Blood Alarm System.

According to the World health organization (WHO), blood is an essential medicine. Though the blood donation rates have significantly increased in sub-Saharan Africa, timely availability of safe blood components to patients is still challenging. For example, in 2019, the Uganda Blood Transfusion Service (UBTS) collected 288,000 units (that years target was 300,000 units), however blood stock outs in health facilities remained rampant. 

The discrepancy has been attributed to the lax process of accessing blood products in hospitals for transfusing patients, which encourages indiscriminate blood use. For example, a 2018 study showed that transfusions to 55.5% of children with anemia are inappropriate and clearly no indication in at least 16.3% of cases. It should be noted that 50% of the blood collected in Uganda is given to children and that a unit of blood costs the UBTS $45 to process hence an enormous waste of money and a rare critical resource.

Secondly, there is over reliance on humans (lab technicians) in deciding when to place blood orders. This often leads to late initiation of the lengthy process of ordering for blood, usually after receiving emergency cases requiring transfusion. With a centralized blood bank system having only seven Regional Blood Banks, most health facilities are far away from these regional blood banks making delays inevitable, with very poor clinical outcomes. For example, an 8-hour delay in blood transfusion in severe anemia due to malaria, one of the leading causes of under-five mortality, has been associated with very high mortality of 52%. Research ascribes about a quarter of maternal deaths due to hemorrhage (contributing 27.1% of maternal mortality rate in Uganda (336 deaths per 100,000 live births)) to inadequate blood access. In addition, a significant portion of deaths due to road traffic accidents (claiming 28.9 lives per 100,000 population in Uganda) is due to lack of timely transfusions.

Proposed solution.

The Blood Alarm System is a low-cost digital platform that eliminates avoidable blood stock outs in health facilities through:
(1) Guiding clinicians in determining the patients’ eligibility for blood transfusion before accessing blood products in blood refrigerators, hence efficient blood use.
(2) Automatically and accurately quantifying health facilities’ minimum blood requirements.
(3) Monitoring blood stock status in real time and notifying the health facility and regional blood bank about impending bloodstock out at the former before actual stock outs.

How does it work?
The system consists of:
(i) A hardware piece (attached to the hospital blood refrigerator),
(ii) A mobile app (used by clinicians, hospital lab staff/administrators & blood couriers) and
(iii) A web-based server.
The web-based server does most of the computation (for example estimating the minimum blood requirements of each health facility) and monitoring all activities at the hospital blood refrigerator by means of a simple hardware piece attached to a blood refrigerator. The server gives updates to the regional blood bank and the hospital including those about impending bloodstock outs at the latter before the actual disastrous stock outs.
The app enables hospital administrators/lab staff to timely and easily place blood orders upon receiving notifications about the impending blood shortages with an option of using cheaper blood couriers. 
The app also guides clinicians in determining the eligibility of the patients for blood transfusion. If eligible, the app allows the clinician generate a random unique code. This code is entered in the hardware piece in order to open the blood refrigerator door and access blood units.
When online the smart phone app of the clinician automatically sends the transfusion details e.g. patient IP number, reason for transfusion, pre-transfusion hemoglobin levels etc. to the regional blood bank via the server. 
Other notifications relayed by the hardware piece include; blood receipt acknowledgements, expiry, order discrepancy and power blackout alerts.

Schematic overview of the Blood Alarm System.

Patients who require blood transfusions in hospitals will be benefit through the following ways:

The availability of blood to patients will be increased as the Blood Alarm System will ensure appropriate and thus efficient blood use, saving the blood that would be given to patients who don’t need it to those in need.

The transfusions to patients will be given in a more timely manner, as the Blood Alarm System; will always provide information about impending blood stock outs at the health facilities before actual stock outs thus minimizing delays.
The platform will eliminate unnecessary blood transfusions, which carry a risk of transfusion-transmitted infections and other morbidities associated with transfusions.

All the above benefits to the patients will positively impact the reputation of hospitals (public and private) concerning service delivery, as clinical outcomes with timely blood transfusions are great.

Since it is the regional blood banks that pay for the blood ($45 to process a single unit of blood), appropriate and hence efficient blood use will enable them minimize waste. The system is to improve the hemovigilance, a weakness in the SWOT analysis of the Uganda Blood Transfusion Service. Also, research shows that hemovigilance is still poor in sub-Saharan Africa so if the system is rolled out in these nations, the benefits to national blood services in Sub-Saharan Africa will be significant.

The project will create financial opportunities for people in the society, for example, blood couriers, software administrators for the project, mechanics to install and maintain hardware pieces.

The project is to have a positive impact on the environment in the long run. Since the blood supply chain has a number of resource intensive stages with a carbon footprint that is; collecting blood, transporting it to regional blood banks, screening and processing and distributing blood and its products to health facilities, efficient blood use can greatly save these resources and hence reduce on the carbon footprint of the blood supply chain.

Am at Mulago National Referral hospital, Uganda, as an intern doctor and I always get involved in transfusing patients with blood. I have trained at this hospital (as well as Kirrudu and Kawempe referral hospitals) as a medical student at Makerere University (from where I have just completed my MBChB program (January 2022)).

In addition, as part of the academic program, I was exposed to the health centers in the countryside that is Budadiri Health Centre IV in Sironko district, (a very remote area in Eastern Uganda with poor internet connectivity and road network) in 2019 for about 3 months.
The horrible experience concerning the blood supply chain in both the countryside and urban health centers motivated me to come up with the idea of the Blood Alarm System, which I have been developing since December 2020.

In the process of developing my idea, I have reached out to a number of people for help and these include:
Eng. Brian Matovu (mentor); a biomedical Engineer and assistant lecturer, department of biomedical engineering at Makerere University. He was helpful during the ideation stage and he is guiding me in matters concerning intellectual property rights.

Mr. Michael Odal (Mentor); Senior Supply Chain Information Systems Advisor to the Management Sciences for Health-Uganda. He helped me in coming up with ways of reducing the cost of the project and briefed me on the challenges faced in the implementation of health information systems in Uganda including legal implications.

Professor Nakimuli Annette (mentor); Associate professor, department of obstetrics and gynecology and Dean School of medicine, Makerere University. President East, Central and Southern Africa College of Obstetrics and Gynecology. She has picked interest in my project and guiding me in getting necessary information concerning the aspect of guiding clinicians in determining the eligibility of patients (in obstetrics and gynecology) for blood transfusion. She has gone ahead to give me her real life clinical experiences about the poor blood supply chain enabling me make adjustments to cover such problems.

Professor Victor Musiime (mentor); Associate Professor, department of pediatrics, Makerere University. He has been my lecturer during my undergraduate program; he has picked interest in my project and guiding me in getting necessary information concerning the aspect of guiding clinicians in determining the eligibility of pediatric patients for blood transfusion. He has also given me his real life clinical experiences about the poor blood supply chain.

Dr. Wambi Wilson; a lab technician and researcher at Nakasero blood bank/Headquarters of the Uganda Blood Transfusion Service. I have had several one on one interviews with him to learn more about the problem am solving in the blood supply chain and explaining to him how am solving these problems. He has greatly appreciated the idea and accepted to facilitate my meeting with the head of the Uganda Blood Transfusion Service to explain more about my project and initiate high-level talks about the pilot phase.

Eng. Karugaba Ivan; Mechanical Engineer and CEO of Microfuse Computer Technologies Uganda. He has helped me with writing the code for the hardware piece (SERVICES PAID FOR). He has also helped me cost some aspects of the project and identify Original Equipment Manufacturers in China (e.g. EbyTon in Shenzhen) whom he has been dealing with in developing his computer products.

Artisans at Makerere University College of Engineering, Design and Art. These helped me in designing the hardware piece that is to be fixed on the blood refrigerators (SERVICES PAID FOR).

My team is deficient but I have a plan to include a computer science engineer excellent at App development, embedded systems, Cloud computing & Machine learning and a sales person to accomplish tasks easily and more efficiently as am still paying for some tasks to be accomplished for example coding.

Lastly, my project was selected among the best 34 projects in the Africa-Oxford Health Innovation Platform 2021 where I was helped to refine it.

Am applying to MIT challenge to get mentorship, make collaborations and raise funding for my project.

The Blood Alarm System is innovative through the following ways.
Through ensuring appropriate blood use in hospitals, the Blood Alarm System is to be at least 8% more efficient than methods in use today. Interestingly, this is to be done with just simple modifications in the current methods. For example, currently when a clinician thinks his/her patient needs a blood transfusion, all he has to do, is to go to the hospital blood bank or send someone there to fill in the blood request forms and pick blood. Though these request forms are meant to support appropriate blood use, they have inadequate information to do so, for example, under the section of “reason for blood transfusion”, there are nine elements (reasons) which one is just required to tick against (yet each element has different clinical scenarios with different transfusion criteria), fill in the clinician and patient details and hand it over to the lab technicians who rarely ask for details before giving out blood units. In the Blood Alarm System, I have just adopted those forms and made them interactive in a mobile app, asking simple chronological questions that more accurately guide in determining the eligibility of the patient for a blood transfusion. If eligible, a unique random code is generated by the app, which is taken to the hospital blood bank, entered by the lab technician in the hardware piece fixed on the hospital blood refrigerator to open the door and access blood. 
Hospital transfusion committees are also meant to ensure appropriate blood use through a number of activities including continuous medical education (CME) on blood transfusion. Unfortunately, these committees are inactive in Ugandan health facilities and thus CME on blood transfusion rarely done. However, the Blood Alarm System App is to be educative giving reasons as to why a particular patient may not be eligible for a transfusion and criteria for transfusing patients with different clinical conditions as per local guidelines at the convenience of the clinician.

The system is cheaper than existing solutions as it is compatible with existing infrastructure, that is, a simple and cheap hardware piece is fixed on blood refrigerators currently possessed by all hospitals registered with the Uganda Blood Transfusion Service (UBTS) and a free download app on the clinicians smartphones, other than buying sophisticated infrastructure e.g. smart blood refrigerators and/or dedicated desktop computers with accessories like barcode readers when using electronic blood bank management systems or hospital blood tracking systems.

Unlike the electronic Blood Bank Management Systems, which are strictly reliant on the internet, the hardware piece (the fixed point of communication of a health facility and the web based server) can automatically switch to SMS encoded messages relayed via a GPRS modem to the web based server enabling sustained communication. This makes the platform crucial in areas with poor internet coverage. In addition, the app does not need an active internet connection to do the most important tasks for example determining the patients’ eligibility for blood transfusion and generating the code for accessing blood.

The blood alarm system is to revolutionize the process of ordering for blood from regional blood banks by health facilities. The process is be more reliable, short and simplified through, minimizing reliance on humans (hospital lab technicians) to decide when to place blood orders as they have often failed to place them in a timely manner. This is to be achieved through using a machine learning algorithm on the web server that more accurately quantifies the health facilities minimum blood requirements (currently not clearly known by the UBTS) for a given health facility, monitor blood stock in real time and notify the health facility and regional blood bank about impending blood stock outs before actual disastrous stock outs at the former. With a few clicks, a blood order can be placed upon receiving a notification.

Given that Uganda is still far from meeting the national blood requirements (according to the WHO), an assumption can be made that any unit of blood that goes to waste, that is, given to a patient who doesn’t need it, leads to mortality or severe morbidity to one who needs it but doesn’t get it. In addition, whoever gets a needless blood transfusion, he/she is exposed to an unnecessary risk of transfusion-transmitted infections and other morbidities like transfusion reactions and volume overload.

The impact goal for the next year is to have six health facilities registered with Uganda Blood Transfusion Service (UBTS) in central Uganda and Nakasero regional blood bank/headquarters of UBTS enrolled for a six months pilot phase to eliminate inappropriate blood transfusions and ensure timely availability of blood to patients. (At least 5,000 patients will be positively impacted).

The impact goal for the next three years is to have all health facilities registered with UBTS and all regional blood banks of UBTS enrolled on to the system. At least, 20,000 lives will be saved as at least 23,000 blood units will be saved. In addition, at least 20,000 more people will be saved from unnecessary risks associated with unnecessary transfusions.

The impact goal for the next five years is to have at least 95% of all patients in need of blood transfusions to get them in a timely manner throughout Uganda.

Note.
The values for the impact goal for the next three years goal have been obtained using the values from a study (stated in the problem section above) showing that transfusions to 55.5% of children with anemia are inappropriate and clearly, no indication in at least 16.3% of cases, together with the fact that 50% of the blood collected in Uganda is given to children and that the Uganda Blood Transfusion Service collected 288,000 units of blood in 2019. A conclusion can be drawn that at least 23,000 units of blood were wasted in 2019 and the number is to grow as the blood collection capacity increases with time.

Am to measure the impact of my innovation through;

Determining and comparing the percentage of patients receiving appropriate blood that is, with blood transfusion guidelines well followed, before and after introducing the platform at health facilities in a specific period. The data is to be collected from the Blood Transfusion Daily Activity Register (Health Information Management Systems 003 (HMIS 003)) before the introducing system and from the Blood Alarm System database after introducing the platform.

Determining and comparing the number of blood units in stock (in the hospitals’ blood refrigerators) at the time of placing orders for a fresh blood batch, before and after introducing the blood alarm system.  The data is to be collected from the transfusion reports submitted to the regional blood banks at the time of requesting for blood by health facilities and from the Blood Alarm System database after introducing the platform.

The Blood Alarm System is to be successful because of the following:

The Uganda Blood Transfusion Service (UBTS) has not yet met the national blood requirements. For example, in 2019, before the nationwide lockdowns due to COVID-19, the UBTS collected 288,000 units of blood and though it almost hit its annual target of 300,000 units that year, it was still far below the amount recommended by the World Health Organization of 450,000 units (1% of the national population). This makes appropriate and hence efficient blood use extremely key in trying to meet the national blood demands. Therefore, there is an unquestionable need and hence market for the project. In addition, the ongoing COVID-19 pandemic has made efficiency in blood use more important than ever before given the low blood donation rates making the need for the project even more urgent.

Influential health experts at Makerere University, College of health sciences, have liked the project and have accepted to provide guidance in the process of developing the project. Their recommendation will also be a key part in my marketing strategy.

I have reached out to the UBTS, which has liked the project, and low-level talks about a pilot have been initiated.

The Ugandan government is willing to invest in the digitization of health information systems and since public health facilities are to be part of the customers, there is an assured market from the public sector.

The technology of the Blood Alarm System is cheaper than that used by the alternative solutions on the market as it is compatible with existing infrastructure, for example, a free download mobile app on clinician and lab technician smartphones and a hardware piece fixed on the already existing hospital blood refrigerators other than buying new infrastructure such as smart blood refrigerators when using electronic blood bank management modules.

In addition, the hardware pieces are to be given to health facilities for free making it easy to penetrate the market (costs off set by monthly subscriptions).

The web-based services in Uganda have improved making the implementation of the project easier. There are a number of local commercial data centres that can be used such as Raxio Data Centre and Liquid Intelligent Technologies (commercial data centres).

A gradual process is to be gone through to realize the full potential of the Blood Alarm System, that is:

In the first 6 months after funding, I will register the company and concentrate on research and product development to have a Minimum Viable Product. This will be done through continuing to deal with will local IT companies for coding or collaboration with world class computer science engineers to accomplish the software aspects of the project and critically reviewing the design of the hard ware piece, again through either dealing with local companies or collaborating with world class mechanical engineers and outsourcing components from Shenzhen China. 
This is to be followed by obtaining a license to operate and 6 months of a pilot phase involving six health facilities in central Uganda and Nakasero regional blood bank/headquarters of the Uganda blood transfusion service (UBTS).
Guided by the information gathered from the pilot, 150 health facilities out of the 350 health facilities currently registered with the UBTS in different parts of the country together with 7 regional blood banks in the country will be enrolled on to the platform at the beginning of the second year.
In the third year, the rest of the health facilities registered with the Uganda Blood Transfusion Service will be included on to the platform. 
In the fourth year, I will extensively study the market in the neighboring sub-Saharan Africa most especially Kenya and Tanzania and carry out a pilot phase. 

Application program to be used by,

Clinicians on smart phones to guide them in determining the patients’ eligibility for blood transfusion and generating a code that allows access to blood products in hospital blood refrigerators.
Lab technicians/hospital administrator to receive notifications about impending blood stock outs at the health facility and easily place blood orders in a timely manner.
Blood issuing officers at regional blood bank computer stations to accept blood requests from health facilities and send information about the blood units in the blood batch to be sent a certain health facility.
Blood couriers who receive order for transporting blood from a given regional blood bank to a particular health facility.

Embedded systems for the hardware piece, which is fixed on the hospital blood refrigerator to control opening of the blood refrigerator to access blood. It continuously receives and sends information to the web-based server even in absence of internet connection through using a SMS encoded messages. The hardware piece prototype consists of a raspberry pi computer (cheaper and customized printed circuit board assembly to be used in the final product), touch screen (currently using a raspberry pi 7 inch touch screen in prototyping but a 3.5 inch touch screen is to be used in the final product), solenoid lock, relay, USB serial converter, fingerprint sensor(used by lab technician upon entering the code generated by the clinician app), barcode reader (for scanning the barcodes on blood units taken out or brought into the refrigerator) and a GSM module (for relaying SMS messages and for internet connectivity).
Cloud computing; a web based server will have a database and the algorithms that do much of the computations. 

Machine learning; the algorithm on the web server will automatically and accurately quantify the health facilities minimum blood requirements for each health facility, monitor blood stock in real time and notify the health facility and regional blood bank about impending blood stock outs before actual disastrous stock outs at the former.

SMS technology, which will allow sustained communication even in absence of internet connection.

I have ensured diversity in my project through working with people of different educational backgrounds for example doctors, mechanical, biomedical and software engineers without restrictions on any dimensions of diversity like gender, ethnicity, race, geographical location, income, marital status, national origin, religious status among others. As I build my team and company, I will continue interacting or recruiting people without restrictions impeding diversity.
Inclusivity will be ensured through making decisions after consulting members of the team.
A platform that gives all members of the team or the company an opportunity to put forward their suggestions concerning the company will be established to ensure equity.

Customer segments;
1. Health facilities registered with the national blood transfusion service.
2. Regional blood banks.

Value proposition to the;
1. Regional blood banks; appropriate and hence efficient blood use by health facilities.
2. Hospitals; accurate and automatic notifications about impending blood stock outs before actual disastrous stock outs in the health facility and easily place blood orders regardless of internet coverage.

Channels
1. Recommendations by health experts.
2. Printed adds.
3. Company web site (not yet established).
4. Mobile app
5. Hardware pieces installed on the blood refigerators of health facilities.

Revenue.
1. Monthly subscriptions by the regional blood banks and health facilities;
2. Advertisements targeting clinicians and lab technicians through the mobile app.
3. Commission from the transactions between the health facilities and blood couriers as there will be an option of the health facility using blood couriers upon receiving notifications of impending blood stock outs.
4. Prizes, grants and investment.

Cost structure.
1. Research & product development to an MVP (R&D after pilot phase).
2. Pilot phase (License and IPR-acquisition inclusive).
3. Hardware pieces.
4. Wages.
5. Maintenance (monthly data and SMS bundles for the hardware pieces, repair of the hardware pieces averaging, server subscription).
6. Marketing & sales.

Key resources.
Web server
Software administrators
Mechanics to install and repair the hardware pieces in health facilities.
Funds

Key activities.
Maintaining the web based server
Maintaining the company web site
Advertising
Customer service

Key partners.
Blood couriers.
Uganda Blood Transfusion Service.
Commercial data centres.

The project is to have diversified revenue streams to ensure self-sustainability of the project that is to say:
1. Monthly subscriptions by the regional blood banks and health facilities;
2. Advertisements targeting clinicians and lab technicians through the mobile app.
3. Commission from the transactions between the health facilities and blood couriers as there will be an option of the health facility using blood couriers upon receiving notifications of impending blood stock outs.

I have not generated any revenue.