Protocol: Identifying Policy, System, and Environment Change Interventions to Enhance Availability of Blood for Transfusion in Kenya, a Mixed Methods Study
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Date
2023
Authors
Valencia, Alejandro Munoz
Aridi, Jackline O.
Barnes, Linda S.
Rudd, Kristina E.
Bidanda, Bopaya
Epuu, Tonny
Kamu, Robert
Kivuli, Tecla
Macleod, Jana
Makanga, Cindy M.
Journal Title
Journal ISSN
Volume Title
Publisher
BMC Health Services Research
Abstract
Background Safe blood is essential for the care of patients with life-threatening anemia and hemorrhage. Low
blood donation rates, inefcient testing procedures, and other supply chain disruptions in blood administration
afect patients in low-resource settings across Sub-Saharan countries, including Kenya. Most eforts to improve
access to transfusion have been unidimensional, usually focusing on only point along the blood system continuum,
and have excluded community stakeholders from early stages of intervention development. Context-appropriate
interventions to improve the availability of safe blood at the point of use in low-resource settings are of paramount
importance. Thus, this protocol proposes a multifaceted approach to characterize the Kenyan blood supply chain
through quantitative and qualitative analyses as well as an industrial engineering approach.
Methods This study will use a mixed-methods approach in addition to engineering process mapping, modeling
and simulation of blood availability in Kenya. It will be guided by a multidimensional three-by-three-by-three matrix:
three socioeconomic settings, three components of the blood system continuum, and three levels of urgency
of blood transfusion. Qualitative data collection includes one-on-one interviews and focus group discussions
with stakeholders across the continuum to characterize ground-level defcits and potential policy, systems, and envi‑
ronment (PSE) interventions. Prospectively-collected quantitative data will be used to estimate blood collection
and transfusion of blood. We will create a process map of the blood system continuum to model the response to PSE
changes proposed by stakeholders. Lastly, we will identify those PSE changes that may have the greatest impact
on blood transfusion availability, accounting for diferences across socioeconomic settings and levels of urgency.
Discussion Identifying and prioritizing community-driven interventions to improve blood supply in low-resource
settings are of utmost importance. Varied constraints in blood collection, processing, delivery, and use make each
socioeconomic setting unique. Using a multifaceted approach to understand the Kenyan blood supply and model
the response to stakeholder-proposed PSE changes may lead to identifcation of contextually appropriate interven‑
tion targets to meet the transfusion needs of the population.
Description
Artcle
Keywords
Blood transfusion, Blood supply, Bleeding, Anemia, Process mapping, Industrial engineering, Policy system and environment change, Mixed-methods, Kenya, Sub-Saharan Africa
Citation
Munoz-Valencia, A., Aridi, J. O., Barnes, L. S., Rudd, K. E., Bidanda, B., Epuu, T., ... & Puyana, J. C. (2023). Protocol: identifying policy, system, and environment change interventions to enhance availability of blood for transfusion in Kenya, a mixed-methods study. BMC Health Services Research, 23(1), 1-12.