Exploration of the vein to vein blood transfusion system in three Kenyan counties: a qualitative study

Severe shortages of blood for transfusion are a persistent global health crisis, with the burden disproportionately concentrated in low-income countries. Diverse stakeholder perspectives on blood availability might inform improvements. We aimed to use a comprehensive approach to identify the challenges, facilitators, and innovations within the blood transfusion continuum (BTC) in three different Kenyan settings.

In this qualitative study, we interrogated the BTC in Siaya, Nakuru, and Turkana counties as part of the Pathways for Innovation in Blood Transfusion Systems in Kenya (PITS Kenya) mixed methods research study. We used purposive sampling, and through interviews and focus group discussions, we solicited perspectives about the challenges, barriers, and facilitating features of the BTC, including any innovations, from health-care workers, hospital administration, government officials, transfused patients, and blood donors aged 18 years and older, who were familiar with the BTC, from Aug 5, 2021, to May 9, 2022. We thematically analysed interview and discussion transcriptions using an iterative approach to achieve saturation of the thematic content. The findings were validated via member checking and stakeholder meetings in Nairobi that included research participants, non-governmental organisations, and Kenyan health authorities.

197 participants (84 [43%] female and 113 [57%] male) participated in 74 interviews (76 participants) and 18 focus group discussions (121 participants). Seven themes emerged: (1) massive shortages of blood, (2) mismatches between where blood is stored and where patients need it, (3) reliance on family replacement donors, (4) delays in patient care, (5) stresses to the health-care system and workforce hardship, (6) variable knowledge and attitudes towards blood donation and transfusion, and (7) limited resources. Facilitation of blood transfusion involved local champions through self-organised and community engagement. Innovations advocated for improved resource allocation, education, and collaborative efforts.

This study identified BTC challenges, facilitators, and innovations. The participants described the BTC as fragmented in these settings. The most poignant findings revealed how the lack of blood availability caused profound stress on the health system, contributing to delays, inefficiencies, and worry for patient wellbeing. Innovations encouraged collective stewardship and governance of the BTC, bridging communities and health-care facilities.

The US National Institutes of Health National Heart, Lung, and Blood Institute.