Commercial donors give blood to earn cash and are normally contacted by middlemen who broker deals between them and the patients. A donor is advised to donate no more than twice a year, but because this practice is illegal, it is not regulated in any way. Many commercial donors donate blood much more frequently than this.

Oloyede Adebola, a 37-year-old mother of two, has had to deal with racketeers twice. Talking to Al Jazeera at her home in Sarumi, a quiet neighbourhood in Ibadan, she explained that her eight-year-old daughter suddenly fell ill in 2021 and received a transfusion at an Ibadan hospital that then refused to discharge the girl until the blood was replaced. Like most Nigerians, she prefers not to donate blood, so she was connected by a friend to a network of middlemen, which in turn connected her to a commercial donor. Adebola told the hospital this man was a relative and paid $23 for donating a pint (nearly half a litre) of blood – three times her monthly earnings. The middleman took half the money.

There are some privately run blood banks in Nigeria, but not all are registered with the National Blood Transfusion Commission and are, therefore, unregulated.

This causes an additional layer of anxiety for patients and their families who worry about the quality of blood they are receiving, especially for economically disadvantaged families who receive blood via clinics that don’t have state-of-the-art facilities and are not regulated.

There is no way to be sure that this blood has been checked at all, let alone collected and stored in accordance with proper medical practice. Patients also worry about the extra costs because they have to pay for the screening of the blood as well.

The commission itself does not have the resources to monitor these blood banks or oversee screenings of blood used by hospitals that has been sourced by patients themselves.

Commercial blood donations carry a penalty of six months in prison. In reality, however, few people have ever been prosecuted.Even in Lagos, where the blood donation service receives higher funding than the one in Ibadan and where blood donations are screened and tracked, only two clinics have been shut down for operating without a licence. One prosecution is currently going through the courts but has dragged on for five years because of backlogs in the court system.

Ideally, Omale said, the commission aspires to transform all six regional blood transfusion services from mere donation centres to resources similar to the Lagos State Blood Transfusion Service, which carries out regular inspections of blood banks and hospitals to ensure that they follow safety guidelines.

For now, most hospitals cannot even verify the identity of donors. The process of doing so is just too far down the list of priorities that the commission needs to meet. Its primary focus is on meeting the demand for blood, which currently outstrips supply by 75 percent in Nigeria, according to the World Health Organization.

While enforcement of blood donation regulations is “the next phase in the plan”, Omale says, the commission is currently throwing its energies into advertising campaigns across the country to encourage voluntary blood donations through official channels.

In the meantime, the use of commercial blood donors remains a thriving business in most parts of the country.

At Ibadan University College Hospital, the region’s main government hospital, a nurse and a janitor who spoke to Al Jazeera on the condition of anonymity confirmed that most people who come to donate blood are commercial blood donors.These donors, overwhelmingly men, are usually contacted by a middleman and paid to pretend to be relatives of patients. One of the donors waiting at the clinic, a motorcycle taxi driver, told Al Jazeera that he donates blood at least twice a year in exchange for money and has been doing it since 2017.

“The price for donating blood changes depending on how I negotiate. Normally, I earn $10 from donating a pint of blood,” he said. “That’s double what I can earn on a good day if I work for 10 hours straight.”

A family in debt

To pay for Fowarogun’s emergency blood transfusion this year, Dasola took out a loan of $70 from a local lender who she frequently turns to whenever she needs a bailout. She had agreed to pay $3 a day for 24 days on the condition that missing a single payment would double her daily payment to $6. And if she failed to pay the lender back in full, he said he would show up at her house to cause a scene and seize her furniture. He even threatened to have her arrested for the debt.

On the one occasion Dasola could not afford to pay, Fowarogun’s 25-year-old brother, who works in aluminium manufacturing, was able to step in. He then became the guarantor for the loan – another issue that causes anxiety. “I am not happy about my condition,” Fowarogun said. “I get teary when I think about how burdensome it has been for my family.”

Fowarogun faces a future of constantly “chasing” safe blood. The teenager says she’s given up on her dream of becoming a nurse because her family can’t afford to pay for more schooling when they have already fallen into debt because of her medical treatment.

Dasola, preoccupied by a stack of medical receipts tucked into a maroon Bible on the family’s living room table, said that while she’s glad her daughter is healthy for the time being, she’s not sure how she’ll pay for the future blood transfusions that Fowarogun will inevitably need.

“I fear for my daughter,” Dasola says. “Her condition has taken a major toll on my health too because of stress and family finances. This would not be our situation if blood was readily available and safe.”

Additional reporting by Linus Unah

This article was produced with the support of the Investigative Reporting Program at the UC Berkeley Graduate School of Journalism