LETTERS: Reform the management of blood services

Recent reports appearing in the Kenyan media suggest an impending crisis on blood services in the country. This is as a result of the recent withdrawal of Sh2 billion US funding for the services, which will exacerbate an already bad situation.

The Kenya National Blood Transfusion Services (KNBTS), the organisation mandated to run blood services in the country, says that the country needs approximately 500,000 units of blood per year.

However, only 32 percent of this is collected, leaving the country with a major shortfall. One can only imagine the impact the funding withdraw will have on the already bad situation.

Blood is a crucial requirement in many clinical processes. Blood is a constant requirement for accident victims, mothers in labour, individuals with sickle cell disease, and cancer and malaria victims, among others. We posit that the Universal Health Care (UHC) agenda will only remain a pipe dream if we fail to fix the management of blood services.

The current situation, as bad as it appears to be, offers a chance to revisit blood services management with a view to implementing long overdue structural changes that would boost donations and inject efficiency and effectiveness into the system.

The country needs to get it right with financing blood services. The fact is that blood is such a crucial component of healthcare delivery that it should not be left to the whims of external funding. While US funding may have sustained the service to date, its withdrawal, and accompanying reasons are beyond our control as a country. This places a number of lives at risk, at the very least. In the worst case scenario, a number of lives could be lost.

It is critical that the national government (through the Ministry of Health) and county governments, move quickly to remove this external dependency for financing crucial aspects of health care such as blood services. As a principle, core services such as blood services management need to have predictable funding duly catered for through our budgeting processes at the two levels of government. The regulation and administration of blood services needs a re-assessment with a view to improving its efficiency and effectiveness.

Today, the KNBTS plays the most critical role in sourcing, screening and distributing blood across the country for public health facilities. Except for establishments like Kenyatta National Hospital (KNH) and Moi Teaching and Referral Hospital (MTRH) and non-public hospitals, most public transfusing facilities rely on the KNBTS for blood screening and distribution. This is the case even where transfusing facilities do their own blood donation drives.

For blood donations, most facilities rely on institutions such as schools, colleges and churches. And while blood donation appeals targeting the public are routine, they are not as effective as those targeting institutions. Blood screening is usually done at the KNBTS-run six Regional Blood Transfusion Centres (RBTCs) across the country. Usually, the turnaround time for screening is significant and can be the ‘distance between life and death’.

Technology can help with donor registration and keeping ongoing contact with the donors. It has been demonstrated that such an approach helps boost blood donations; ongoing contact with donors helps to convert one-time donors to regular donors.

Technology can also help with information-sharing among facilities and other stakeholders. Today, an ambulance picking an accident victim only guesses where to take the patient. It is often the case that the ambulance lands at a facility and there is no blood.

Facilities routinely call one another to find out whether there is blood to spare. This manual process can be exhausting and consumes a lot of time that otherwise would be devoted to attend to patients. It is possible to use technology to share blood-related information among facilities. Such an approach could be the difference between life and death for many a patient.

In summary, blood is an integral component of Universal Health Care. It needs to be managed with substantial diligence and requisite standards, efficiency and effectiveness. It is not sustainable to run blood services in its current form. Fixing current processed requires appropriate and commensurate financing, regulation and use of technology.

There is a need for assured budget lines (at national and country government levels) for the services to avoid external dependency as has happened with the withdrawal of US funding for the service.

Matunda Nyanchama, Aaron Ogunde and Francis Kilemi – Damu-Sasa Systems Ltd., Nairobi.