OUR BUSINESS

MEDICAL DIRECTOR'S REPORT

it is a point of personal pride that at SANBS we provide products and services to the public sector that are on par with that provided to the private sector, and even with that provided in many high development index countries …

Dr Karin van den Berg, MEDICAL DIRECTOR

OUR BUSINESS

MEDICAL DIRECTOR'S REPORT

it is a point of personal pride that at SANBS we provide products and services to the public sector that are on par with that provided to the private sector, and even with that provided in many high development index countries …

Dr Karin van den Berg, MEDICAL DIRECTOR

Introduction

Having recently completed my first year as the Medical Director for SANBS, I continue to be amazed at how complex the business of supplying safe, sufficient blood products to the patients of South Africa is, especially when one prides oneself on providing the same quality product regardless of whether the patient is in Sandton, Gauteng or in Madwaleni, in deep rural Eastern Cape. The fact that this process often appears effortless to those looking in, is a testament to the quality of the people and processes we have in SANBS, much of which was developed by the giants that came before us and indeed still walk among us.

 

Following recommendations by the World Health Organization (WHO) that the Ministries of Health should “have the ultimate responsibility for ensuring an adequate supply of safe blood and blood products”, South Africa underwent a process of unifying the multiple smaller blood services operating in South Africa during the 1990s. It is through the hard work and dedication of people such as Prof. Anthon du Plessis Heyns, and indeed, Ravi Reddy, our current CEO, that the country was able to amalgamate most of these fragmented services into what is today, 21 years later, the South African National Blood Service. Utilising relationships that have been forged over decades, SANBS is today able to collaborate extensively with the Western Cape Blood Service locally, but also with other blood services in Africa and the rest of the world.

Introduction

Having recently completed my first year as the Medical Director for SANBS, I continue to be amazed at how complex the business of supplying safe, sufficient blood products to the patients of South Africa is, especially when one prides oneself on providing the same quality product regardless of whether the patient is in Sandton, Gauteng or in Madwaleni, in deep rural Eastern Cape. The fact that this process often appears effortless to those looking in, is a testament to the quality of the people and processes we have in SANBS, much of which was developed by the giants that came before us and indeed still walk among us.

 

Following recommendations by the World Health Organization (WHO) that the Ministries of Health should “have the ultimate responsibility for ensuring an adequate supply of safe blood and blood products”, South Africa underwent a process of unifying the multiple smaller blood services operating in South Africa during the 1990s. It is through the hard work and dedication of people such as Prof. Anthon du Plessis Heyns, and indeed, Ravi Reddy, our current CEO, that the country was able to amalgamate most of these fragmented services into what is today, 21 years later, the South African National Blood Service. Utilising relationships that have been forged over decades, SANBS is today able to collaborate extensively with the Western Cape Blood Service locally, but also with other blood services in Africa and the rest of the world.

Scientific Advancement Underpinned by Robust Quality Systems

In South Africa, the role of the Medical Director of a blood service is to be accountable for the safety, quality and general sufficiency of the blood supply, a role that has had a shifting focus over the past 21 years. Historically, the driving force behind ensuring a safe blood supply was the prevention of transfusion-transmitted infections (TTI) such as HIV. The implementation of individual donation nucleic acid amplification testing (ID-NAT) in 2005 enabled SANBS to not only expand our donor base, but also enabled the Medical Directors to broaden their quality focus beyond concerns of TTI, to where we, today, are focused on implementing international quality standards such as ISO 15189 and ISO 9001.

 

During this time, the world has seen many dramatic advances in the healthcare arena. Diseases, such as certain genetic conditions, major trauma, complications in pregnancy (e.g., ectopic pregnancy, abruptio placentae), and cancer that previously were associated with poor health outcomes and high rates of mortality, are today not only treatable, but often curable. These newer modalities are often only possible due to the availability of a reliable, safe and sufficient blood supply. Simply put, without good quality blood products, most of the oncology treatment regimes, stem cell and organ transplant programmes commonplace today would not be possible at all. Blood transfusion in South Africa has advanced in line with advances in healthcare delivery, whether it is through expanded access to blood products as healthcare delivery in rural areas were expanded or through the provision of hi-tech clinical apheresis solutions to programmes such as ABO-incompatible liver transplant programmes. SANBS has always strived to meet the needs of our patients and treating clinicians.

 

In recent times, ensuring that we continue to provide a reliable, world-class service within the South African two-tiered healthcare system, has become increasingly challenging. Despite the challenges of a resource-constrained public service and the low uptake of Patient Blood Management (PBM) principles in the private sector, it is a point of personal pride that at SANBS we provide products and services to the public sector that are on par with that provided to the private sector, and even with that provided in many high development index countries.

Scientific Advancement Underpinned by Robust Quality Systems

In South Africa, the role of the Medical Director of a blood service is to be accountable for the safety, quality and general sufficiency of the blood supply, a role that has had a shifting focus over the past 21 years. Historically, the driving force behind ensuring a safe blood supply was the prevention of transfusion-transmitted infections (TTI) such as HIV. The implementation of individual donation nucleic acid amplification testing (ID-NAT) in 2005 enabled SANBS to not only expand our donor base, but also enabled the Medical Directors to broaden their quality focus beyond concerns of TTI, to where we, today, are focused on implementing international quality standards such as ISO 15189 and ISO 9001.

 

During this time, the world has seen many dramatic advances in the healthcare arena. Diseases, such as certain genetic conditions, major trauma, complications in pregnancy (e.g., ectopic pregnancy, abruptio placentae), and cancer that previously were associated with poor health outcomes and high rates of mortality, are today not only treatable, but often curable. These newer modalities are often only possible due to the availability of a reliable, safe and sufficient blood supply. Simply put, without good quality blood products, most of the oncology treatment regimes, stem cell and organ transplant programmes commonplace today would not be possible at all. Blood transfusion in South Africa has advanced in line with advances in healthcare delivery, whether it is through expanded access to blood products as healthcare delivery in rural areas were expanded or through the provision of hi-tech clinical apheresis solutions to programmes such as ABO-incompatible liver transplant programmes. SANBS has always strived to meet the needs of our patients and treating clinicians.

 

In recent times, ensuring that we continue to provide a reliable, world-class service within the South African two-tiered healthcare system, has become increasingly challenging. Despite the challenges of a resource-constrained public service and the low uptake of Patient Blood Management (PBM) principles in the private sector, it is a point of personal pride that at SANBS we provide products and services to the public sector that are on par with that provided to the private sector, and even with that provided in many high development index countries.

The Year Under Review

Reviewing the past year through the lens of our six capitals, SANBS has had a number of achievements but also a few challenges.

Financial capital

Covid-19 had a greater impact on our alternative revenue streams than on our core business, in part because several of these streams are highly specialised services that were disproportionally affected by the healthcare service disruption during the various Covid-19 waves. The teams were, however, able to introduce a number of new services, including immuno-absorption programmes for patients undergoing ABO incompatible liver transplants. In addition, the number of clinical units we are providing clinical apheresis to has increased to 78, of which 26 are stem cell transplant units.

Human capital

As reported previously, SANBS has invested significantly in the RAD Academy and developed a Dual Career Pathway (DCP) strategy, both aimed at increasing scientific and research skills in SANBS, but also to ensure that we have a talent pool from which to promote internally. Over the past year, this investment has paid off with both senior manager vacancies in the Medical Division as well as all three subject matter expert positions created as part of the DCP, being filled by internal applicants.

Intellectual capital

Over the past year, we have successfully continued our strategy of expanding research and publication capacity among a growing proportion of SANBS staff and divisions with 20 publications in peer reviewed scientific journals. During the early days of the newly formed SANBS, we developed relationships that put SANBS on the international arena in relation to TTI related research, especially HIV.Over time, we have expanded our collaborations beyond the traditional TTI field, to now include donor and donation, blood utilisation, PBM, clinical apheresis, stem cell and genetic research.

Manufactured capital

During the interactions with MAK Systems, an international organisation with whom SANBS is collaborating for the delivery of the new BECS, it became clear that the sophisticated blood collection, processing and issuing systems and processes developed by SANBS over the past 21 years, took our international partners by surprise as they were not fully aware of the sophistication of the Blood Supply Chain in South Africa. The new Mount Edgecombe campus is our flagship from which this sophisticated journey of blood can be viewed, however, it is but one part of the significant network of collection, processing and issuing sites created from the fragmented blood services 21 years ago.

Natural capital

At SANBS we are acutely aware of the impact we have on our environment. One aspect of this is the biological waste requiring incineration we generate through our business processes, a significant portion of which relates to the discarding of used test reagents and consumables. Active management of discards at each step of the business process has resulted in overall discard rates below 5%, which compares very favourably to the ~10% seen in other comparable blood services. The second aspect worth noting is the positive impact that the implementation of the remote working policy and the use of virtual platforms for meetings and training has had on travel and therefore our carbon footprint.

Social and relationship capital

At our heart, SANBS is about people, in the words of one of our directors, SANBS is about people being trusted to save lives. To be able to do so SANBS needs to forge relationships built on trust with all our stakeholders, not least of which is our donor communities. Over the past 21 years, through a dedicated focus on transformation supported by scientific developments such as ID-NAT testing, SANBS has managed to transform our donor base to be more reflective of the population we serve.

The Year Under Review

Reviewing the past year through the lens of our six capitals, SANBS has had a number of achievements but also a few challenges.

Financial capital

Covid-19 had a greater impact on our alternative revenue streams than on our core business, in part because several of these streams are highly specialised services that were disproportionally affected by the healthcare service disruption during the various Covid-19 waves. The teams were, however, able to introduce a number of new services, including immuno-absorption programmes for patients undergoing ABO incompatible liver transplants. In addition, the number of clinical units we are providing clinical apheresis to has increased to 78, of which 26 are stem cell transplant units.

Human capital

As reported previously, SANBS has invested significantly in the RAD Academy and developed a Dual Career Pathway (DCP) strategy, both aimed at increasing scientific and research skills in SANBS, but also to ensure that we have a talent pool from which to promote internally. Over the past year, this investment has paid off with both senior manager vacancies in the Medical Division as well as all three subject matter expert positions created as part of the DCP, being filled by internal applicants.

Intellectual capital

Over the past year, we have successfully continued our strategy of expanding research and publication capacity among a growing proportion of SANBS staff and divisions with 20 publications in peer reviewed scientific journals. During the early days of the newly formed SANBS, we developed relationships that put SANBS on the international arena in relation to TTI related research, especially HIV.Over time, we have expanded our collaborations beyond the traditional TTI field, to now include donor and donation, blood utilisation, PBM, clinical apheresis, stem cell and genetic research.

Manufactured capital

During the interactions with MAK Systems, an international organisation with whom SANBS is collaborating for the delivery of the new BECS, it became clear that the sophisticated blood collection, processing and issuing systems and processes developed by SANBS over the past 21 years, took our international partners by surprise as they were not fully aware of the sophistication of the Blood Supply Chain in South Africa. The new Mount Edgecombe campus is our flagship from which this sophisticated journey of blood can be viewed, however, it is but one part of the significant network of collection, processing and issuing sites created from the fragmented blood services 21 years ago.

Natural capital

At SANBS we are acutely aware of the impact we have on our environment. One aspect of this is the biological waste requiring incineration we generate through our business processes, a significant portion of which relates to the discarding of used test reagents and consumables. Active management of discards at each step of the business process has resulted in overall discard rates below 5%, which compares very favourably to the ~10% seen in other comparable blood services. The second aspect worth noting is the positive impact that the implementation of the remote working policy and the use of virtual platforms for meetings and training has had on travel and therefore our carbon footprint.

Social and relationship capital

At our heart, SANBS is about people, in the words of one of our directors, SANBS is about people being trusted to save lives. To be able to do so SANBS needs to forge relationships built on trust with all our stakeholders, not least of which is our donor communities. Over the past 21 years, through a dedicated focus on transformation supported by scientific developments such as ID-NAT testing, SANBS has managed to transform our donor base to be more reflective of the population we serve.

Looking forward

Adjusting to the new normal introduced by Covid-19 moving from an epidemic to an endemic disease, will require SANBS to re-assess our processes and systems. With the normalisation of the blood demand, our Donor Teams will need to develop new and innovative ways of collecting blood with programmes such as the “Good Hood” campaign and #MoreBlood in the pipeline. Multi-disciplinary teams are developing strategies and processes to ensure sufficient platelets products; improved blood component processing; completion of the SMART fridge pilot; completion of the blood bank automation project and implementation of new testing strategies in our specialised laboratories, all of which will be underpinned by our new BECS. Key focus areas for staff development will include the roll-out of our new Learner Experience Portal, bedding down of the dual career pathway and continued research capacity development, including the continuation of the Covid-19 sero-prevalence and immunology research.

Looking forward

Adjusting to the new normal introduced by Covid-19 moving from an epidemic to an endemic disease, will require SANBS to re-assess our processes and systems. With the normalisation of the blood demand, our Donor Teams will need to develop new and innovative ways of collecting blood with programmes such as the “Good Hood” campaign and #MoreBlood in the pipeline. Multi-disciplinary teams are developing strategies and processes to ensure sufficient platelets products; improved blood component processing; completion of the SMART fridge pilot; completion of the blood bank automation project and implementation of new testing strategies in our specialised laboratories, all of which will be underpinned by our new BECS. Key focus areas for staff development will include the roll-out of our new Learner Experience Portal, bedding down of the dual career pathway and continued research capacity development, including the continuation of the Covid-19 sero-prevalence and immunology research.

Conclusion and appreciation

As is the case for many industries, the past year has been tough on SANBS and our staff, with the coming year likely to be equally challenging. However, the way our staff responded to the adversity brought about by the Covid-19 epidemic bodes well for our continued ability to overcome the challenges of the future. I know that I speak for the Executive when extending a heartfelt appreciation to our staff, donors, patients and all other stakeholders for their support over the past 21 years; with your support and dedication, we can be trusted to save lives.

Conclusion and appreciation

As is the case for many industries, the past year has been tough on SANBS and our staff, with the coming year likely to be equally challenging. However, the way our staff responded to the adversity brought about by the Covid-19 epidemic bodes well for our continued ability to overcome the challenges of the future. I know that I speak for the Executive when extending a heartfelt appreciation to our staff, donors, patients and all other stakeholders for their support over the past 21 years; with your support and dedication, we can be trusted to save lives.