WORKING WITH GOVERNMENT FOR THE PROMOTION OF PATIENT CENTRED BLOOD TRANSFUSION MEDICINE IN KENYA, THE RSBTK EXPERIENCE Mary W. Kariithi IAPO Africa Region Meeting Entebbe, Uganda 4th – 5th July 2017

Background Information; Introduction to RSBTK; RSBTK Work (Implementation of a Blood Safety Project in partnership with Government), challenges and lessons learned ; Recommendations Trust Building and Acceptance Tips

BACKGROUND INFORMATION Blood is life, a drug and a biological product. Blood transfusion is a risky but necessary practice. Currently there is no alternative to blood transfusion. Governments across the globe are responsible for ensuring availability, safety and efficacy of the transfused blood. In African region, ensuring blood availability and safety has been a challenge for many African governments. Many lives are lost due to lack of blood and poor transfusion practices. The challenges include, blood shortages, inappropriate usage, wastage of the available blood and inadequate knowledge and skills amongst health workers.

BACKGROUND INFORMATION (cont.) Kenya government developed policy guidelines to assist blood transfusion practitioners ‘’ (appropriate use of blood and blood products among others). The guidelines were developed following lobbying, advocacy and participation of the RSBTK and its members. The government experienced challenges in the distribution and dissemination of the guidelines. With the mandate of and in partnership with the Ministry of Health (MOH) and Kenya National Blood Transfusion Service (KNBTS), RSBTK has been disseminating and implementing the guidelines through blood safety programs with considerable successes and has learned lessons that can be applied in other health programs in Africa.

INTRODUCTION TO RSBTK A Kenyan indigenous non- profit professional organisation, Registered in 2007. National Secretariat based in Nairobi, Kenya. Has an Established constitution and a board of directors. Membership Consists of individuals, corporate and honorary members. Professionals mainly from the National Public Health Laboratory Services, the Kenya National Blood Transfusion Service (KNBTS), Kenyatta National Hospital, University of Nairobi’s Department of Haematology, Medical Training colleges, Public and Private hospitals across the country. These include: Doctors (General Practitioners), Surgeons, Haematologists, Pediatricians, Gynecologists, nurses, Clinical Officers, Laboratory Technologists, University Lecturers and Public Health Specialists. RSBTK is an associate member of IAPO and a patients’ advocate.

Mission, Vision and Goal  To provide technical expertise and interventions for the promotion of local and international standards in blood transfusion and the related health practices in Kenya and beyond. Safe and Efficient Blood Transfusion Services and Related Health Practices.  To make blood transfusion medicine safe and accessible for the benefit of all needy patients.

Objectives To promote and maintain the highest level of ethical and professional standards in blood transfusion; To contribute to the advancement of knowledge and skills in blood transfusion; To be a resource institute accessible to individual blood transfusion services; To encourage international collaborative programs dealing with manpower development, donor recruitment, safety in donor recruitment, donor screening and general transfusion practice; To collaborate with other national and international organizations with similar objectives; To undertake any project/research in the area of blood transfusion in Kenya.

RSBTK WORK (IMPLEMENTATION OF A BLOOD SAFETY PROJECT) RSBT-K provides a forum for networking for health care professionals interested in safe blood transfusion practices, Working through its volunteer experts to advocate, disseminate national guidelines, promote, train and mentor healthcare workers involved in blood transfusion and related medical fields at the hospital settings. RSBTK successfully implemented a blood safety project in partnership and collaboration with the government at both national and hospital Management Teams level. The following are the project details  

Project Goal Quality clinical transfusion process that ensures transfusion of the right unit of blood, to the right patient at the right time, and in the right condition and according to appropriate guidelines. Project Strategy RSBTK blood safety project strategy involved establishment and mentorship of Hospital Transfusion Committees (HTCs), through which the national guidelines on blood transfusion were disseminated and implemented as follows:- Establishment of Hospital Blood Transfusion Committees (HTCs); Capacity building of the established HTCs; Support regular HTCs meetings aimed at addressing blood transfusion issues; Provision of mentorship to the HTCs;

Project Strategy Cont Support CMEs on blood transfusion through provision of experts for facilitation; Dissemination of National Blood Transfusion Guidelines through CMEs. This is to ensure adherence to national policy guidelines on blood transfusion including the appropriate use of blood and blood products; Institutionalizing systems that ensures safe blood transfusion practices; ( HTCs, cold chain, haemovigillance) Training of health workers. Provide support for development of hospital based policy guidelines

Health workers from Webuye District Hospital at a haemovigilance workshop

Expected Outcomes Safe: No adverse transfusion reactions or infections. Clinically effective: For patient benefits only and Benefits the patient. Efficient: No unneccessary transfusions. Transfusion at the time the patient needs it.

Project Implementation Strategy Involved establishment and mentorship of Hospital Transfusion Committees (HTCs), through which the national guidelines on blood transfusion were disseminated and implemented as follows:- Establishment of Hospital Blood Transfusion Committees (HTCs); Capacity building of the established HTCs; Support regular HTCs meetings aimed at addressing blood transfusion issues; Provision of mentorship to the HTCs; Support CMEs on blood transfusion through provision of experts for facilitation; Dissemination of National Blood Transfusion Guidelines through CMEs. This is to ensure adherence to national policy guidelines; Institutionalizing systems that ensures safe blood transfusion practices; Training of health workers.

Poor handling of blood

Approach To The Overall Program Implementation Obtain the introduction letter from the director of medical services; Organize sensitization meetings at the hospital level targeting hospital management teams; Identify problems and agree on solutions and systems that support the program implementation; Form the hospital transfusion committees through which activities will be implemented; Train members of the hospital transfusion committees; Monitor and provide support to the committees; Train the doctors, nurses and laboratory personnel in a multidisciplinary forum ; Train ward and laboratory in charges on haemovigillance; Carry out support supervision aimed at identifying challenges and providing solutions; Monitor and evaluate the implementation, receiving, compiling and submitting reports to the government and funding organization.

Advocacy meeting with the Coast Province Director of Medical Service

Successes Changed blood transfusion practices at 40 targeted hospitals, including KNH. Increased blood component use which is more effective than whole blood. Reduced wastage through effective management of the cold chain and component use. Increased availability and access to more patients. Reduced risks associated with blood transfusion and saved lives.

Launch of the Bungoma District Hospital Transfusion policy

Challenges Experienced Inadequate and erratic funding; Staff shortages and turn over in the government hospitals; Professionals attitudes towards appropriate use of blood; Erratic blood supply from the national blood transfusion centers; Inadequate blood components; Unavailability of cold chain equipment.

Lessons Learned Non-governmental organizations have a role in transforming healthcare services in Kenya and Africa Region. There is need to re train clinicians on applied transfusion medicine and related fields to ensure patient safety and reduce mortality rates. Effective partnerships with the government can transform healthcare into patient centered healthcare services. Engaging health workers through consultative forums aimed at sensitizing them on patient rights and needs is key to changing the way patients are treated. Healthcare providers are ready and willing to implement programs aimed at improving services and saving patients lives.

Lessons Learned (cont.) RSBTK Blood Safety project demonstrated that effective training, skill transfer through training, mentorship and support supervision can translate into change of mindsets and best practice amongst health workers. Effective approach and advocacy is key to successful partnerships with the government. Involving health professionals in the design and development of health programs is key to their success.

RECOMMENDATIONS As a patient organization with a wide range of membership from patients organizations and advocates, IAPO can play an important role in changing the current practices at healthcare institutions. The organization should therefore be given adequate support and resources by national and international organizations interested in quality healthcare services.   IAPO should work with regional and national patient organizations as well as patient advocates to provide additional support to governments and its institutions. IAPO member organizations should be strengthened and supported to make them play their important role of advocating for patient centred health care in Africa region. As all human beings are potential recipients of blood, patient organizations and stakeholders should be involved in advocating for safe and harmonised blood transfusion medicine for the Africa Region

Trust Building and Acceptance Tips The following were the strategies used to promote trust and acceptance: Effective advocacy at national and hospital levels, leading to acceptance and support from the top managements; Development of evidence based messages/information; Selection of communicators, trainers, lecturers; Use of committed and pro-active RSBTK staff. Ensuring agreed support is provided. Sustained support supervision

PARTNERS Ministry of Health, Kenya Kenya National Blood Transfusion Service (KNBTS) Hospital Management Teams CDC Kenya LVCT Health CHF International

Training on blood cold chain management

Thank you for listening to me!! Contact Regional Society for Blood Transfusion Kenya KNBTS Head Office, P .O Box 2584 – 00202 Mobile +254 – 0722777473, 0717182997 Email: info@rsbt-kenya.org