World Blood Donor Day: Safe Blood for Saving Mothers

World Blood Donor Day: Safe Blood for Saving Mothers
The theme of World Blood Donor Day (WBDD) this Saturday, June 14 is Safe Blood for Saving Mothers. Global Communities in partnership with the Regional Society for Blood Transfusion Kenya (RSBTK) is implementing the five-year Implementation and Expansion of Blood Safety Activities program. Supported by the U.S. Centers for Disease Control and Prevention with funding from the President’s Emergency Plan for AIDS, the goal of the program is to ensure provision of a safe and sufficient blood supply to health facilities in Kenya through the provision of expert guidance and targeted technical assistance to the Kenya National Blood Transfusion Service (KNBTS) and its affiliates. The program has tremendous impact; it affects more than 40 million people – essentially the entire population of Kenya – and has succeeded in large part because of the hard work of Global Communities on the ground working with various partners to achieve excellent results in ensuring blood safety for at-risk communities. The Global Communities team has worked tirelessly to create legislation to support the blood safety program in the country, implemented a system that tracks blood from donor to recipient, worked to ensure that KNBTS labs are accredited and much more. 
For more information on WBDD go to: https://www.who.int/campaigns/world-blood-donor-day/2014/en/.  To learn more about the Implementation and Expansion of Blood Safety Activities program, please read the interview with Global Communities’ Serah J. Malaba Kambale, Senior Program Manager below.

Interview with Serah J. Malaba Kambale, Senior Program Manager, Kenya Blood Safety

What is your role in the Kenya Blood Safety Program?
I coordinate work plans and oversee the capacity building and program management aspects of the Blood Safety program. My position includes ensuring all technical and administrative support is coordinated, deadlines are met, and that we are on target with deliverables. I also work on the budgeting of the program in collaboration with the finance department.
What is your background and how did you come about to be doing this work?
My first degree was a Bachelors of Science in Family and Consumer Studies, and I received first class honors (which is rare in this country). The degree included aspects of nutrition and development. After getting my Bachelors, I pursued a Masters in Public Health, and spent a long time on my thesis, which was about the referral system for individuals who test HIV positive. We don’t have 100% translation of people living with HIV into care and treatment programs because of gaps in the referral the system. We have lost some people to follow-up. Health care workers refer HIV infected persons to the next level of care and treatment, however there is no active follow-up as to whether or not individuals go to the referral points.
This is my eighth year with CHF/Global Communities; I started in April 2006. I came in originally as a program officer supporting the HIV prevention program under the Local Prevention and Treatment of HIV and AIDS program (LPATH). I was part of the team that closed out the program with Country Director Kimberly Tilock, which was a rigorous process. Then, with a bigger team, I helped to write the proposal for the Blood Safety program. When we won the award, it was clear that my role would be building capacity, as I had previously helped to build the capacities of local partners under LPATH.
How big is the National Blood Transfusion Service?
In total, there are 17 facilities across the country. Six of these are major regional blood transfusion centers, which provide donor education, collect, test, prepare and distribute blood and its components. 
There are also 11 satellite facilities that don’t do blood screening. They collect the blood and then send samples to regional centers for testing. When results come back that the blood is free from infection, they issue it out to transfusing facilities. 
The blood service has an estimated 288 staff. There are also a lot of volunteers that come in through partners and are doing blood donor education and mobilization. There is also support from community donor clubs, which are made up of people taking the initiative to say “let’s come together and donate blood every so often.”
What are some of the successes of the program?
There are many successes. It’s all work in progress but I hope that when we close out it will all be neat and clean.
One of the big goals is to put into place a legislative framework that guides blood transfusion management in Kenya. It will help us to create an institution that manages blood transfusion. The National Blood Transfusion Service currently doesn’t have any legal backing or mandate for the work that it does, though this is critical. Because of this they cannot regulate who collects blood, how it is tested, who can use it, and how to use it. There is no responsible party in the country we can take legal action against if there is no blood. If the legislation is passed, it will ensure that the government will put financing into the system. Now the system, including commodities, equipment, staff, travel, and outreach, is about 95% donor funded (ie: U.S. government). If we pass this legislation, the Kenyan government will put in money as well as regulate the sector, so everything will be streamlined. This is one of the core deliverables for program – creating a semi-autonomous blood transfusion service, as is the practice internationally.
We are also in the process of deploying software to manage information at the blood banks called the Blood Establishment Computer System (BECS). Institution of this will enable the county to have an automated database that will tell us who donors are, where they donated, their blood type, and will give us the ability to recall them through email, text messaging or letters. Currently we have a manual database that is not interconnected.
There is a new concern emerging now – though the blood may be safe, screened and maintained properly, once it gets to the facility, it may be given to the wrong patient, be exposed to microbes, or given in the wrong way—and the risk of killing the patient with “safe” blood occurs. We have medical clinicians who are supposedly experts, however many say they don’t know how to prescribe blood, or don’t know what a specific component looks like. As we close out our program, CHF/Global Communities believes the next step is to look at the idea of blood safety at the hospital level.
What’s the greatest challenge about implementing the Blood Safety program?
The disjoint in funding has been the biggest challenge. We are giving technical assistance to the Kenyan government – NBTS – which gets its own grants to implement blood safety activities. It’s been hard to figure out what motivation/incentive we can give them to take our advice and guidance. We don’t have a budget to give them to implement our guidance – that’s given from many separate entities. For instance, there are different granting mechanisms for procurement, commodities, other partners who are doing blood donor mobilization, construction of centers, and communication/health promotion aspects of program. Because these granting mechanisms are all different with different targets and not coordinated by us, it’s very difficult to ensure that all support is systematic and in sync with what we are advising.
Has there been a change in attitude of blood donors after the work the program has done?
This is very hard to measure because of disjoint in blood donor mobilization funding and partner responsibilities. When we first came in, these partners were only reaching a particular population. We’ve seen increases in blood transfusion and mobilization as part of major calendars of national events. One of the biggest challenges to help our partners overcome is that the adult population cannot leave work between the hours of 8 and 5. So mobilizers need to go to where the donor is and expand mobilization through corporate, faith based orgs, community events and giving them the equipment and tents. We bought tents for Kenya Red Cross to do a simulator for open air blood donation for instance. There is also the scheduling aspect –we give the donor a chance to donate 3-4 times per year, retain the person, and help to build the culture of regular blood donation.
What do you do when you’re not hard at work on the Blood Safety Program?
I am busy with my family – my husband Davis and my children Verisciah and Joseph. I got married and had both of my two babies while working at Global Communities. The day I leave I’ll really cry! When I’m not here I’m either taking care of them or singing with friends. My friends from university and I have a small Christian music band and do concerts once in a while. There are fourteen of us– my husband sings and plays drums, and my children sing too.
I also have a passion for teaching women how to take care of children. Friends will call me up and I will help teach them how to wean babies, how to treat and how to wash a newborn baby. I’m now thinking of going out into the community to do similar work because maternal and child mortalities are high in this country, and we have a lot of “under fives” losing their lives. I feel like I should go to many of these disadvantaged communities. Most of the problems occur due to not knowing about vaccines, the milestones for children, and effective feeding. If you didn’t do the courses I took at university or if you haven’t babysat, then you may not know how to care for a baby. I’ve given people advice on what do if a baby is not achieving certain milestones, and sometimes I’ll advise them to go to a doctor.