**2. UHC and the WHO model lists as governmental obligations to implement before 2030**

Nigeria is a party to the United Nation (UN) General Assembly adopted 2030 agenda for Sustainable Development and the UN High-Level Meeting (UN HLM) Universal Health Coverage (UHC) UHC2030. In September 2015, the UN General Assembly adopted the 2030 Agenda for Sustainable Development that included 17 Sustainable Development Goals (SDGs) ensuring that all persons are carried along and that no one is left behind [4]. The agenda laid emphasis a holistic approach aimed at achieving sustainable development for all. The 17 sustainable development goals (SDGs) included; no poverty, zero hunger, good health and well-being, quality education, gender equality, clean water and sanitation, affordable and clean energy, decent work and economic growth, industrial innovation and infrastructure, reduced inequality, sustainable cities and communities, responsible consumption

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*Distribution of Clinically Relevant Blood Group Antigens among Nigerians…*

and production, climate action, life below water, life on land, peace and justice strong institutions and partnerships to achieve goal. On September 23rd 2019, a high-level meeting on universal health coverage held at the United Nations General Assembly. The meeting focussed on Universal Health Coverage: Moving Together to Build a Healthier World (UHC2030) and brought together heads of state, political and health leaders, policy-makers, and universal health coverage champions to advocate for health for all. The meeting agreed on Key Asks from the UHC Movement aimed at accelerating progress toward Universal Health Coverage (UHC) [4]. Among others, UHC2030 advocates that countries should; ensure political leadership beyond health (that all countries to ensure healthy lives and wellbeing for all at all stages as a social contract), leave no one behind (pursue equity in access to quality health services with financial protection), regulate and legislate (create a strong, enabling regulatory and legal environment responsive to people's needs), uphold the quality of care (build high-quality health systems that people and communities trust), invest more and better (increased domestic investment and allocation of more public financing for health through equitable and mandatory resource) and move together (establishing multi-stakeholder mechanisms for engaging the whole of society for a healthier world). Nigeria is a party to the global commitment ensuring the well-being, universal health coverage and access to quality healthcare when and where they need it, without facing financial hardship [5]. There is general expectation among Nigerians for the government to mix word with action by ensuring that all Nigerians in both rural and urban communities have access and can use the promotive, preventive, curative, rehabilitative and palliative

health services they require, that is of sufficient quality and affordable [6].

**3.1 Distribution of ABO and other clinically significant blood groups**

The human red blood cell membrane is complex and contains a number of clinically relevant blood group antigens, the most relevant being the ABO and the Rhesus blood group antigens. Apart from the ABO and Rhesus blood group systems, thirty-four other blood group systems have been identified as at November 2014 [7]. In addition to the ABO and Rhesus blood group antigens, 364 other red cell antigens have been identified serologically. The clinical relevance of a blood group system depends on the distribution of antigens of the blood group system in the population, ability of antibodies of the blood group system to cause haemolytic transfusion reaction (HTR) and haemolytic disease of the foetus and newborn (HDFN) [8]. The ABO blood group system is one of the most clinically relevant blood group systems [9]. It was first discovered by Karl Landsteiner in 1901 [10]. The ABO blood group system has three main antigens (A, B and H). Four major ABO groups exist (A, B, AB and O). The ABO blood group system is based on the A and B antigens occurring singly as A or B, doubling as AB or the absence of both as O. Individuals who have lack the A or B antigens on their red cells have the group specific antibody in their serum or plasma. Antibodies of the system are predominantly IgM originally thought to be naturally occurring but are now known to occur in the first years of life as a result of sensitization to ABO-like antigen and environmental substances that occur in nature such as bacteria, viruses and food. Evidence has shown that these antibodies are not present at birth and that animals kept in a sterile room from birth do not produce these antibodies. The ABO blood group system is important in transfusion medicine, HDFN and in organ transplant. Transfusion of ABO incompatible unit can cause severe HTR. Similarly, an immune response can also occur

*DOI: http://dx.doi.org/10.5772/intechopen.90372*

**3. Current situation in Nigeria**

*Distribution of Clinically Relevant Blood Group Antigens among Nigerians… DOI: http://dx.doi.org/10.5772/intechopen.90372*

and production, climate action, life below water, life on land, peace and justice strong institutions and partnerships to achieve goal. On September 23rd 2019, a high-level meeting on universal health coverage held at the United Nations General Assembly. The meeting focussed on Universal Health Coverage: Moving Together to Build a Healthier World (UHC2030) and brought together heads of state, political and health leaders, policy-makers, and universal health coverage champions to advocate for health for all. The meeting agreed on Key Asks from the UHC Movement aimed at accelerating progress toward Universal Health Coverage (UHC) [4]. Among others, UHC2030 advocates that countries should; ensure political leadership beyond health (that all countries to ensure healthy lives and wellbeing for all at all stages as a social contract), leave no one behind (pursue equity in access to quality health services with financial protection), regulate and legislate (create a strong, enabling regulatory and legal environment responsive to people's needs), uphold the quality of care (build high-quality health systems that people and communities trust), invest more and better (increased domestic investment and allocation of more public financing for health through equitable and mandatory resource) and move together (establishing multi-stakeholder mechanisms for engaging the whole of society for a healthier world). Nigeria is a party to the global commitment ensuring the well-being, universal health coverage and access to quality healthcare when and where they need it, without facing financial hardship [5]. There is general expectation among Nigerians for the government to mix word with action by ensuring that all Nigerians in both rural and urban communities have access and can use the promotive, preventive, curative, rehabilitative and palliative health services they require, that is of sufficient quality and affordable [6].
