This is an Entry to the Government Best Practice Recognition Awards
Community-based Blood Banking: a prototype of a people-centered health care
Cotabato Regional and Medical Center
Best practice Focus Area(s)
Leadership, Human Resource, Process management, and improvement
Access to blood services is difficult when there is a low inventory of blood in the blood bank. During these seasons, the Cotabato Regional and Medical Center (CRMC)- Blood Bank can hardly provide blood products not only for their own patients but also to other hospitals located both in Region 12 and Bangsamoro Autonomous Region in Muslim Mindanao (BARMM).
In order for CRMC to cope up to the increasing need for blood products, in 2012, the team led by Dr. Sherjan P. Kalim, the Blood Bank Head, initiated a prototype of a community blood banking scheme that is adopted from the conventional financial banking system and at the same time applied the people-centered approach of the World Health Organization (WHO).
A community blood banking scheme is community-led management of access to blood services. This prototype greatly increased CRMC’s blood collection, thereby producing more blood products, which benefited more patients in Region 12 and BARMM, including those in other regions of Davao and Zamboanga del Sur. It made blood available in all hospitals within the catchment area and eased communities and patients in securing blood when needed.
Background and Problem
In the early 2000s, there was a limited number of patients who have access to blood services because of the scarcity of blood products in the CRMC – Blood Bank and from the Philippine Red Cross. Patients who needed blood products include those admitted in hospitals outside of Cotabato City and from the nearby municipalities, provinces, and sometimes from other regions.
Blood donation then was dependent on family/replacement donations and paid donations rather than from voluntary non-remunerated blood donations. Paid donors dominate most of the replacement donors. Paid donors are high-risk donors for transmission of transfusion-transmissible infections. It was also very expensive to pay a paid blood donor who is being facilitated by blood fixers. Most of the time, poor patients are victimized because they cannot afford the cost of blood services.
Geography, multiculturalism, and the multi-religious composition of the area makes health service delivery a challenge in implementing a one-size-fits-all health program. There is a need to localize it and adopt a local culture and incorporate religious aspects in the implementation of the program.
Solution and Impact
One of the approaches utilized to address these issues was the people-centered approach of the WHO to improve health services delivery particularly access to blood services. The framework of people-centered healthcare has 4 domains which include individual and community participation, as health care provider and organization, healthcare practitioners, and health system.
This initiative was a product of a series of multi-stakeholder consultations involving individuals, experts, community leaders, local chief executives, and hospital administrators. During the consultations, there were visioning exercises, brainstorming, and action planning. All the activities were facilitated by the Blood Bank team of the CRMC with funding support from the National Voluntary Blood Services Program (NVBSP) of the Department of Health.
One of the outputs of this initiative was a community-based blood banking scheme that was co-created by all stakeholders. On the part of the CRMC Blood Bank, it was a major institutional arrangement that was needed to abide by.
The community-based blood banking scheme was patterned on the conventional financial banking system, wherein a community opens up a blood bank account at the CRMC – Blood Center by organizing a mobile blood donation activity and the blood units collected will be counted as their deposit. A representative of the community controls the deposit and withdrawal of blood. The representative may be the local chief executive like a barangay captain or alter ego, a barangay health worker. All transactions are recorded in a community file similar to a passbook.
In this prototype, a community opens a blood bank account by organizing a mobile blood donation activity in their community. The number of blood vials collected becomes their deposit. In case the community needs blood, the person-in-charge of the blood bank account makes a withdrawal by issuing an authority to withdraw, a form of withdrawal slip, to the patient. Their blood bank transactions such as blood deposits and withdrawals are recorded in their community file, which is similar to a passbook.
In the community blood banking scheme, the donated blood is owned and controlled by the community. Unlike the Red Cross scheme of issuing a donor’s card where the donor keeps it and personally owns the blood, in community blood banking scheme, the community is being issued by CRMC Blood Bank with a master list of blood donors. This master list serves as the roster of individuals in the community with known blood type and has safe blood. The donors with positive tests for any of the 5 transfusion transmissible infections (HIV, Hepatitis B and C virus, Syphilis, and malaria) can be excluded from donating again. Hence, in case of emergency, the community can outrightly identify potential donors with safe blood.
Because of this scheme, every year, there is an increasing number of communities organizing community-based mobile blood donation activities. CRMC now has a stable supply of blood that can be provided for patients, except during lean seasons where few mobile blood donations are organized. The season where blood supply is low includes the Christmas season (December) that extends to January, campaign period, and election, and during Ramadhan where Muslims are fasting. One of our strategies during these lean seasons is faith-based organized blood donation activities, private companies, and through military personnel.
One of the notable outcomes of this prototype was the increasing number of Muslim communities organizing community-based mobile blood donation activities. Through a partnership with the Bangsamoro Development Agency, CRMC organized the Muslim Blood Donation Program. With consultation with the Darul Ifta, blood donation pamphlets include the Islamic teachings on voluntary blood donation and at the same time, these were translated into the local dialect, Maguindanaon. CRMC has also trained the imams of mosques on the Islamic perspective of voluntary blood donation. The imams have become community advocators of blood donation by including voluntary blood donation in the announcements in the mosques, including an invitation to mobile blood donation activities.
The CRMC -Blood Bank has been awarded annually by the DOH Regional Office 12 for being a top collector of blood. CRMC has also been recognized by communities as a valuable partner in providing access to blood services.
It has been a culture of the CRMC-Blood Bank to regularly conduct multi-stakeholder consultation meetings on a semi-annual basis together with a quarterly zonal blood services network meeting of hospitals where CRMC provides blood products. In this way, CRMC can keep community partnership stronger by updating them with new DOH issuance, policies, and guidelines, and finding solutions to issues that arise during the implementation of the blood program.
Before, most of the needs of hospitals for blood are being transported by patients, especially from other provinces and municipalities. Currently, CRMC is implementing a direct blood distribution scheme wherein CRMC – Blood Bank delivers blood on a weekly basis to other hospitals. Now, blood is always available in hospitals, and patients do not anymore need to specifically go to CRMC to get blood.
A new development in the implementation of the blood program is the construction of the Region 12 Regional Blood Center where a facility has been dedicated to ensure access to blood services. It will have advanced technologies in blood testing such as full laboratory automation, and 4th generation testing of blood products. The regional blood center is targeted to be operational by the 2nd quarter of 2020.
CRMC’s partnership with the Bangsamoro Development Agency has influenced the Turkish Cooperation and Coordination Agency (TIKA) to approve their proposal to provide them with a mobile blood donation bus wherein daily blood donation activities can be organized. The blood donation bus will be delivered at least before 2019 ends.