South African National Blood Service Value PropositionInformation for Portfolio

Committee on Health

14 OCTOBER 2009

Overview• SANBS runs a comprehensive blood

service operation in 8 Provinces• The model is aligned to National Health

Act and Millennium Development Goals• Transforming Blood Donor, Staff and

Board demographics is being achieved• Social Responsibility programmes• Supplies National BioProducts Institute• Collaborates with WPBTS and DOH

SANBS Purpose

• As an association of voluntary blood donors we provide all patients with sufficient, safe, quality blood products and medical services related to blood transfusion in an equitable and cost effective manner.

• The vision is to be acknowledged nationally and internationally as a centre of excellence in the discipline of blood transfusion.

SANBS Footprint

Population Served

Province Population

Density (People/sq km)

Total

Eastern Cape 32.04 6,436,764Free State 18.27 2,706,776Gauteng 466.62 8,837,179

KwaZulu-Natal 89.62 9,426,017Limpopo 39.2 5,273,642

Mpumalanga 35.27 3,122,991North West 28.25 3,669,350

Northern Cape 1.97 822,727Western Cape 29.29 4,524,336

44,819,782

SANBS serves 90% of the population – challenges in geographic distribution: Supply chain and Logistics

WPBTS serves 10% - mostly urban and peri-urban community

Overall Operational Footprint and Governance

• Structured in line with National Health Act and key strategies of DoH – Designed to provide equitable service at

regional levels (urban, semi-urban and rural models to distribute blood)

• SMSB initiative (compliant to Point 6)• NSP 07 - 11 for HIV/AIDS (goal 4 – Prevention)

– Section 21, not for profit company• DoH represented on the SANBS Board • Corporate Governance compliance

Vein to Vein Operation• Vein to Vein = 300,000 blood donors to 286,000 patients per year.• Needs to meet demand for approximately 680 000 units of red cell units• Responsible for all aspects related to collection, processing, testing and

issue of blood products

Key Elements of the Value Chain

• Operations– Blood Procurement– Logistics (cold chain, transport)– Processing, Testing and Issuing of Blood– Specialised Laboratories

• Support Services– Marketing– Medical and Research– Human Resources– SHE and Quality– Information Technology– Finance

Blood Procurement

• Need to procure 780 000 units of blood annually– Approximately 2 700 units daily– Collections at fixed site and mobile clinics– Partnerships with government, communities,

schools, businesses are essential

SANBS BUSINESS SANBS BUSINESS PARTNERSHIPSPARTNERSHIPS

•• SAMANCOR Vehicle SAMANCOR Vehicle Donation Nelspruit Donation Nelspruit

•• Vodacom Vodacom –– 3 Mobiles 3 Mobiles Free State, Limpopo Free State, Limpopo and Mpumalangaand Mpumalanga

Outreach – Communities, Schools, Work Places

Processing, Testing and Issue• Blood is processed into components in 7

processing laboratories• State of the art testing done on every donation

– Serology tests for HIV, HCV and HBV– RNA/DNA tests for HIV-1, HBV and HCV

• Issuing of blood via 79 SANBS blood banks and over 400 emergency blood fridges– Blood on a returnable basis

• Hospital Transfusion committees– Usage monitored

Products and Services

• Blood being processed into components– Red cells– Plasma– Platelets

• SANAS Accreditation Maintained

• Emphasis on Standard Operating Procedures (SOPs)

ID NAT Technology Safest Blood Ensured

Emergency Blood

Blood Conservation

Appropriate Blood Usage• Wastage and inappropriate usage must be

minimised to conserve blood and reduce costs– BRB (Blood on Returnable Basis) roll out to reduce

hospital costs and conserve Group O blood – Pilot study in Jhb and roll out in progress to other

areas• Hospital Transfusion Committee’s at major

hospitals– Promote regular meetings to discuss blood related

issues– Reports to hospitals detailing usage by ward

SS

26% Childbirth & Gynaecological cases 26% Childbirth & 26% Childbirth & Gynaecological casesGynaecological cases

27% Medical cases27% Medical cases27% Medical cases

21% Surgical cases21% Surgical cases21% Surgical cases

10% Paediatric cases10% Paediatric 10% Paediatric casescases

6% Research / Laboratory6% Research / 6% Research / LaboratoryLaboratory

4% Casualty4% Casualty4% Casualty6% Orthopaedic cases6% Orthopaedic 6% Orthopaedic casescases

Supply Chain Logistics – Complexity of Operations

• Blood has to be collected at many decentralised sites daily – forecasts are sometimes unpredictable

• Needs to be transported to centralised labs for processing (red blood cells, plasma, platelets) and testing and then re- distributed to blood banks– Compliance to cold chain, quality and

regulations – Mpumalanga zone operations illustrated in

next few slides

Transport Transport –– Collection routesCollection routesNelspruit Local (10 km Radius)

Driver 1•1 Morning trip collecting units(11h30 to 13h00) •1 Afternoon trip collecting units – (15h00 to 16h30) + mobile clinic units 1 1

Total Annual units = 19499

Driver 2Collect samples at Nelspruit and Middelburg (20h00) and deliver to JHB (22h30)

1 2

Transport Transport –– Collection routesCollection routesDriver 3Nelspruit - Middelburg – TEKSA

- Ermelo •1 Day trip (10h00 – 18h30)

2 3

Total Annual units = 25499

Total Annual units = 14248

Middelburg - TEKSA•Sweeping Witbank and Middelburg •Deliver from TEKSA to Middleburg by 19h30

3 4

Total Annual units = 24659

Total Annual units = 25499

Transport Transport –– Collection routesCollection routes

Service Delivery• Blood is a national asset. The health care

system is dependant on having a safe and sustainable blood supply for all citizens.

• Contributing to MDG’s – HIV prevention; Maternal and Child mortality prevetion.

• In meeting the challenges facing the organisation, this can only be achieved by ensuring that we have committed skilled, loyal management and staff to run the organisation effectively and lead us into the future.

Social Responsibility

• BBBEE – First rating Level 5 Contributor, planning to improve

• Phlebotomy Training – first intake 50 • Supporting Transfusion Practice in SADC• School Education – Healthy Lifestyle and

HIV prevention

Human Capital

• 2 200 employees– Training, Transformation (EE), skills development– Succession planning and Talent Management– Building capacity – Management training programmes– Training of Technologists – upgrading Technicians – Scarce skills – registered nurses– Learnerships – phlebotomy (50 Matriculants)

• Investing in developing skills – access to decent jobs• Supported by Health and Welfare SETA• Courses accredited through Health Professions Council• Employable at SANBS and in Pathology Laboratories• Employable in hospitals and clinis

Employee Profiles

• EE Ratios

Categories Numbers PercentagesRegistered Nurse 303 15%

Phlebotomists/EN 126 6%

J/M. Management 63 3%

S. Management 25 1%

Medical Doctors 10 1%

Technician/logist 610 28%

Admin Staff 145 7%

General/Other 816 39%

Equity Profile Target ActualWhites 13% 31%

Africans 73% 48%

Coloureds 11% 10%

Asian 3% 11%

Quality• Legislative compliance – Safety, Health and

Environment, National Health Act, OHS Act and other relevant legislation

• Appropriate Quality Management System– SANAS accreditation of all SANBS centres

• Serology Reference laboratory – building knowledge and quality standards

• Quality Management Systems development and supportive training for SADC (Malawi, Botswana, Zimbabwe, Mauritius etc.)

• Haemovigilance and constant surveillance of adverse reactions and Transfusion Transmitted Infection's

Additional Donor Related Services

• HIV Prevention through education, healthy lifestyle promotion and HIV education at schools, churches, work places

• Donor recall, counseling and referral of HIV positive blood donors to health services

• Specialized donations programmes for Medical interventions - Platelets, Anti-D Serum, Stem cells

Research Activities At SANBS

• Reduction of Vaso-vagal reactions in adolescent donors after preloading with oral fluid

– To improve Blood donation safety• Transient vaccine induced Hepatitis B surface antigenemia

– To improve Blood screening and reduce donor deferrals• Elite controllers study: Analysis of host cellular and humoral immune

response, comprehensive human genome analysis and genomic analysis of the infecting viruses from persons that control HIV infection.

– Improve our search for HIV vaccine. • The prevalence HIV-2 infection in South African blood donor population as

a uni-infection or co-infection with HIV-1.– Improve Science Knowledge on susceptibility to HIV.

• The prevalence of G6PD deficiency among accepted donors at SANBS.– To improve efficacy of RBC blood transfusions.

• Roche Study: Evaluation for the TagScreen MPX Test and cobas s201 System, South African Blood service.

– To improve cost-effectiveness of SANBS Blood donation testing

Research Activities At SANBS

• Potential infective risk exposure among donors who test positive despite SANBS pre-donation screening.

– To improve our donor selection and retention strategy • Comparative evaluation of Hemocue Donor Hb Checker, and

Haemoquick Hb Photometer.– To reduce donor deferrals.

• Relationship between Duffy phenotype and HIV in black donor.– To contribute to the Science Knowledge

• Transfusion-associated Microchimerism in the Transfused Obstetric Population

– To Monitor long term effects of blood transfusion• First HBV TTI since NAT testing: A case report

– To improve our understanding of the pathogenesis of Hepatitis B.• Evaluation of Platelets function in various solutions.

– To improve the efficacy of Platelet Transfusion.

Blood Collection Challenges• Retaining and Expanding donor base to meet

future demand – Challenges in increasing the number of regular black

donors– Ageing of current donors– Attracting youth to be regular donors– Retention rates issues when entering new markets

• International local trends of decreasing number of donors– Economic crisis and challenges– More mobile population; lack of loyalty

• Using more resources to recruit and retain donors

ANY QUESTIONS?