Kenya is among the African nations reported to have a 17 percent drop in blood donation, a threat to major health services in the country.
A report by the World Health Organisation (WHO) attributes this significant drop in lack of finances and inefficient collection systems by governments to ensure national blood services to stay afloat.
“Inadequate financing and lack of effective systems to collect, analyse and ensure safe and steady supply of blood undermine the availability and provision of this critical life-saving product in many countries in Africa, where around five million pouches of blood—half of the required quantity—are collected every year,” says the WHO.
This is no surprise for the country whose blood transfusion services entered a strained phase following the loss of donor funding from the US Centers for Disease Control and Prevention (CDC) in 2019.
The CDC had set up the Kenya National Blood Transfusion Services (KNBTS) in 2000, immediately after and as a result of the bombing of the US Embassy in Nairobi, during which Kenya’s acute shortage of safe, quality blood and blood products became apparent.
They supported the KNBTS to the tune of KEs1.6 billion until their phased, planned exit in 2019, which left a lean, Kenya-funded budget of Kes275 million.
Most of the funds directed to KNBTS was channeled towards testing of the blood for diseases such as HIV/AIDS, Hepatitis and Syphilis. Kenya. Unlike other countries it does not test for malaria, however, since it is an easily treatable disease.
Other monies are channeled towards blood bags, transportation and refreshments which are critical elements in blood donation drives. The country has also partnered with the Kenya Red Cross, International Rescue Committee, and Médecins Sans Frontières (MSF)–Switzerland Kenya Mission to delicate regions such as the Dadaab and Kakuma refugee camps.
Some of the partnerships were however riddled with scandal that led to investigations by the Directorate of Criminal Investigations (DCI) following allegations that blood was sold outside the Kenyan borders.
KNBTS signed a memoranda of understanding (MOU) signed by then Director, Dr Josephine Githaiga to supply blood from the Embu Regional Blood Transfusion Services (RBTS) to Dadaab and Kakuma which is alleged to have shady under dealings that saw the blood sold to Somalia.
Dr Githaiga signed the first MOU with the National Council of Churches of Kenya (NCCK) to supply blood and blood components from the Embu RBTS to Dadaab and Kakuma refugee camps.
The team led by Dr Githaiga drew up a budget of Kes369,000 for refreshments and fuel for KNBTS vehicles during the three months of their partnership.
Upon the expiry of the contract, KNBTS entered another MOU with MSF Switzerland Kenya Mission in 2019 to provide 60 units of blood and blood components supplied in two phases bi-monthly to MSF Dagahaley Hospital in Dadaab.
As per the agreement, the blood would be transported by the MSF Dagahaley and would be supplied from Embu RBTS yet again.
“Unless otherwise specified MSF will undertake the payment of Kes150,000 per quarter in local currency in support of the Embu RBTC blood camp drives as the supplier of blood components to MSF Dagahaley Hospital,” the MOU reads in part.
In March 2019, however, Dr Githaiga wrote to MSF to make amendments to the MOU requesting the money be channeled to the accountant at KNBTS whose name is Terry Boore. Details of the account given are Cooperative Bank, Ukulima Branch, account number 01116025720000 bank code 0011.
Although the former Cabinet Secretary Mutahi Kagwe called for investigations to be carried out by the DCI to find out if the blood made its way out of Somalia the findings were never publicly revealed.
Another challenge has been the Covid-19 pandemic, which led to a decrease in the number of voluntary blood donors in Kenya, Lesotho, Malawi and Mauritius, from more than 80 percent to less than 50 percent.
In fact, the highest number collected by KNBTS is 172,041 units that were collected between July 2018 and June 2019. This is against the World Health Organization guidelines for the proportion of donors relative to the total population. Kenya should be collecting 500 million units of blood a year.
Hematologist, Dr Kibet Shikuku says that there are other impediments that have led to the decrease in blood donations with the largest being the Covid-19 pandemic which caused a worldwide shortage of blood.
The WHO concurs stating that donation dropped by 13 percent owing to the suspension of routine surgeries in some countries and fewer people seeking care in health facilities.
While the global health body did not touch on the management of the blood donation bodies in Africa, wrangles surrounding the management of KNBTS have set back the blood collection services back for decades.
In 2019, Dr Fridah Govedi, a paediatric specialist was appointed as the director of the very troubled KNBTS “To reinvigorate and transform” the department that had just lost donor funding from the CDC.
On Dr Govedi’s priority list was the injection of additional funds from the government to keep the Service going – Sh4.6 billion to start with, she said; even more would be required later. She also wanted staff who had worked for the Service for over 15 years removed or transferred.
The fighting between the management team came at a time when a Bill proposing a semi-autonomous, centrally coordinated blood service with a specific mandate, structure, and governance mechanisms to carry out blood transfusion services in the country was tabled in the National Assembly.
This means the Director of the KNBTS would run a fully functional parastatal with its own funds, and the CDC would not be there to keep an eye on the expenses. It would also mean that the director would have access to the Sh500 million from the UHC programme as well as Sh1billion from the World Bank intended to strengthen capacity at the
The proposed law also targets a cartel said to be profiting from the trade, also states that health facility owners face Kes1 million in fines or a three-year imprisonment for sale of blood without the Cabinet Secretary’s clearance.
The management of KNBTS has been at war for years and although the dust has settled on the issues there are still some other issues that have led to blood donation drop in Kenya.
While speaking to BBC Swahili, Dr Shikuku explained lifestyle choices made by the youth who are the biggest contributors of blood donations in the country.
Dr Shikuku states that many youths are getting tattoos which impedes on their ability to give blood given that the WHO stipulates that anyone with a tattoo or body piercing cannot donate for six months from the date of the procedure.
He also stated that the majority of blood donors are school going children who mostly give blood during school drives which in turn makes the blood supply go down during school holidays.
“The highest number of donors are the youth who are healthy. The national legislation permits 16 to 17 year-olds to donate provided that they fulfil the physical and hematological criteria required and that appropriate consent is obtained,” he said.
Data from the recently released WHO report further states that of 118.5 million blood donations collected globally, 40 percent of these are collected in high-income countries, home to 16 percent of the world’s population.
In low-income countries, up to 54 percent of blood transfusions are given to children under five years of age; whereas in high-income countries, the most frequently transfused patient group is over 60 years of age, accounting for up to 76 percent of all transfusions.
But blood donation rates remain too low to meet the demand, with 38 African countries recording a combined shortfall of more than three million units of blood in 2020.