philippines blood safety program: needs assessment trip · the world health organization has made...
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Philippines Blood Safety Program: Needs Assessment TripAdam Weiss MD1, Elizabeth Donegan MD1
1Department of Anesthesia and Perioperative Care, University of California, San Francisco
GLOBAL HEALTH
BACKGROUND
A safe, reliable blood supply is a key element of modern healthcare systems.
However, in many developing countries, including the Philippines, the blood supply
lacks both the safety and capacity provided by a fully volunteer blood supply.
Instead, replacement and remunerated donors comprise the majority of blood
collected for transfusion.
The World Health Organization has made blood transfusion safety a priority for
improving healthcare in the developing world. The five key elements of their plan
include:
• Voluntary donation of blood from low-risk populations
• Screening for transfusion transmitted infections
• Blood compatibility testing
• Blood component fractionation
• Reduction in unnecessary transfusions
PURPOSE
The Philippines Blood Safety Program is working with Ormoc City in Leyte,
Philippines to develop a regional blood system that builds on the community’s
existing resources, and that meets the World Health Organization’s goals. An initial
needs assessment trip was completed in August, 2015.
Needs assessment trip goals:
• Collect data on Leyte’s regional blood supply
• Learn about Ormoc City’s healthcare infrastructure
• Meet community organizations interested in philanthropy
• Build personal and industry connections that will facilitate the program
APPROACH
The Philippines Blood Safety Task Group, a multidisciplinary group of volunteers
from UCSF, was formed in order to plan and implement improvements to the
Ormoc City blood system. They teamed up with Global Healing, an East Bay non-
profit with expertise in developing blood systems.
Methods for assessing need:
• Remote data collection forms emailed to the five Ormoc City hospitals and
Ormoc Red Cross
• Face to face meetings with directors of each hospital, Ormoc Red Cross, Rotary
club, and Ormoc City government
• Tour each facility to better understand the process and limitations of the current
blood system
EASTERN VISAYAS REGION
The Philippines ranks 117 out of 187 countries in the UN Human Development
Ranking. In terms of healthcare, resources are severely limited as compared to the
United States and other developing countries.
HEALTH INDICATORS
Country USA Haiti Honduras Philippines
Birth rate (per 1,000 population) 13.4 26 26.1 24.2
Death rate (per 1,000 population) 8.15 8.8 4.5 4.92
Life expectancy (years) 78.9 63.1 73.8 68.7
Under-5 mortality rate (per 1,000 live births) 11 94 28 37
HIV prevalence (per 100,000 population) 5 15 3 14
TB prevalence 4.1 254 74 438
Incidence of malaria (per 100,000 population) N/A 13 1.5 1.3
Incidence of dengue N/A 0.9 6.1 145
Whole blood donations (per 1,000 populations) ≥30 <5 5-9.9 5-9.9
Percentage of voluntary, unpaid donations (%) 99-100 50-89.9 <25 50-89.9
Ormoc City’s population is 191,200 (second largest on Leyte). Its primary form of
commerce is agriculture. Principle crops are sugar cane, rice, and pineapple.
BLOOD SYSTEM IN ORMOC CITY
When patients require blood transfusions they must negotiate an antiquated
ordering and procurement system that requires them to personally, or via family,
pay for and pick up blood products from the Ormoc Red Cross. They must also
provide a replacement donor. This process often takes up to 24 hours, making
emergency blood for transfusions virtually unattainable.
150
100
50
100
20
100
190
40
78
10
0
50
100
150
200
OSPA-FMC Ormoc DistrictHospital
Doctor'sHospital
Gatchalian Women's andChildren's
Ormoc City Hospitals’ Bed Capacity
Total Capacity Average Census
3832
21
0
10
20
30
40
Ormoc Red Cross
Blood Product Costs ($ USD)
Whole Blood pRBC Platelet/FFP
73.6
26.4
Ormoc Red Cross Donor Types (%)
Replacement Volunteer
BLOOD TESTING AND SAFETY
There is limited blood testing, fractionation, and storage equipment scattered
across the six facilities. However, the frequent disrepair of these machines leaves
the overall blood system unreliable. Additionally, there is no antibody screening
available when patient’s have reactive cross-matches.
0.46
2.67
0.73 0.73
0.07
2.43
0.6 0.66
0
0.5
1
1.5
2
2.5
3
HIV Hepatitis B Hepatitis C Syphilis
Transfusion Transmitted Infection Screening* (%)
Screen Positive Seropositive
*Total # of Units Tested Annually at
Ormoc Red Cross = 6,530
CLINICAL BLOOD UTILIZATION
180
56
25 20
020406080
100120140160180200
OSPA-FMC OrmocDistrict
Hospital
Doctor'sHospital
Gatchalian
# of Transfused Units per Month
75
20
5
Products Transfused at Ormoc District Hospital (%)
Whole Blood pRBC Platelets/FFP
47
28
17
3 5
Transfusions by Department at Ormoc District Hospital (%)
Medicine OB/Gyn Surgery
Pediatrics Other
10
5
0
2
4
6
8
10
12
OSPA-FMC OrmocDistrict
Hospital
Discarded Products (%)
PROJECT GOALS
• Development of a robust volunteer donor program. Accomplished through
partnerships with local business and news media to increase awareness and
community involvement in blood donation drives.
• Improve the quality and safety of blood product preparation and
distribution. Accomplished by procurement and maintenance of blood banking
equipment. As well as development of standard operating procedures and
quality assurance programs.
• Decrease unnecessary transfusions through changing clinical practice.
Accomplished by hosting regional transfusion symposiums on rational
transfusion guidelines, and online modules with updates on clinical practice.
CONCLUSIONS
The destruction of Typhoon Haiyan
adversely affected Ormoc City’s
healthcare system. Now, we have
the opportunity to work with local
physicians, hospitals, and the Ormoc
Red Cross to develop and put in
place a functioning, model blood
system; one that also can be
replicated in other regions of the
Philippines. Support the Philippines
Blood Safety Program today!
PhilippinesBloodSafety.org
Support in part by grants from the Global Health Clinical Scholars Grant, Global Healing, and the Donegan Lab.
ACKNOWLEDGEMENTS
The Ormoc City healthcare community is comprised of one semi-private farmer’s
hospital, one public district hospital, three private hospitals, and the Ormoc Red
Cross blood bank.