Nigeria faces a reported shortfall in blood collection alongside challenges in timely access to suitable blood. This narrative review and policy analysis explores evidence from within Nigeria, combined with publications from the World Health Organization, relevant legislation and blood safety standards, as well as reports from departments and organizations. The experience of a number of multicentre studies reveals the variability between centers for the preparation of blood components, the use of testing for blood-borne infections, recording of blood issues, and other aspects of blood transfusion. The paper discusses the use of electronic reporting, subnational haemovigilance, and an evolving National Blood Management System. Local studies point to the major barrier of affordability and the persistence of commercial donation. Blood availability is a system property: safely collected and clinically appropriate blood must be able to be identified, verified, allocated, transported, and delivered to the patient who needs it in time. Rather than establishing entirely new institutions, blood systems can be strengthened in a phased manner, with the option of expansion depending on local ‘operational readiness’ and their subsequent performance. However, there is uneven coverage of studies, conflicting data on collection figures, and a lack of data on the implementation and cost of different strategies to increase blood availability, which limits analysis of the national situation and of cause and effect.