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					Denham Pole Speech to NBTS – 20.11.2006

Slide 1

How to promote “Regular” blood donation on a voluntary, nonremunerated basis - challenges and approaches for an effective donor recruitment program
September 11 , 2001
One of the most important days in the history of the American blood system was September 11, 2001. In the hours following the terrorist attacks, blood donors swamped America‟s hospitals and blood centers. “Our small but determined staff at the NIH screened eight times the anticipated number of donors” wrote the Chief, Dr Harvey Klein. “Every cot, couch and stretcher was occupied by a volunteer donor, as were the chairs taken from every office to line the halls and the entrance hall. Blood donors waited for three hours to donate and then thanked us a lot for the opportunity.” This is a scene to warm our hearts – the kind of turnout that is usually reserved for great wars. But health officials learned an unexpected lesson from the public‟s response to September 11. What had worked years before was no longer the right thing to do. Blood bankers quickly knew that they had more than enough blood – there were precious few survivors – but felt powerless to turn away the flood of donors. The staff at blood banks sagged beneath the load. Transportation bottlenecks made it impossible to send blood to regional testing laboratories in a timely way. The situation quickly became so unmanageable that partly trained technicians were called up and the FDA even established emergency waivers to accept blood that had not been fully tested.
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Slide 2

Not even these measures could cope with the flow. Within a day and a half, most of America‟s blood banks and the Department of Health decided to put out a plea for donors to stay home. Only the Red Cross kept collecting blood, but ended up with vast stocks; and when it reached the expiry date, were forced to discard tens of thousands of units. Even the plasma that was spun off could not be used as the country already had an adequate supply. Thousands of units never even got tested. Slide 3 Later, the crisis produced an equal-and-opposite reaction of apathy, in which few of the people who had waited in-line ever returned. For example, the return rate of New Yorkers, who should have been the most motivated donors, was a paltry 9 percent. By winter, the New York Blood Center and others throughout the country were once again broadcasting emergency appeals. One exception was the Oklahoma Blood Institute whose director, Dr Ronald Gilcher, had learned from the City bombing in 1995. He came up with an elegant solution – instead of taking a bag of blood from each donor, he recorded the donors and took just a few drops of blood as a test sample. His lab processed the samples, then later called in the qualified donors as they needed them. Even months after the emergency, Gilcher‟s return rate exceeded 50 percent.

Lessons learnt
The lessons to be learnt were clear. Great patriotic blood drives, while psychologically helpful to a wounded society, must now become a thing of the past. It used to be easy to collect blood. There were only a few health-related questions to answer, a couple of simple lab-tests to perform; and a pint of blood was collected and put in the fridge until needed. But this appalls us now, especially if we remember the high blood-borne disease rates of those days. Donors now face dozens of probing questions about their lifestyles and habits; their blood undergoes a battery of lab tests unknown a few decades ago. Blood banks now resemble modern pharmaceutical factories, requiring sustained, controlled input for maximum production. Mass appeals are now old-fashioned – overwhelming the system and causing bottlenecks and errors.

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Denham Pole Speech to NBTS – 20.11.2006

They are also unnecessary – such emergencies even the tsunami – required no more blood than regional centers had on their shelves or could order from Colombo. It‟s the routine shortages that plague us today, with patients having to postpone surgery and hospitals always scrambling to maintain their supply. The blood should be waiting for the patient rather than the patient waiting for the blood. Society faces an enduring paradox – chronic blood shortages in routine times, and a glut whenever a tragedy occurs. Addressing this paradox has always been a central priority of blood transfusion services, and will remain so for many years. Clearly, people are willing to give – we see that after every disaster. The challenge is how to convert that generous impulse into long-term behaviour. Like many other countries, Sri Lanka faces the challenge of how to get enough blood.

Voluntary non-remunerated donors

Slide 4

In this region, the blood transfusion service of Sri Lanka is recognized for a number of important features. One that stands out in regional comparisons, is the high level of separation into red cells, platelets and plasma – virtually no whole blood is available or used in the Government health services. Another is the high level of centralization with the great majority of the blood supply under one single authority – a rarity in developing countries. The third outstanding feature of the Sri Lankan transfusion service is the one that I would like to talk about today – that the supply of blood comes almost entirely from voluntary donors. Paid donors are rare in the national blood supply – there is no official payment and family members of the patients are strongly warned against it. Reports to the Global Database on Blood Safety consistently demonstrate a lower prevalence of HIV and other blood-borne pathogens among voluntary, non-remunerated blood donors than paid or family replacement donors. South Africa, for instance, has an HIV prevalence of 20.1% in the adult population, but only 0.02% among its regular blood donors. A few figures from a WHO presentation illustrate these facts. See slides:    Hepatitis after transfusion Anti-HCV in volunteer and paid donors Window risks Slide 8 Slide 5-7

Retaining donors – making them regular
A fact sheet from the EURO office of WHO recently advised that:  
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Each year, 37.6 million units of blood are collected from regular (at least two donations per year), voluntary, non-remunerated blood donors. Of these, 89% are collected in high-income countries. Seventy-one countries report that they have no regular voluntary, non-remunerated blood donors. Slide 9

Retention
Once you have donors, the biggest problem is how to keep them. Retention is the name of this game. Dr. Deepika Chatterjee on the IndMedica web-site from Chandigarh has given some very useful advice here. She reminds us of the 3 types of blood donors:

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Denham Pole Speech to NBTS – 20.11.2006

1. Family or family replacement donors. 2. Paid commercial or professional donors 3. Voluntary, non remunerated donors. Disadvantages of family replacement donors: is a donor who gives blood when it is required by a member of the donor‟s family or community: 1. Patients or their relatives are expected to find replacement donors. This puts additional responsibility and stress on them at a time when they are already under strain because of the patient‟s illness. 2. There is pressure on members of the family unit to give blood, even when they may be unsuitable to do so; either because of their health status or because of the risk of transfusion transmissible infection. 3. The blood given to patients will not necessarily be replaced in type or quantity. As a result, the blood needs of the community may not be met adequately. 4. Relatives who cannot find suitable donors within the family unit who are willing to give blood may seek donors who are prepared to give their blood for payment. 5. Blood from family or family replacement donors has to be rejected more often than blood from unpaid voluntary donors. This is probably because people who give blood under pressure or for payment by the patient‟s family are less likely to reveal any reasons why they may be unsuitable as donors. Advantages of Voluntary non-remunerated donors : Slide 10

Voluntary non-remunerated blood donors are considered safer than family or family replacement donors and, in particular, commercial or professional donors. Similarly, regular donors are safer than new or occasional donors because they should be well informed, are committed to helping others and are regularly screened for transfusion transmissible infections. Establishing a panel of regular, voluntary non-remunerated blood donors is therefore the most effective way of ensuring adequate supplies of safe blood on a continuing basis. Educating potential Blood Donors Slide 11-12

People are not likely to become voluntary non-remunerated donors unless they receive accurate information about why blood is needed and are given positive encouragement to donate blood. Education is an essential part of a donor recruitment strategy. Before people can be motivated to donate blood for the benefit of others, they must understand how they, as individuals, can play an important part in contributing to the health of the nation. There are 3 basic goals for a donor education, motivation and recruitment campaign: 1. to promote changes in the public‟s knowledge, attitudes and beliefs so that they understand why blood donation is a vital, life saving service to the community. 2. to promote changes in people‟s behaviour so that they become willing to donate blood on a regular, voluntary basis, without payment. Slide 13

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Denham Pole Speech to NBTS – 20.11.2006

3. to ensure that potential donors understand the importance of safe blood so that they do not donate blood if they are in poor health or at risk for transfusion transmissible infections. Educational material such as leaflets, posters, films and videos play an important part in donor recruitment campaign.

Club 25

Slide 14-15

Finally I would like to talk about an important concept that is starting to spread around the world – Club 25. the idea initially came from the Zimbabwean BTS, whose director at the time was Dr Jean Emmanuel. I am happy to mention this man as he was the person who arranged for me to come to Sri Lanka 5 years ago. Origins: about ten years ago in two blood centers in Zimbabwe (Harare and Masvingo), a pilot program was introduced to retain a pool of young regular blood donors after leaving school. Entitled “Pledge 25” the strategy involved the setting up of donor clubs, targeting young people. The pledge required members to commit to making 25 donations after leaving school and each club had a patron who had donated blood more than 100 times to serve as a model for the members. Peer support became a crucial element, as the clubs helped young people talk about their experiences and to discuss issues related to healthy lifestyles. Members were given educational material and the promotion of safe blood donation and healthy lifestyles was soon finding its way into the whole community. Another effect apart from extending the period of blood donation beyond school years, was that they also convinced their families and friends of the value of what they were doing. The concept rapidly gained a foothold in Zimbabwe and has spread to other parts of Africa (South Africa, Togo, Kenya, Uganda, Zambia, Malawi, Botswana) and across the world to include the Philippines, Indonesia, India, Haiti and elsewhere. Nowadays various models of the original Club idea exist but generally they follow a similar structure: Membership: criteria will vary from country to country but here are some ideas:   Blood donors aged 16-25 years who have donated at least 2 donations a year „First-time‟ donors who commit to giving blood regularly (2-3 donations a year) Slide 16

Aims: these will also vary from country to country but generally Club 25 Programs are part of an overall blood donor retention strategy. For example, in South Africa the Club 25 Program aims to:   Establish a process whereby senior school blood donors will be retained at the time they leave school Create a lifelong commitment in school leavers to the concept of regular donation of safe blood after they leave school. The Club elects a national or provincial administrative committee to organize activities, eg., a national youth blood donor day, or in recent times, a World Blood Donor Day celebration Peer promoters are elected to assist the Blood Service in the recruitment of voluntary blood donors from low-risk populations and in turn the Blood Service supervises and supports the Club

Organization: 



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Denham Pole Speech to NBTS – 20.11.2006

Benefits: education of young people about risk behaviour to ensure they remain free of HIV/AIDS is one of the advantages of Club 25 Programs, and data from the South African National Blood Service helps to underline the significance of Club 25 in this important area. Within four years of implementing Club 25 Program there were 35,193 active donors on Club 25 donor panel and 177,426 donations from Club 25 members ! In summary: Club 25 is a youthful concept, promoting the value of saving lives by giving blood. Peer support is a crucial element as the clubs help young people talk about their experiences and to discuss issues related to healthy lifestyles. One important detail is that membership may also embrace young people who cannot donate blood but choose to volunteer their services to the overall aims of the Club 25 Program. There is now an International Club supported by the IFRC linking young blood donors together from all countries. Slide 17 10th International Colloquium on the recruitment of VNRBD: in March this year, 223 people from 66 different countries and 46 National Societies of Red Cross and Red Crescent attended this meeting in Santiago (Chile). Participants discussed ways of building quality into donor recruitment and engaging young people. After presentations on Club 25 programs from Africa and the Philippines, there was overwhelming support for the establishment of an international network to link leaders of the various Clubs around the world and to enable members of the Clubs share their experiences with other countries wishing to set up economical models of health care. Now, arising from the workshops, it is likely that Club 25 Programs will be implemented in many South American countries. I hope that a similar movement will also become strong in this region.

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