furthermore, two complete linkage disequilibrium leading to the absence of the two alleles RHCE*C-RHCE*E (C-E) and FY*01N.01 (FY*Anull) were detected. Additionally, it appeared that approximately 91% of these blood donors are positive for the RHD gene; and all subjects who lacked the RHD exon 10 are homozygous for the RHCE*c and RHCE*e variants. The study also revealed that the RH1 negative blood cannot be universal to the Rh system because almost all RH1 negative donated blood is RH:-2,4,-3,5 (ccee), which may constitute a risk in some recipients carrying the anti-RH4 and/or anti-RH5 antibodies. Considering that some donated RBC units may contain blood with very immunogenic phenotypes, greatcautionisrequired when transfusing some subjects, especially in emergency situations because it can be a step towards subsequent complex or multiple alloimmunization.

Next generation public health: towards precision and fairness

Information about mental health systems is essential for mental health planning to reduce the burden of neuropsychiatric disorders. Unfortunately, many low- and middle-income countries lack systematic information on their mental health systems. The objectives, scope, structure, and contents of mental health assessment and monitoring instruments commonly used in high-income countries may not be appropriate for use in middle- and low-income countries. The World Health Organization (WHO) has recently developed the WHO Assessment Instrument for Mental Health Systems (WHO-AIMS), a comprehensive assessment tool for mental health systems designed for middle- and low-income countries. WHO-AIMS was developed through an iterative process that included input from in-country and international experts on the clarity, content, validity, and feasibility of the instrument, as well as a pilot trial. The resulting instrument, WHO-AIMS 2.2, consists of six domains: policy and legislative framework, mental health services, mental health in primary care, human resources, public information and links with other sectors, and monitoring and research. These domains address the ten recommendations of the World Health Report 2001 through 28 facets and 155 items. All six domains need to be assessed to form a basic, yet broad, picture of a mental health system, with a focus on health sector activities. WHO-AIMS provides essential information for mental health policy and service delivery. Countries will be able to develop information-based mental health policy and plans with clear baseline information and targets. Moreover, they will be able to monitor progress in implementing reform policies, providing community services, and involving consumers, families, and other stakeholders in mental health promotion, prevention, care and rehabilitation. This article provides an overview of the rationale, development process, and potential uses and benefits of WHO-AIMS.

Re-Imagining a Global Surgical Organization: A View during and beyond the Pandemic.

BackgroundIn recent years, the fast-paced adoption of digital health (DH) technologies has transformed health care delivery. However, this rapid evolution has also led to challenges such as uncoordinated development and information silos, impeding effective health care integration. Recognizing these challenges, nations have developed digital health strategies (DHSs), aligning with their national health priorities and guidance from global frameworks. The World Health Organization (WHO)’s Global Strategy on Digital Health 2020-2025 (GSDH) guides national DHSs.ObjectiveThis study analyzes the DHSs of Tanzania and Germany as case studies and assesses their alignment with the GSDH and identifies strengths, shortcomings, and areas for improvement.MethodsA comparative policy analysis was conducted, focusing on the DHSs of Tanzania and Germany as case studies, selected for their contrasting health care systems and cooperative history. The analysis involved a three-step process: (1) assessing consistency with the GSDH, (2) comparing similarities and differences, and (3) evaluating the incorporation of emergent technologies. Primary data sources included national eHealth policy documents and related legislation.ResultsBoth Germany’s and Tanzania’s DHSs align significantly with the WHO’s GSDH, incorporating most of its 35 elements, but each missing 5 distinct elements. Specifically, Tanzania’s DHS lacks in areas such as knowledge management and capacity building for leaders, while Germany’s strategy falls short in engaging health care service providers and beneficiaries in development phases and promoting health equity. Both countries, however, excel in other aspects like collaboration, knowledge transfer, and advancing national DHSs, reflecting their commitment to enhancing DH infrastructures. The high ratings of both countries on the Global Digital Health Monitor underscore their substantial progress in DH, although challenges persist in adopting the rapidly advancing technologies and in the need for more inclusive and comprehensive strategies.ConclusionsThis study reveals that both Tanzania and Germany have made significant strides in aligning their DHSs with the WHO’s GSDH. However, the rapid evolution of technologies like artificial intelligence and machine learning presents challenges in keeping strategies up-to-date. This study recommends the development of more comprehensive, inclusive strategies and regular revisions to align with emerging technologies and needs. The research underscores the importance of context-specific adaptations in DHSs and highlights the need for broader, strategic guidelines to direct the future development of the DH ecosystem. The WHO’s GSDH serves as a crucial blueprint for national DHSs. This comparative analysis demonstrates the value and challenges of aligning national strategies with global guidelines. Both Tanzania and Germany offer valuable insights into developing and implementing effective DHSs, highlighting the importance of continuous adaptation and context-specific considerations. Future policy assessments require in-depth knowledge of the country’s health care needs and structure, supplemented by stakeholder input for a comprehensive evaluation.

Q: China has said it will end its reliance on the organs of executed prisoners for transplantation, when did the move towards a new system start? A: Many major transplant countries used the organs from executed prisoners during the history of the development of their organ transplantation services. But with social progress, this unethical practice was abandoned and they started to develop national donation systems that addressed the need for transplant organs. In 2006, Vice Minister Jiefu Huang of the Ministry of Health, who is in charge of organ donation and transplantation in China, stated publicly to the transplant community [all the agencies involved in organ donation and transplantation activities] that China cannot continue to rely on the organs of prisoners and that it's time for China to move on and develop an ethical and sustainable organ donation system. In 2007, the human organ transplant regulation was passed by the State Council of China. This is a crucial piece of legislation for the development of a transplantation system for the Chinese people who need organ transplants. The World Health Organization's (WHO) support has been vital in making this law consistent with international norms. Q: When will the practice of harvesting the organs of executed convicts stop? A: While we cannot deny the executed prisoner's right to donate organs, an organ transplantation system relying on death-row prisoners' organs is not ethical or sustainable. Now there is consensus among China's transplant community that the new system will relinquish the reliance on organs from executed convicts. The implementation of the new national system will start early next year at the latest. This will also mark the start of phasing out the old practice. Although it took decades to establish a sophisticated national organ donation system in western countries, I am optimistic that China can leapfrog to success in a relatively short period of time given the combination of governmental support and international experience. Q: The legislation is in place, how will you make it a reality? A: It has been five years since the law was passed and now it's being revised to address the challenges of establishing a new national system, such as defining the role of national accountable organizations and their responsibilities in line with WHO guidelines. Based on this law, we are establishing procedures for the new system and this is a great challenge for China. On the one hand, we face a great public demand for transplant organs but, on the other hand, organ donation is not only a scientific matter but cultural and societal. That is why, we must address these non-scientific aspects of organ donation to gain public confidence and support. Q: To gain that confidence you need transparency. How are you building transparency into the new system? A: The Red Cross Society of China has been commissioned by the Ministry of Health to run the organ donation system. It also acts as a watchdog to see that organ donation, procurement and allocation within the medical system are done in accordance with the law. In addition, our research team at the University of Hong Kong has developed and maintains our national organ computer system, which allocates organs according to national policy that reflects urgency, compatibility and patient need, known as the China Organ Transplant Response System or COTRS. It is free of human intervention and monitored by many bodies to ensure the transparency, fairness and traceability of organ procurement and allocation. These measures provide the basis for public trust in organ donation. Q: How will the new system work? A: We need public awareness campaigns encouraging people to donate their organs and explaining that there is now a transparent system to handle this. The idea is for people to volunteer by registering with the donation scheme, run by the Red Cross Society of China, and, after their death, their organs can then be allocated via the COTRS. …

UNSTRUCTURED Digital health is having its moment on the diplomatic stage. Recognising the rapidly accelerating digital transformation of healthcare following COVID-19, the ‘G20 Bali Leaders’ Declaration’ called for “continued international dialogue and collaboration on the establishment of trusted global digital health networks, aligning well with the World Health Organization’s (WHO) advocacy for “more effective public participation and transparency in national and international digital health decision-making processes, such as through international consultation processes or a stakeholder forum”. Recognising MEDINFO 2023 as a prime example of such a ‘trusted global digital health network’ and ‘stakeholder forum’ for ‘international digital health decision-making’, we propose a MEDINFO2023 panel discussion on how 'Digital Health Diplomacy’ (DHD) may serve as a boundary-spanner in this growing field to build functional knowledge bridges between regions and cultures. We will present examples from different international contexts where progress is being made on global projects for digital health services. DHD may help the public understand the value of global digital health services, and inform policy-makers and academics about the diplomacy required to achieve them. Following this panel presentation, we invite the convened global digital health community of digital health professionals, diplomats, political and social scientists, epidemiologists, academics, and clinicians to discuss, critique, and advance the emerging domain of DHD for advancing global digital health.

The rapidly advancing digital health requires a standardized approach to classifying Digital Health Interventions (DHIs) for better planning, monitoring, and resource distribution. The World Health Organisation (WHO) developed a Classification for Digital Health Interventions, Services, and Applications in Health (CDISAH) in response to this need. The purpose of this study was to develop an interactive toolkit based on WHO's CDISAH to enhance categorization, making it more interactive, user-friendly, and effective in classifying DHI services and applications, and demonstrate its practical implementation in the field of cardiac rehabilitation. We used a descriptive approach with a seven-step iterative process to create the toolkit. The process began with a review of best practices for converting framework into toolkit, followed by drafting an initial toolkit structure, which was refined through team discussions. The content was based on WHO CDISAH. Expert feedback was incorporated, and quality assurance was conducted through internal and external reviews. The toolkit’s functionality and usability were evaluated through a use case including DHIs, services, and applications for cardiac rehabilitation. The toolkit for WHO CDISAH has a structured interface with clear definitions, practical examples, and intuitive navigation across three main axes: health system challenges, digital health interventions, and digital health applications and services. Pilot testing improved its usability and functionality for accurate classification, highlighting areas for refinement and identifying challenges and solutions for practical implementation. The developed toolkit provides a standardised, portable platform for classifying the multimodal DHIs that align with the framework presented by WHO.

ObjectivesDigital health technologies (DHTs) are recognized by the World Health Organization (WHO) as essential to achieving Universal Health Coverage, yet major equity gaps persist in low-resource settings such as Ethiopia. This scoping review applies the PROGRESS-Plus framework to examine how overlapping social identities (e.g., gender, residence, and income) shape inequities in access to, use of, and engagement with DHTs in Ethiopia's primary healthcare (PHC) system.MethodsFollowing Arksey and O'Malley's framework enhanced by Levac et al. and reported using PRISMA-ScR 2020 guidelines. Searches were conducted in PubMed, Scopus, Web of Science, EMBASE, Google Scholar, and grey-literature sources for studies published between 2015 and 2025. Eligibility criteria were guided by the PCC framework, focusing on digital health interventions (DHIs) within Ethiopia's PHC system with explicit equity relevance. Data were extracted, charted, and synthesized using the PROGRESS-Plus framework, supported by thematic analysis, descriptive statistics, and integration with the WHO digital health intervention taxonomy and the NASSS implementation framework.ResultsTwenty-one studies met inclusion criteria. Digital health inequities consistently clustered around residence, education, socioeconomic status, gender, occupation, and marginalized-group status. Structural barriers, poor connectivity, limited devices, and inadequate digital health skills, disproportionately affected rural and pastoralist communities. Advanced digital health tools (AI, telemedicine, EMRs) were largely restricted to urban and better-resourced settings. Engagement was shaped by cultural and linguistic relevance, trust, peer support, and institutional readiness.ConclusionDigital transformation in Ethiopia's PHC system remains constrained by intersecting social determinants. Applying PROGRESS-Plus demonstrates that technological expansion alone cannot ensure equitable uptake. Equity-centered digital strategies, emphasizing infrastructure, contextualized design, capacity building, and inclusive governance, are essential for meaningful and sustainable digital health transformation adoption across all populations.