Questions/Answers

Lumajang is a regency with the area of 1,790.90 square kilometres and the population of 1,104,759. It has 7 hospitals: 2 government hospitals and 5 private hospitals. The Blood Center of Indonesian Red Cross (IRC) is the only blood provider in Lumajang, located 1-15 km away from the hospitals. Public transport limitation, no routes directing to the hospital and improper blood-transfer technique became problems for the patients’ families when taking the blood bags from the Blood Center. Blood distribution is one of important aspects in blood services. The distribution length and packaging of the blood will affect the quality. The initiative aims to improve the blood distribution mechanism for safe and punctual delivery to the Lumajang’s hospitals through “Blood_Jek” The Lifeguard. The target of “Blood_Jek” is to reduce the number of complaints from 366 cases in 2007 to 0 cases in 2021, and the average number of blood needs from 4 bags in 2007 to 2 bags in 2021 for raising 1 g/dl Haemoglobin. Blood Jek's blood distribution mechanism is to use a two-wheeled vehicle equipped with a coolbox, thermometer, siren to get special access on the road, as well as personnel who are trained in blood packaging and transportation.

This initiative is intended for people who need blood, especially for pregnant and giving birth women. Nearly 20-40% of maternal deaths were caused by postpartum hemorrhage, therefore the availability of fast and safe blood received special attention. Blood distribution had been conducted by the patient's family by carrying it in a plastic bag without maintaining the storage temperature and using public transportation. As a result, there was a delay in transfusion and the quality of the blood decreased. Blood_Jek aims to improve the blood distribution mechanism and the management information system (SIMDONDAR) for more accurate blood recipient data

To achieve the SDGs, Lumajang Blood Center established a program to realize safe, punctual, affordable and sustainable blood services by 2022. “Blood_Jek” has a direct contribution to reducing the maternal mortality rate (MMR) caused by postpartum hemorrhage as indicated in SDGs’ target 3.1. In 2011, the MMR in Lumajang was 116 per 100,000 live births with 20-40% of deaths caused by postpartum hemorrhage. From a total of 762 complaints submitted to the Blood Center of IRC Lumajang, 366 cases or 48% were women who gave birth and complained about delays and damaged blood. The Blood_Jek initiative, which has been running for almost 10 years, has been able to contribute to reducing MMR due to bleeding. In 2020, the MMR decreased to 97 per 100,000 live births and only 4% of maternal deaths were caused by postpartum hemorrhage. There were no complaints filed for delays and damage in blood distribution process. Blood_Jek is an effort to improve the blood distribution mechanism by providing direct delivery service and proper packaging, keeping the temperature under control during distribution to hospitals. Blood delivery is carried out by competent personnel.

Nowadays, convenience is a priority in service. People need fast and easy services, including the provision of blood as part of medical services in hospitals. This becomes more urgent for patients, especially mothers who experience bleeding during childbirth. Blood_Jek is very relevant that can be continuously implemented and developed as technology advances. Blood_Jek's operational funding comes from the Replacement Fee for Blood Processing paid by patients. The amount of this fee has been determined by the government through a decree, thus the patient is not burdened with other additional costs. Independence in providing operational costs makes Blood-Jek sustainable.

Safe and timely preparation of blood is a major aspect of medical treatment in hospitals, especially in the case of postpartum hemorrhage that requires transfusion. If this aspect is not met, the medical action will not proceed according to the doctor's plan. The pain will last longer, it can even lead to death. Blood_Jek guarantees safe and timely blood delivery. The patient's blood sample from the hospital will be processed and after the blood is ready, the Blood_Jek personnel will deliver it to the treatment room. Thus, errors and delays in delivery or blood damage due to improper distribution mechanisms can be avoided. Data accuracy on SIMDONDAR can be guaranteed because Blood_Jek personnel directly input data transmission data in real time. This makes it easier for the Blood Center to track and make a report. Lumajang’s Blood Center (LBC) and Health Office agreed that one of the programs that can reduce maternal mortality is Blood_Jek. This is stated in the MoU between the Health Office, LBC, and hospitals regarding quick wins to accelerate the reduction of maternal mortality rate in Lumajang.

Blood_Jek is one of the programs to accelerate the reduction of maternal mortality rate in Lumajang Regency. All hospitals in this regency already have Blood_Jek as a form of replication and acceleration program. “Blood_Jek” The Lifeguard is a service for transporting blood using motorcycle equipped with coolbox, thermometer and sirens for getting free passage and carried out by personnel who are trained in blood packaging and transportation. Personnel who ride motorcycles are usually men, but in this program, women also become Blood_Jek riders.

This program can have a significant impact on groups who directly experience the benefits of blood delivery services, namely women who give birth. Based on data on blood demand in 2020, there were 1,142 maternal patients who requested blood at Lumajang's Blood Center due to bleeding during childbirth or other causes. Pregnant women diagnosed with postpartum hemorrhage desperately need blood quickly and safely. If it is too late or the blood is damaged, it can cause death in pregnant women. Blood_Jek is designed to improve existing blood service mechanisms to ensure speed and safety of blood delivery to the hospital and ready for transfusion. A fleet of motorcycles for delivery are equipped with standard blood storage facilities and competent personnel. This makes Blood_Jek able to guarantee the speed and safety of blood delivery.

The stages of implementing the Blood_Jek are as follows: a. Prepared internal readiness for program implementation by conducting internal dissemination, recruiting personnel, and designing Blood-Jek motorcycles (in 2013 the inventory motorcycle was designed with the "Emergency Blood Motor" brand and in 2016, rebranded as Blood_Jek) b. Issued the Head of Unit’s Decree on Blood_jek Services c. Prepared Standard Operational Procedures and Work Instructions for blood distribution in 2016 d. Synchronized the Blood_Jek program with SIMDONDAR (Blood Donor Management Information System) in 2016 e. Signed Service Commitment by all staff regarding blood distribution in 2016 f. Made collaborations with 3rd parties in 2016 to disseminate Blood_Jek as an initiative to improve blood services in Lumajang. Partners who are the targets of this collaboration include: print media, electronic media, and Customer Service Relationship (CSR) of Bank Rakyat Indonesia (BRI) Lumajang branch g. Make a cooperation agreement on Blood_Jek's blood delivery service with all hospitals in Lumajang Regency. The cooperation for this service was then stated in the MOU between the Hospital and Lumajang Blood Center (LBC). Hospitals that cooperate with LBC include General Hospital of dr. Haryoto, Lumajang Islamic Hospital, Bhayangkara Hospital, and Wijaya Kusuma Hospital, all Hospital in Lumajang (in 2018) h. The cooperation agreement between the Health Office, Lumajang Blood Center and all hospitals is linked to the program to reduce maternal mortality rate in Lumajang in 2019 i. Conducted monitoring and evaluation by documenting complaints and community satisfaction surveys at least every 6 months.

Difficult to contact personnel during delivery become an obstacle. Many hospitals called the Blood Center to ask the current position of Blood_Jek because blood must be transfused to emergency patients. To overcome this, the procedure taken is, every time Blood_Jek departs from the center, the personnel will notify the nurse that the blood is ready to deliver. The challenge is the risk of accidents due to passing through busy provincial roads. Therefore, riding safety equipment is a requirement in Blood_Jek. Personnel are required to wear complete safety equipment to be safe and secure on the road.

1. First time in Indonesia In 2011, out of 212 Blood Transfusion Units (BTU), only Lumajang Blood Center provided blood delivery services. Generally, BTUs in Indonesia distribute blood directly to the patient's family without maintaining the temperature. This risks lowering the quality of the blood. 2. Low Cost Blood_Jek's operating costs are low, around 20 million, with enormous benefits. Effective medical services can be achieved because of this. 3. Simple and Significant Blood_Jek uses simple technology, a motorcycle equipped with a coolbox and temperature control. But this technology is really needed to improve blood services in Indonesia.

Concerns about slow medical treatment for mothers who were pregnant and gave birth due to delay in receiving blood or damaged blood were the inspiration for this initiative. The result of joint thinking with all relevant parties, such as the Blood Center, Hospitals and Local Government, has made this initiative exist and continue to be developed. Pregnant women at risk of bleeding need fast and safe blood to avoid the risk of death. The Blood Donor Unit seeks to improve the blood delivery service mechanism to reduce maternal mortality in Lumajang.

Information technology used is technology for blood delivery services in general. The Lumajang Blood Center has implemented SIMDONDAR (Blood Donor System) since 2013. This system continues to be developed following the improvement of services at LBC. However, Blood_Jek service has not been fully integrated with SIMDONDAR, only limited to donor data and handover time. However, with the current obstacles and challenges, it is possible that Blood_Jek will upgrade, for example providing the position of Blood_Jek on the road in real timetime and so on.

Blood_Jek is a simple initiative that has been transferred to several blood service units within and outside East Java. They did a comparative study at Lumajang Blood Center (LBC). The implementation of Blood_Jek was strengthened by the issuance of a letter from the Headquarters of the East Java PMI No. 0316/02.06.00/ADM/II/2017 on 21 February 2017 concerning the Blood_Jek’s blood distribution mechanism to be an inspiration for all BDUs in Regencies/Cities of East Java. This initiative was presented at a public service innovation workshop in South Sulawesi Province organized by the Ministry of Administrative and Bureaucratic Reform. It was also introduced by the Ministry of Health at the APEC event attended by 21 countries. The Blood_Jek poster was presented at the International Society of Blood Transfusions in Toronto Canada. This initiative has also been replicated by several Blood Donor Units in Probolinggo, Ponorogo, Blitar, Bondowoso, Mojokerto, Purbalingga and 5 regencies/cities in South Sulawesi. The collaboration and synergy between the Blood Center and the Regency Government makes Blood_Jek a program to accelerate the reduction of MMR in Lumajang and thus, all hospitals in Lumajang have Blood_Jek services.

Blood_Jek the savior is being transferred

There are 25 Blood_Jek motorbike riders in Lumajang. They received training on packaging and blood distribution from Lumajang Blood Center. In addition, there are 9 Blood_Jek motorbikes. Two of them were given by PMI of East Java Province and the Lumajang Regency Government as a token of appreciation for the successful implementation of this initiative. The LBC also cooperates with CSR of Lumajang’s BRI Bank to provide Blood_Jek uniforms. Funding for this initiative comes entirely from Replacement Fee for Blood Processing. The total cost is Rp. 45,000,000 allocated for personnel, vehicle maintenance and fuel.

The Blood_Jek service has been running for almost 10 years and is constantly improving. A motorbike given by the Lumajang Government in early 2021 shows that this initiative is still very relevant to be carried out in this region. This service is sustainable because of the cooperation agreement between the Lumajang Health Office, the Blood Center and the Hospital to make Blood_Jek one of the quick win activities to accelerate the reduction of maternal mortality in Lumajang. All hospitals in Lumajang Regency already have Blood_Jek services.

Yes

The evaluation was carried out internally by the Lumajang Blood Center (LBC) through complaint management and satisfaction surveys. Due to the open management system, complaints can be made daily by telephone or directly submitted to the LBC staff. The complaints will be recorded and promptly followed up by LBC staff in the management review meeting. The results of the meeting will be immediately disseminated to all officers and relevant stakeholders. Meanwhile, a satisfaction survey is conducted by LBC every 6 months. Respondents to this survey are the medical officers at the hospitals (nurses/doctors).

The evaluation indicator is the capacity of the Blood Center in classifying complaints from service users on blood request services (delays or blood damage). The Blood Center conducts a Blood_Jek’s customer satisfaction survey every 6 months. The satisfaction index includes the Blood_Jek delivery system, the condition of the blood received, errors in blood delivery, the speed of service and the responsibility, competence, courtesy and friendliness of the personnel. The blood center also facilitates suggestions and complaints from the public as well as evaluation meetings with the Health Office regarding maternal deaths in Lumajang, particularly due to hemorrhage.

The evaluation found that there were no complaints about delays and blood damage in the blood delivery service. Based on the survey results, the satisfaction index is 96 with service quality category A. This means that Blood_Jek's service is very good. What needs to be improved is the friendliness of the personnel. Hence, to improve service, customer service training will be conducted for all Blood_Jek's riders. Most of the suggestion that goes to Blood Center is about improving the technology Blook_Jek uses today. The expectation is that service users can easily access the location of Blood_Jek. The Center will fulfill this through SIMDONDAR development. Evaluation coordination with the Lumajang’s Health Office is routinely carried out, especially to reduce maternal mortality rate. In 2020, maternal mortality rate has decreased to 97 death per 100,000 live births, and only 4% of maternal deaths are due to postpartum hemorrhage.

The high maternal mortality rate in Indonesia is a priority issue in the government's work program in the health sector. Since 2019, the regency government has declared blood distribution services to be a quick win of Lumajang's Health Office to increase public awareness of the importance of adequate blood supplies in reducing maternal mortality. The mechanism is in the form of collaboration between Community Health Centers, Hospitals and Blood Center to ensure there are enough blood donors in order to meet the need for safe and fast blood. One of the roles of PMI Lumajang’s Blood Center is to prioritize blood services to reduce maternal mortality and distribute blood using Blood_Jek to hospitals. Meanwhile, the hospital's role is to optimize Blood_Jek's innovation services for fast and precise handling of blood needs. All of these roles are stated in the memorandum of understanding between Lumajang's Health Office, Blood Center, and General Hospital Dr Haryoto on blood services to reduce maternal mortality.

a. Lumajang Blood Center Lumajang Blood Center is the only blood provider in Lumajang district. To provide standardized blood services, LBC initiated Blood_Jek as a fast and safe blood delivery service to ensure blood quality is maintained. b. PMI of Lumajang and PMI of East Java Province LBC is a unit under PMI (Indonesian Red Cross) of Lumajang. Based on Government's Regulation No. 18/1980, PMI is in charge of providing blood transfusion services. The purpose of the Blood Center is to maintain and improve the quality of blood services and facilitate access to obtain blood for treatment and recovery. c. Public and/or Private Hospitals in Lumajang Hospitals in Lumajang are stakeholders that use Blood_Jek's services for blood delivery. Their cooperation with Lumajang Blood Center is bound by an MoU made to accelerate the government program to reduce maternal mortality in Lumajang. d. Lumajang Health Office The Health Office facilitates all hospitals to have Blood_Jek as an effort to improve blood services in Lumajang e. Bank Rakyat Indonesia (Lumajang Branch) Blood_Jek received support from BRI in the form of Blood_jek personnel uniforms. In return, the BRI logo was installed in the uniform.

Patients who need blood transfusions are people with critical conditions. Therefore, the speed of blood delivery to hospitals is an expectation for patients and for hospitals as medical service providers. Safety is also equally important. The blood to be transfused should not be damaged and have a therapeutic effect on the patient. "Blood_Jek" The Lifeguard has shown the importance of improving blood distribution mechanisms. This initiative greatly affects the speed and safety of blood distribution. Delay in distribution risks the patient's death. Unmaintained blood temperature and wrong packaging can cause blood damage which in turn results in slow medical treatment and a long duration of treatment. Improvement of SIMDONDAR as an information system also needs to be done. This system should not only record the blood recipient data, but also record the blood delivery process. For example, the hospital or the patient's family can easily see the status of the blood request to plan any medical action. The Lumajang Blood Center has developed a simple and low-cost blood distribution service system. This system can be replicated by all blood service providers in Indonesia, even in the world. With this innovation, comprehensive and quality blood services can be provided