Investing in Access: Sickle Cell Care as an Entry Point for Blood-Health Systems in Africa

Abstract

Sickle cell disease is one of Africa's highest-burden inherited conditions, yet access to early diagnosis, essential treatment, blood services and follow-up remains uneven. Financing is fragmented, and households often incur substantial out-of-pocket costs. This policy and thought-leadership paper reframes the problem as a financing and delivery gap. It argues that sickle cell disease can serve as a practical starting point for strengthening wider blood-health systems, and that observed spending can understate true need when people delay or forgo care. The term access intelligence is used to describe the combination of registry, service, patient, and cost data to identify where care is missed and what requires financing or strengthening. Building on existing African programmes and financing approaches, the paper outlines a staged model: foundational public functions, shared infrastructure, and specialised capabilities added only when basic services are working reliably. ReachOne for sickle cell disease is presented as a bounded Nigerian implementation and learning platform, not a substitute for public financing or existing programmes. Screening prices have fallen sharply, but cost per child in continuing care is set by linkage and retention, not the price of a test. Three steps follow: access measures with published baselines; funded baseline establishment in one high-burden country; and matching diaspora financing mechanisms to a defined pathway and registry.