Formative Evaluation to Inform Recruitment and Engagement Strategies for emergency activation of blood donors in Nimba County, Liberia

In many parts of the world, the ability to save a life often depends on a single, simple act: someone giving a pint of their own blood to a stranger. While the ideal system relies on people who donate freely and regularly without expecting anything in return, reality in poorer nations often looks different. When a patient arrives at a hospital in critical condition and the blood supply is empty, doctors must turn to a different group: family members of the sick person or individuals who are paid to step forward. These donors are often called into action only during an emergency, creating a makeshift system where the community itself becomes a walking blood bank. This approach is not a formal, scheduled program but a reactive one, activated only when a specific person needs help. Understanding why these people agree to give their blood, and what stops them from doing so, is vital for keeping patients alive in regions where the medical system cannot always provide a steady supply.

Researchers recently traveled to Nimba County in Liberia to listen to the stories of these specific donors. They wanted to understand the minds of the people who show up when a hospital calls for help, whether they are family members or those receiving payment. The team conducted interviews with twelve people who had donated blood in the year before the study. The group was almost entirely men, including students, workers, and retirees. The researchers asked them about their experiences, what motivated them to give, and what fears or hurdles they faced. The goal was to find out how to build a more reliable system that could save more lives without relying solely on the chaos of emergency calls.

The interviews revealed that the drive to give blood is deeply personal and often rooted in a desire to save a life. Many participants spoke of a strong sense of duty, particularly when the person in need was a family member. One donor described how his children convinced him to give, saying he would do anything to keep them alive. Others felt a sense of accomplishment, describing the act as a way to contribute positively to their community. Some even believed that donating was good for their own health, thinking it helped clear out old blood or reduce headaches. A few donors mentioned that they felt a special responsibility because they knew they had a common blood type that could help many different people. Beyond these internal feelings, the experience at the hospital mattered greatly. Donors appreciated when staff treated them with respect, kept their information private, and encouraged them to eat a meal of tomatoes and eggs before and after the procedure. These small acts of care made the process feel less daunting and more human.

However, the path to giving blood is not always smooth. The biggest obstacles were practical and financial. Many donors lived far from the hospital, and the cost of getting there—often paying for a motorbike ride—was a significant barrier. One person noted that a one-way trip could cost 150 Liberian dollars, a sum that might be hard to find in an emergency. There were also deep-seated fears about the medical process itself. Before their first donation, many people worried that giving blood would make them sick or that their bodies would run out of blood if they did not keep giving. Others were terrified of the testing process, specifically the fear that a test for HIV might reveal a positive result and that this private information would be shared with others. These fears were powerful enough to stop people from volunteering, even when they wanted to help.

The study also uncovered a complex mix of motivations regarding payment. While the World Health Organization prefers that blood be given freely, the reality in Liberia involves a mix of family replacement and paid donors. Some participants admitted they would prefer to receive cash, with one suggesting a figure of 3,000 Liberian dollars as a fair exchange. Yet, many others said that simply being thanked or recognized was enough. They felt that a certificate or a public ceremony would be a meaningful reward, perhaps even more than money. The researchers found that the idea of a "walking blood bank"—where a list of ready donors is kept and called upon in emergencies—was generally acceptable to the people interviewed. They believed that reaching out to schools, churches, and community centers would be an effective way to find new donors.

Despite the willingness to help, the study suggests that building a better system requires addressing the specific fears and costs that hold people back. The researchers found that the anxiety about testing and the worry about health risks often disappeared after a person had donated blood once. This suggests that the best way to grow the donor pool might not be to focus only on new people, but to keep in touch with those who have already given. Once someone has experienced the process and realized it is safe, they are more likely to return and even bring others with them. The study concludes that while emergency activation works, a more organized approach that covers travel costs, ensures privacy during testing, and maintains a connection with past donors could make a life-saving difference in Liberia and similar regions.