Kigoma has delivered a resounding message during this year’s World Blood Donor Day celebrations: we can achieve our vision of a time when our mothers and babies do not needlessly die at that blessed moment of giving life, and that it is our collective responsibility to champion their survival.
Kigoma has delivered a resounding message during this year’s World Blood Donor Day celebrations: we can achieve our vision of a time when our mothers and babies do not needlessly die at that blessed moment of giving life, and that it is our collective responsibility to champion their survival. Inspired to save mothers lives, Kasulu residents donating blood. Safe Blood Saves Mothers LivesI’m on the plane back to Dar right now, reflecting on another remarkable World Blood Donor Day national celebration. This year the international theme was particularly befitting of the current efforts to accelerate maternal survival, inspiring our community to take the lead in ensuring ‘Safe Blood Saves Mothers Lives’.The evidence is incontrovertible: WHO estimates that 80% of our blood donated is used for mothers and children; heavy bleeding during childbirth is the leading cause of maternal mortality accounting for between one in three to one in five of all maternal deaths in Tanzania. There is a critical shortage of blood supplies in our hospitals – with an estimated one-third only of the required 450,000 blood units collected in Tanzania every year. There are mothers who heavily bleed during and after childbirth who are dying due to the shortage of blood in our health facilities. When heavily bleeding after childbirth, women may need blood transfusion to survive. If blood supplies are readily available in our health facilities, then more mothers’ lives will be saved.Kigoma region provided a compelling setting for shining the national spotlight on safe blood saving our mothers lives. Only one in three of Kigoma’s mothers give birth in a health facility in the hands of a skilled birth attendant.Only 2% of all births are delivered by caesarean section, meaning hundreds if not thousands of Kigoma’s mothers and babies miss out on this life-saving intervention when complications arise. Inspiringly, Kigoma region and its partners are taking huge steps to increase access to comprehensive emergency obstetric care, including caesarean section and safe blood transfusion. And yet if there exists inadequate safe blood supplies then mothers will continue to needlessly die.During the year preceding April 2014, the National Blood Transfusion Services collected just over 4,000 units of blood from Kigoma region; moreover only 2,500 blood units were subsequently made available to Kigoma’s hospitals, equivalent to only 12% of Kigoma’s projected blood requirements given a regional population of more than 2,100,000. Undeniably an increased availability of safe blood supplies across Kigoma region will save hundreds of lives, including those of Kigoma’s mothers.Residents of Kakonko participating in a Q&A session on maternal and newborn survival WBDD history made, once more...World Blood Donor Day (WBDD) 2014 came in the wake of last year’s unprecedented achievements in Mara.Remarkably, Kigoma just took this to yet another level, with more than 3,000 blood units collected in the fortnight marking WBDD celebrations, 300 more units than had been collected in Mara. This represented half of all the blood units collected across the whole of Tanzania during this year’s WBDD; all the more staggering given Kigoma region represents only 4% of the national population, distributed across huge distances connected by dusty rural roads or by boat along the shores of Lake Tanganyika.Regional success was played out across all of Kigoma’s districts – Buhigwe, Uvinza, Kakonko, Kibondo, Kasulu and Kigoma - each exceeding their individual targets. The national celebrations were graced by the First Lady, Mama Salma Kikwete, the first time a state-level guest of honour had participated in WBDD, further raising the profile of safe blood services in Tanzania.One is humbled at the thought that Kigoma’s efforts in these past two weeks will go towards saving the lives of hundreds of mothers, children and others across Tanzania over the next month. Significantly, thousands more Kigoma residents have enthusiastically engaged with the communications messaging around maternal and newborn survival, our anticipation that the wider community have been inspired to take additional actions to save the lives of our mothers and babies.(left) First Lady Mama Salma Kikwete visits the Mama Ye! tent; (right) Kakonko mothers reading flyers on maternal survival The ingredients of success?From the outset on learning that Kigoma region had been earmarked to host the national celebrations for WBDD, Kigoma’s regional and district leadership came together and determined to pull off an event exceeding even Mara’s achievements. District commissioners and their council leaderships were actively on the ground urging their teams and communities to participate fully; the regional leadership kept a close track on progress; the regional medical officer capitalised on the occasion to mobilise funding for a regional satellite blood bank, anticipated to be inaugurated by the end of this month.The Kibondo District Commissioner Venance Mwamoto (in green tracksuit) mobilising Kibondo residents to donate bloodOnce more the Mama Ye! team excelled, traversing over 1,500km of Kigoma’s rural terrain, with an indefatigable desire and resolve to inspiring the wider community to take unprecedented action in voluntary blood donation, motivated by the goal of saving mothers and babies lives.Our youthful volunteers, teaming up with local Red Cross volunteers, once again demonstrated just how effective youth volunteerism can be in community engagement, and were admired by all. The special individuals who make up the Mama Ye! Tanzania field team dedicated themselves to the person and collectively to achieving the extraordinary, with special mention of Kenny who really is a quite incredible beacon of leading our community campaigns.Mama Ye! youth volunteers celebrating WBDD successAnd what champions the National Blood Transfusion Services (NBTS) Western Zonal team and their district counterparts were! It is easy to reel off the targets achieved without appreciating the enormous effort that 3,691 units of blood collected actually represents. The process behind one blood unit, from taking vital data, to counselling, to pricking and bleeding, and organising blood samples and storage, takes around ½-hr per blood donor.Taking the total blood collection achieved, this is equivalent to at least 1,845 hours of provider work, or put differently two and a half months of 24-hr days dedicated service provision, achieved in only three weeks! Furthermore, this does not consider the time spent capturing vital data and counselling those blood donors who end-up non-eligible; or the time taken traveling between and setting-up/taking down blood donation sites, etc. Just take a moment to absorb the enormity of their effort; and applaud their part in making WBDD history, as well as setting the standards for future efforts to aspire to. Mama Ye! Tanzania team inspiring Kigoma residents to take action for mothers and babies What Now?What Now?: we must build on these successes, transform voluntary blood donation, and ensure safe blood is widely available in Tanzania, saving thousands of mothers and children’s lives. Some thoughts on what do we need to do?:
- The selling of blood needs to be dealt with an iron fist. It is a pervasive complaint bitterly raised everywhere we have conducted community campaigns, Arusha, Mara, Rukwa and Kigoma to date. Selling blood is a vile act. What is the difference between holding someone armed hostage as compared to pawning a critically ill patient’s life for ‘blood money’? Some leaders, particularly at health facility level, live in denial. “Where’s the evidence; where’s the official complaints?” Let’s not treat our communities as universally ignorant or cheats; there are not many of us with the courage or awareness to stand up to corruption and authority. Blood selling in Tanzania is rife. It demoralises communities to voluntarily donate blood. Politically strong words discouraging blood corruption are reiterated at various levels, but where are the rolling heads? Without dealing decisively with blood corruption Tanzania will never get even near achieving our blood targets, and our mothers and children will continue to die needlessly.
- Regional and district leadership need to be engaged and at the forefront of community sensitisation to voluntarily donate blood. Current awareness of safe blood services is very low, and yet it has been demonstrated that local leadership has a pivotal role to play in effective community mobilisation.
- Invest in satellite blood bank infrastructure, especially in regions which are a considerable distance from their respective NBTS zonal blood bank. Regions would be encouraged to take ownership of mobilising sufficient voluntary blood donations to meet regional blood demand, with blood samples sent to the zonal blood bank for quality assurance. Additionally it would significantly reduce on the logistics required to transport blood supplies back to the region, as well as more efficiently facilitate distribution to district hospitals and upgraded health centres.
- Increase central government and donor funding of NBTS. While blood collection remains a huge challenge, NBTS has significantly improved the quality of blood supplies: blood supplied in Tanzania’s hospitals is safe. Yet there is uncertainty as to the funding level committed to NBTS beyond 2015. The government, development partners, and other interested stakeholders have a responsibility to put in place a clear roadmap for medium-term support of NBTS. While this may well pivot around some form of arrangement for increased autonomy, and increased public private partnerships, crucially NBTS must oversee quality assurance and overall coordination of safe blood services nationally.
- Safe blood services must be adequately captured, budgeted for and funded in the next Health Sector Strategic Plan IV (2016-2020), including the follow-on national roadmap for accelerating reduction of maternal, newborn and child deaths, to be known as One Plan 2; both of which are expected to be finalised over the next few months. Safe blood transfusion is a critical signal function of Comprehensive Emergency Obstetric and Newborn Care (CEmONC); the evidence shows that increasing the coverage and equitable access to CEmONC services will significantly contribute to accelerated reduction of maternal, newborn and child mortality. The government has made important commitments to dramatically scale-up provision of CEmONC services. To honour these commitments, it is crucial that safe blood services feature prominently across all Maternal, Newborn and Child Healthcare policy and planning, at all levels from national across all councils.