NAIROBI — When someone in Kenya needs blood, their friends and family often seek out donors on social media, putting out an urgent plea for whatever type of blood is needed. They are forced to do this because the nation’s blood bank doesn’t function as it should.
“When somebody needs blood for surgery right now in the hospitals, it's very much: find your own blood," said Yaniv Gelnik, global business development lead at Zipline, which is in conversations with the government about expanding its services of delivering blood by drone to health facilities in Kenya.
There is a perennial shortage of blood in the country. Last year, the Kenya National Blood Transfusion Service collected only 16% of the 1 million units the country needed. The year before, it had the same shortfalls.
“COVID-19 does not stop people from having babies, it doesn't stop them from needing blood transfusions.”— Temie Giwa-Tubosun, founder and CEO, LifeBank
“A critical review of the blood situation in Kenya shows that there is a huge, huge, huge gap that we have,” said Mutahi Kagwe, the nation’s health cabinet secretary, during a speech this week.
One of the issues is that there isn’t a culture of donating blood in the country, another is funding gaps.
The national blood service took a hit last October, when the U.S. President's Emergency Plan for AIDS Relief cut its support to the country’s blood services, which provided the bulk of its financing, leaving the country unprepared to fill in the gap.
There are also questions around the mismanagement of the scarce resource. Kenya’s Directorate of Criminal Investigations is currently investigating officers of the blood service for allegedly stealing donated blood in Kenya and selling it in Somalia.
The coronavirus pandemic has exacerbated an already precarious situation. As parts of the country entered into lockdown in early April and people began to self-isolate, large scale blood drives became impossible to host, and few were willing to visit health facilities to donate because of fear of being infected with the coronavirus.
“We already had a deficit [of blood] even before COVID-19 came … COVID-19 just came and made the situation worse,” said Aaron Ogunde, director of Damu-Sasa, a Kenyan-based blood services information management system, during a recent webinar focused on blood shortages.
Funding to improve blood services
At the beginning of April, Kenya received $50 million from the World Bank for its emergency response to COVID-19. One-fifth of the funding was specifically allocated to strengthening the capacity of the Kenya National Blood Transfusion Service.
Kenya’s Ministry of Health reassured the public that services will continue uninterrupted, but health actors told Devex the government is not adequately prepared.
“This is important especially this time when supply will drop because the would-be blood donors are less likely to go out to donate,” said Jane Chuma, senior health economist and task team leader at the World Bank, in a press release.
Of the 67 countries receiving financial assistance or redeploying existing projects from the World Bank for their COVID-19 response, Kenya is the only country that has funding specifically allocated to improving blood services during the pandemic.
This week a national advisory committee was inaugurated to oversee the supply and distribution of blood products. There is also draft legislation under review that will create a roadmap for reform of the Kenya National Blood Transfusion Service.
While experts say the shortages in Kenya are particularly bad, there are concerns over blood shortages across the world as the pandemic wears on.
“We think that this concern is going to be widely shared across Africa, across the world, really,” said Temie Giwa-Tubosun, founder and CEO of LifeBank, a Lagos-based blood and oxygen delivery company that also operates in Kenya, during the webinar.
But lower-income countries are slated to suffer the worst. Of blood donation globally, 42% are collected in high-income countries, which only account for 16% of the world’s population.
Donor scheduling, moving blood efficiently
There need to be strategies for blood drives to continue amidst the pandemic, experts say.
“COVID-19 does not stop people from having babies, it doesn't stop them from needing blood transfusions,” Giwa-Tubosun said.
One strategy is donor scheduling. Damu-Sasa has a platform that allows for donor scheduling, where a donor inputs their information, including the time and place they want to donate. This allows the facility to space out visits to donate.
“The last thing we want to do is call for a blood donation drive and then we arrive — 100 of us. The need for donor scheduling is now imperative,” Ogunde said.
Health facilities should also advertise what steps they are taking to ensure the safety of donors, he added.
“People need to feel like they're being protected when they come in to make this personal sacrifice to give blood, and people who are working, they also need to be protected,” Giwa-Tubosun said.
But in addition, Kenya needs to effectively manage the blood supplies it already has. “The one thing that we don't want to do is to go ahead and lose what we already have collected either through it expiring or a cold chain violation,” Ogunde said.
With lockdowns and other movement restrictions, moving blood supplies around countries by land is expected to become more difficult.
Delivery was already strained. Kenya's national blood service doesn't deliver blood all the way to the health facility level, Gelnik said. It only delivers it to regional warehouses and then the counties have the responsibility to collect the blood from there, but many of the counties don't have a budget for vehicles.
The company Zipline uses autonomous drones to deliver blood in Rwanda and Ghana. In a rural area, a health care worker can alert Zipline that they need a certain type of blood. The blood would then be transported from the company’s warehouses to the health facility, without a break in the cold chain.
“Demand and curiosity about the service is definitely up. We're seeing multiple emails, every day, from around the world," he said. "Countries that have realized that they need instant delivery of blood or they have certain parts of the country where they've had to cut off deliveries and chronic care patients are suffering — they've come to the conclusion that we're the right solution for that."
There is also a need to enhance collaboration amongst facilities, Ogunde said, to make it easier and faster for facilities to share information on blood that is available so that one facility can share with the other. This includes a mapping of where the need for blood is. Even if a certain type of blood is available, it might not be able to reach the health facility where it is needed.
“Making sure that blood is actually available and ready, not just available within the country, but actually within the facility where the patient has been treated is pretty critical,” said Giwa-Tubosun, whose company, LifeBank, uses drones, boats, trucks, and motorbikes to deliver blood supplies in the countries it operates.
Autotransfusion and apheresis donations
Another strategy to deal with the shortage is the use of medical devices like Hemafuse, which is used for autotransfusion — which is a technique where a patient’s own blood is salvaged during a medical procedure, which allows the health workers to use the patient’s own blood, rather than donor blood. It cannot be used in all circumstances, so this type of device does not negate the need for donor blood, but can be used to supplement the donor supply.
“When you use Hemafuse, you're saving one extra unit or three units sometimes, for those who bleed a lot, for someone else who doesn't have that luxury of using their own blood during surgery,” Dr. Elizabeth Wala, a member of the national advisory committee, said during the webinar on blood shortages.
Apheresis donations can also help to supplement the blood supply, Ogunde said. During these donations, only certain parts of the blood are collected and the rest is returned to the donor. This can increase the frequency in which someone is able to donate.
Beyond the need for blood to save lives in general, one of the potential treatments for COVID-19 is the use of convalescent plasma. This is the isolation of the plasma portion of blood to create an antibody-rich serum from those who recovered from the disease.
“All hands on deck. Blood is needed. There's no substitute for it. We all have to do the work to make sure it is widely available,” Giwa-Tubosun said. “It's the difference between life and death for a lot of people.”