SAN FRANCISCO — Three district hospitals in Rwanda have managed to bring maternal deaths down to zero — in part thanks to technology.
“Our hospital is located high out in the mountainous territory where transport is not easy,” said Dr. Emmanuel Kayitare, director general at Shyira District Hospital, in an article in the Rwandan newspaper The New Times.
Kayitare and his team have convinced community health workers and health centers to send pregnant women to the hospital early so they get intensive care. When a woman needs a transfusion, whether due to a caesarian section, postpartum hemorrhaging, or other complications, the staff can log onto their phones and order blood by drone. The hospital works with Zipline, an automated logistics company that designs, manufactures, and operates drones that deliver lifesaving products including blood.
“This is a continent-wide problem, and we figured if we could hack it in Lagos, that means we have a model that could be replicated across the continent and developing world.”— Ifeoluwa Olokode, head of partnerships and growth, LifeBank Nigeria
Blood availability, safety, and accessibility are essential components of a strong health system and universal health coverage. In developing countries, blood transfusions are often used to treat pregnancy-related complications as well as severe childhood anemia. But insufficient blood supply, challenges with delivery, and transfusion-transmitted infections often mean national blood systems cannot meet the needs of all patients.
A number of efforts are underway to bring innovation to blood donation and delivery, and the most successful efforts focus both on deploying technological solutions, and on working with national health care policy and infrastructure.
Hema Budaraju, product lead for health at Facebook, focused on the need for people to donate blood during a presentation at Devex’s recent Prescription for Progress event in San Francisco, California.
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One to 3 percent of the population needs to donate blood regularly for health systems to function efficiently, and yet more than 70 countries have a shortage of blood, she said, standing in front of a slide quoting the World Health Organization: “Voluntary donation is the foundation of a safe and sufficient blood supply.”
Facebook has built products and features for blood donation, including pages for donor registration, tools for blood banks to recruit donors and alert them when there is a need, and platforms where these donors can remain informed and engaged.
The services began in India, where Facebook saw that blood banks were using its social media network and WhatsApp messaging service, and have since expanded to Bangladesh, Pakistan, and Brazil. More than 20 million people have signed up as blood donors on Facebook and the service has already facilitated tens of thousands of donations.
But some have raised concerns about these tools. For example, in India, public health officials warn they could fuel a black market for blood, and have called for changes by Facebook.
Budaraju highlighted the importance of establishing on-the-ground partnerships, which is one way of avoiding these risks and addressing these concerns.
Improving the blood cold chain
There has been an increase in blood transfusion globally, from 85 million units in 2012 to 112.5 million units in 2016. More than half of the blood donations collected worldwide are in high-income countries, home to just 19 percent of the global population, creating a gap between levels of access to blood between low- and high-income countries. Developing countries also face unique challenges when it comes to the blood cold chain, or the storing and transporting of blood.
“Innovation in this space is vital,” Osaro Erhabor, professor in the department of hematology at Usmanu Danfodiyo University in Nigeria, told Devex via email. “The health ministry should ideally be the driver of safe and effective blood transfusion service delivery.”
One change he would like to see is nurses transporting blood in validated cold chain managed boxes to patients who depend on transfusion, so they can remain in their homes instead of regularly visiting the hospital.
WHO recommended in a report on global blood safety and availability that all activities related to blood collection, testing, storage, and distribution be coordinated at the national level through “effective organization and integrated blood supply networks.”
It calls for national blood policies and legislative frameworks that promote uniform blood quality and safety. As technology companies bring solutions for blood storage and delivery to developing countries, government partnerships are emerging as the key pathways for scale.
Working with health systems
Zipline’s first customer was the Rwandan government, which it partnered with to establish the first national scale drone delivery network.
“The government chose blood delivery because it was one of the most complex and yet critical parts of their medical supply chain and they needed help,” said Brittany Hume Charm, head of global health partnerships at Zipline.
Zipline has helped Rwanda with routine resupply as well as emergency delivery. Last month, the company announced an expansion to reach every hospital in the country, as it also looks at products beyond blood including vaccines, emergency and essential medicines, and specialty products.
“Blood is so precious, and sometimes the roads are not functioning, or even if the roads are functioning it takes four hours and it’s too late,” said Agnes Binagwaho, the former minister of health from Rwanda, who signed the deal with Zipline.
She saw the potential for drones to connect storage facilities with delivery points across the country, and used government funds to cover the cost of the service fees.
Zipline stands out from other technology companies because of the way it works in partnership with health ministries. Rwanda has embraced innovation more than other developing countries, and panelists at Prescription for Progress, where Charm and Binagwaho spoke, said Zipline and Rwanda defy the status quo: technology companies bypassing systems and governments trying to catch up.
Supporting local solutions
When Ifeoluwa Olokode, head of partnerships and growth at LifeBank Nigeria, pitched a room of investors at the International Finance Corporation’s Emerging Markets Venture Forum in San Francisco last month, she called Zipline a limited mobility solution.
“LifeBank is a transportation agnostic company,” she told Devex in a follow-up interview. “We are interested in the quickest way to get things to hospitals, whether it be motorbikes or trucks or drones.”
While there are a number of innovations in blood donation and delivery, donors and investors seem fixated on drones, rather than being open to the best mobility solutions to get blood to the patients who need it, she said.
“This is a continent-wide problem, and we figured if we could hack it in Lagos, that means we have a model that could be replicated across the continent and developing world,” Olokode said.
She welcomed the innovations that Facebook, Zipline, and others are bringing to blood delivery and donation, but also said she hopes to see more entrepreneurs based in developing countries, solving problems their own health systems face.