Banking on Blood
South Africa’s Western Cape Blood Service continues to collect, process and deliver life-saving blood products to public and private healthcare providers in spite of the challenges presented by the coronavirus pandemic
Writer: Tom Wadlow | Project Manager: Callam Waller
The mind boggles when looking at statistics relating to blood.
The fuel that keeps us alive, the human body manufactures around 17 million red blood cells per second, with a single unit of blood containing 2.4 trillion of these cells.
It is estimated that blood accounts for roughly seven percent of the bodyweight of an average person, adults containing around five litres of blood inside their bodies. A small part of that, 0.02 percent, is pure gold.
A complex and intriguing part of our makeup, enduring heavy losses of blood can be fatal, making a reliable and safe supply of blood a critical part of any healthcare system and hospital network.
In South Africa, there are two major bodies responsible for the provision of blood to medical institutions and healthcare providers, with most of the country covered by the South African National Blood Service.
In the west of the country, the Western Cape Blood Service (WCBS) is responsible for collecting, processing, testing and distributing blood products in the Western Cape province.
And it is here that Dr Greg Bellairs presides as CEO.
“A fundamental duty of any blood service is to provide blood products to patients in hospitals timeously, safely and consistently. Without blood, many patients would otherwise die,” he says. “Blood products are critical in many clinical situations – for example, trauma, surgery, and treatment of leukaemia.”
Bellairs goes on to explain the transfusion process and how WCBS fits into this lifesaving series of events.
“It starts with a treating clinician ordering the blood products required for the patient, and submitting an order form and blood sample to the blood bank,” he continues.
“Blood products are selected and matched for the patient – a process called crossmatching, which ensures that the products are compatible with the patient’s blood type.
“After crossmatching, blood products are issued in a specialised container which we call a hamper, designed to keep them at a specific optimal temperature during transport to the hospital and, ultimately, to the patient’s bedside for transfusion by clinical staff.”
Transporting the precious cargo is WCBS’s fleet of around 80 vehicles.
Operating the vehicle fleet and other vital frontline and back office functions are a team of 530 staff members, the service being headquartered in Cape Town with regional offices in the smaller towns of Paarl, Worcester and George.
While much of the processing and testing work is centralised in Cape Town, blood is collected across the length and breadth of the Western Cape from fixed site donation clinics, mobile clinics and even pop-up caravan and bus facilities.
The province itself is home to 6.6 million people, and around 72,000 of them are voluntary blood donors who between them donate around 156,000 units of whole blood and 4,000 units of single-donor platelets a year.
This donation pool supplies eight blood banks which provide blood products to 140 state and private hospitals on a 24-seven, 365 days a year basis. A further 102 emergency blood banks are situated in the hospitals themselves, these being stocked with group O blood, from what are known as universal donors.
Today’s operation is a far cry from the organisation which was established in 1938 at Groote Schuur Hospital. Back then, only 200 donors were on the books and an average of 30 transfusions a month were being carried out, although the practice was in its infancy during the 1930s.
The process was also entirely different. The donors themselves would transfer blood directly to the recipient with just a screen separating them, a key series of turning points arriving in the 1940s when new premises were found and mobile units established, enabling a wider scouting mission for donors across the Western Cape.
It wasn’t until 2019 that the non-profit organisation’s name evolved from the Western Province Blood Transfusion Service to the Western Cape Blood Service, the decision taken to reflect the geographical area of operation and fact that the group does not itself transfuse blood.
Responding to a crisis
This year, the onset of the coronavirus pandemic has presented an altogether unique set of circumstances for the service.
Bellairs explains that the COVID-19 outbreak has impacted WCBS across its three strategic pillars: namely sufficiency of blood supply; safety across donations, products and the working environment; and financial and operational sustainability.
Commenting on the first two of these, he adds: “Blood donations have been significantly impacted by COVID-19, as well as the various degrees of lockdown imposed over recent months. With restrictions imposed on people travelling, blood donors have been assured that travel for blood donation is allowed.
“WCBS also needed to provide a safe environment for blood donation, which included increasing the spacing between donation chairs and beds, amending blood donation clinic workflows, providing PPE for staff and donors, enhanced sanitisation procedures, and more.
“As we collect significant amounts of blood from schools, universities, and corporate clinics, the closure of these and restrictions on visitors markedly reduced opportunities to collect blood. Adjusted blood collection strategies included convening more clinics, for example at shopping malls, as people still needed to continue to shop for food, as well as clinics in residential areas. In addition, donors were redirected to these clinics by the call centre, SMS, website and email.”
Despite the clear and obvious challenges faced, WCBS was able to collect enough blood throughout the peak of the COVID-19 crisis, even though stocks were lower than the organisation usually strives for (five days of each blood type).
This is some feat given that staffing levels were also markedly affected. WCBS lost many working hours due to employees either contracting the virus or having to isolate themselves – fortunately, the organisation has suffered zero coronavirus fatalities and was able to plug the resourcing gap to ensure seamless continuity of service.
Another interesting nuance of the pandemic period has been the demand for blood and subsequent impact on sales and revenue.
“Blood usage varied significantly depending on the degree of lockdown,” Bellairs explains. “At the height of restrictions, and during the period when alcohol was banned and elective surgery curtailed to free up hospital beds for COVID-19 patients, the volumes of blood products sold were reduced by at least 30 percent.
“As restrictions were lifted, sales improved but remained lower than originally expected. In South Africa, trauma is influenced by the availability and use of alcohol – and we saw evidence of this when alcohol became available, as blood usage increased.”
More recent weeks have seen sales normalise, but WCBS is still feeling the impact of several months of reduced income, a period which meant that expenses were reassessed, down-managed, and all non-essential expenditure was curtailed.
Bellairs adds: “We were fortunate to have sufficient reserves to weather the financial storm, and the early uncertainty levels, which were high, have been replaced by recent experience demonstrating that although sales and income were reduced, we now know to what extent, and are able to anticipate the impacts of later waves of the pandemic.
“Despite our financial challenges, we recognise that we are fortunate to operate in the healthcare space, which somewhat insulated us from the financial devastation faced by organisations which could not operate at all during the lockdown.
“One of our core goals was to not retrench any staff, and to pay everyone in full – we were able to achieve this.”
"A fundamental duty of any blood service is to provide blood products to patients in hospitals timeously, safely and consistently. Without blood, many patients would otherwise die"
The power of partnership
Another key observation illuminated by the pandemic has been the critical nature of WCBS’s supply chain and network of partnerships.
The CEO is quick to acknowledge the role each supplier and partner plays towards the organisation reaching its objectives, be they producers of blood collection bags or manufacturers of testing reagents which help ensure blood is safe for transfusion.
Many of its suppliers are multinational companies which operate with local footprints, while a large number of the products used across both consumable and capital categories are specialised and imported, and hence subject to currency volatility.
It makes for a complex picture, one which Bellairs says became even more complicated thanks to the arrival of COVID-19.
“We were worried about the impact on security of supplies, with borders being shut and logistics operations swamped, as well as many other customers in our field seeking to increase their holdings of critical equipment,” he says.
“We asked some suppliers to increase their locally held stock levels to mitigate risk of running out, and we also increased our stock holdings of certain items, for instance from two months of supply to four or even six months.
“With many long-term relationships with our suppliers in place, and due to the fact that security of supply is in both parties’ interests, we successfully navigated the highest level of lockdown and at no stage were inadequate supplies of consumables a threat to ongoing operations.”
At the other end of the chain, customer relationships have also been in the spotlight. Again, WCBS holds long-established, well-developed partnerships with both public and private medical providers/insurers, with each sector accounting for roughly half of the service’s revenue.
“When we have problems, they are usually quite easy to resolve,” Bellairs continues.
“Although due to the impacts of COVID-19 on the local economy, we do anticipate increasing difficulty in managing bad debt, as well as a migration of insured patients to the state sector, which could put extra strain on income.
“In addition, as the exchange rate worsens, this will drive up costs of those items which are sourced internationally, which can be mitigated in the short-term by forward covering US dollar-based purchases.”
Safeguarding the future
As the conversation moves towards what lies ahead for WCBS and the future of the organisation, it quickly becomes clear that education and staff development form an important part of ensuring an ongoing success story.
Here, Bellairs outlines the crucial work of the Learning & Development Department, a body which provides in-house training and organises external learning activities for colleagues. All technical and medical staff are required to participate in regular education exercises, with continuous professional development another key priority.
“It is important for staff to stay abreast of new developments – often through peer-reviewed publications and in-house research projects, and studying evolving technologies,” the CEO adds. “This is often prompted by evolutions or revolutions in the offerings from suppliers, and the changes in the regulatory and operational environment which require constant training and development.”
Further, WCBS offers financial support to students in the form of bursaries, students who are then offered employment on successful completion of their studies. Existing staff are also supported either financially or operationally with postgraduate learning.
Away from WCBS, many staff undertake research studies with their results often presented at national or international gatherings of experts, in some cases going on to be published in industry journals.
Indeed, every other year Western Cape Blood Service involves itself in the South African National Blood Transfusion Congress, an event organised and hosted by the South African Society for Blood Transfusion. It is an important date in the WCBS diary, the next instalment slated for August 2021 in Durban.
“This four-day event showcases expert invited international and local speakers, local research presentations, and a comprehensive trade exhibition,” Bellairs says. “The congress provides a worthwhile opportunity for any people from blood services or related fields in Africa to attend, learn, and network with like-minded professionals.”
It is a forum through which to explore and discover new ideas, something which the CEO is eager to accelerate over the course of the next year or so at WCBS.
For example, in the area of distribution, it is looking into the idea of using smart fridges which will enable clinicians to order compatible blood for patients remotely, while plans to increase the availability of returnable products in order to reduce waste are also afoot.
Drones are another exciting avenue of exploration. Here, WCBS is working with the South African National Blood Service on overcoming the various logistical challenges found in some areas of the Western Cape.
This all feeds into the overarching objective for Bellairs – to fulfil demand for blood products in line with population growth in the coming years.
“Growth in terms of demand for blood products is a factor of population size and burden of disease,” he explains. “The population of the province is increasing at approximately three percent per year, and demand for blood products and related services increases at a similar rate.
“Patient blood management is focussed on ensuring that when blood products are requested, they are clinically indicated and that all alternatives have been considered. This may soften demand going forward, and other opportunities are in the pipeline, like the collection of source plasma for the production of plasma-derived medical products.”
From an operational perspective, WCBS is exploring how it can reduce waste and improve efficiencies in blood component processing and laboratory testing areas – it is currently three years into a lean management programme, an initiative which the CEO says has yielded promising results so far.
Improving the donor experience is another priority and a factor which could lead to greater volumes of blood entering the system. Bellairs reveals that WCBS is planning to enable screening and completion of self-exclusion forms online, improving the overall donor experience.
Such developments leave him optimistic about what lies ahead.
The conversation closes by looking back at the lessons learned from the COVID-19 crisis, and the undoubted positives that have emerged from what has been a tremendously difficult situation for not just the Western Cape, but the whole of South Africa.
“It already appears that we have passed the peak of infections, although there are risks of second and later waves,” Bellairs says. “The impacts will be felt for many years to come, as the local economy has been deeply affected – jobs have been lost, and companies have closed.
“However, a positive outcome has been the development of healthcare capacity, and the relationships between the state and private healthcare providers have been strengthened considerably, hopefully moving us towards a stronger, more collaborative healthcare system.
“The challenges going forward will be the funding of healthcare, and sustaining the enhanced healthcare capability we have seen function so effectively in recent months to manage COVID-19.
“In addition, rather than being disrupted by COVID-19, we are now working in a new normal with the virus. It is now routine for everyone to wear face masks, everywhere, and follow the other universal precautions. Businesses, communities, and individuals have adapted to the ‘new normal’ and creative ways have been found to continue operations safely and sustainably.”