Just like the absurd cousin at the edge of a family photograph, not really fitting in or engaged in serious family conversations, so is supply chain with respect to blood donation. According to E.Y1, out every one person out of ten hospitals daily need some kind of blood transfusion as a cornerstone of medicine necessary to replace the blood and can range from patients suffering from cancer to other blood diseases and replenish blood lost in serious accidents and medical procedures like childbirth or surgery, and this can be reflected in different global health care systems. For instance, it is estimated that, in United States of America, about 32,000 pints (18,184 litres) of blood products are transfused every day, with approximately 4.5 million Americans possibly dying every year without a transfusion.
This article provides a glimpse into the blood supply chain challenges faced in Kenya, and describes the main supply chain networks that need to be orchestrated by conceptual consideration of IoT, data science and blockchain in order to have an efficient blood supply chain system
Blood and blood donation products’ supply chain journey from donation is as follows:
(i) Donation: sourcing of blood, pre-donation screening and collection of the blood
(ii) processing of whole blood into three main components; Plasma, Red blood cells (RBCs) and platelets, testing, labelling and storage
(iii) delivery to hospitals for transfusion
Supply chain conundrum: The Kenyan blood supply chain faces a common, yet unique global supply chain problem; optimization of inventory levels against high service levels.
With a whopping 66% stock-out deficit, Kenya is barely collecting half of the recommended amount as stipulated by the WHO (World Health Organization) of which almost a third is lost or wasted (not fit for use) along the supply chain.
Other supply chain specific issues include:
- Low supply of blood and dwindling number of those willing to voluntarily donate (lost trust, negative donation cultures, allegations around selling of blood)
- Limited to access to donation centers
- Lack of supplies
- Delays in repairing non-functional equipment
- Lack of responsiveness etc.
Supply chain components to consider
This section describes the main areas in which supply chain efficiency can be realized if only blockchain, IoT and data science can be applied. Let us consider:
1. Need of efficient supply chain processes: If, hypothetically, it takes two hours to manufacture blood products and three hours elapsed due to red tape issues pertaining to moving the product between blood banks and hospitals as well as from hospital to hospital, the red tape defines the supply chain capacity/bottleneck.
Therefore as illustrated in the following figure, the supply chains’ capacity is defined by the process stage.
2. Communication and Technology: if for instance one is to carry out Sensitivity analysis using Twitter, TRUST would be the major area of concern especially when there are disheartening reports of cases where there has been monetary gain, yet other individuals donated blood voluntarily, with no such gain. Transporters, blood banks and hospitals need the capability to share information and understand the number of available donors, available blood products, and time lapse between each point in the supply chain and to efficiently transmit and act on the data.
3. Network design: The network challenge revolves around:
- Balancing the number of regional donation centers vs satellite centers (cost vs ROI),
- Optimization and availability of distribution models (road: vehicles /motor bikes vs. drones),
- Allocation of resources (personnel and functional equipment),
- The cold chain specifically as to adhering to the requirements of the blood products e.g red blood cells require a controlled temperature environment of 4°C, special agitators storage for plasma and -40°C for fresh frozen platelets.
4. Inventory management: Key features for blood inventory mapping include:
- Forecasting of the SKUs with consideration of buffer stock hospitals may include per order,
- Service levels,
- Composition of each component,
- The blood groups and the rhesus factor,
- Shelf-life of inventories (Red blood cells: 35 – 42* days, platelets: 5 days and fresh frozen plasma can last for 1 year).
In the next section I describe the possible opportunity of blockchain, not as a standalone solution, but with consideration of other supportive systems in place that can support the blood supply chain to be a more transparent system and one that fosters accountability and trust.
The opportunity and conceptual solutions
In the previous section, the blood supply chain challenge was captured as one that needs streamlining of supply chain processes: the need to shorten the time it takes to process blood products to the point of transfusion, the gap in communication and technology, supply chain network design considerations and inventory management challenges. In this this section, we consider the possible solutions that blockchain can offer.
One might be skeptical of trying to streamline a perishable commodity of the supply chain (blood products), however, there are successful blockchain systems and projects out there which allowed for transparency. Let’s, for instance, consider the Farmer Connect project: all participants are connected in the blockchain with the end user being able to trace the whole journey of coffee beans. Blood supply concept too, can be applied in the blood supply chain. Main cases for supply chain re-engineering include:
1. Trust: Blockchain offers audit trail capabilities therefore can rebuild trust between donors, blood centers and hospitals. Blockchain functions as a shared ledger, keeping track of every transaction carried out and adding each activity to form a chain of information on the transaction. A donor can be permissioned to see and be notified on allowed events such as occurrence of transfusion at a particular location. Hospitals and blood centers can view and act on sensitive aspects such as patient details, inventory and cross-matching data.
Is it logical to spend millions on attracting first time donors and lose them again and repeating the cycle due to misappropriation and wastage of the donated blood?
Radio-frequency identification can also be used to identify and track tags attached as a supporting technology.
2. Operational efficiency: Artificial intelligence and Internet of Things (IoT) technology can be utilized to optimize decisions that factor the constraints and operational logic to deliver viable solutions by using prescriptive analytics. Yes, prescriptive, not descriptive! Descriptive analytics answers, the ‘what happened?, as predictive focuses on ‘what will happen next?’ while prescriptive captures the ‘what can we do?’ question.
AI and IoT solves the:
- Forecasting challenges,
- Clustering of blood donors per blood center,
- Inventory planning challenges,
- Network design and agility challenges e.g. establishing of donor centers, setting of supply chain capacities (storage, vehicle and blood drive scheduling) and flexibility to supply chain dynamics.
Imagine a case where sensors are connected to equipment for monitoring purposes, capturing any event logged, registered and flagged to the relevant personnel in cases of breaking down or maintenance.
If it sounds a little far-fetched, what of having frequently asked questions information made accessible by holding conversations through texts, WhatsApp, telegram and web chat through a trained virtual assistant or a bot?
Maybe this is practical: how about scheduling of donors according to their availability therefore doing away with peak time headaches and not restricting them to the working hour window period?
But before we all get excited, there are thorny issues that need to be addressed before implementation. It’s time for technological companies, experts, NGOs, supply chain and health care practitioners, researchers, political leaders and game changers to discuss this concept further and share views, ideas and make it a reality. IBM’s Design Thinking platform is a good place to start!
Let’s connect, discuss and build!
1EY : How blockchain is helping make every blood donation more effective,https://www.ey.com/en_gl/better-begins-with-you/how-blockchain-could-ensure-every-drop-of-blood-is-tracked-and-every-outcome-is-measured