TRANSCRIPT 1 (MNRH)

Interviewee: Mujaja

Interviewer: Muzahuzi George Ochieng

Date of Interview: 20 June 2021

Location of Interview: Mulago National Referral Hospital

List of Acronyms: MUJ = Mujaja, IN = Interviewer

[Begin Transcript 00:00:02] Interview starts at 02:12 PM.

IN: My name is Muzahuzi George Ochieng, a student of Makerere University, College of

Computing and Information Sciences (CoCIS) pursuing a Master of Information Systems in
Department of Information Systems titled “A framework for tracking and monitoring blood
transfusion Services”. With me is a set of questions which I expect you to help in answering
concerning the topic. Given the need to capture the proceedings of our dialogue, I am kindly
requesting that you allow me to record your voice. The audio will help in collating the discussion
as I need to transcribe the interview and come up with a transcript. Outright, I have given you a
pseudonym. So your other particulars won’t appear on the transcript except that pseudonym. Am
I allowed to go ahead and record your voice?

MUJ: Yes, I have developed trust with immediate effect having realized that you were cleared
by REC of MNRH to carry out the study. Therefore, go ahead and record the conversation

IN: Thank you for assenting to my request. Question number one; Tell me about yourself?

MUJ: I am male…hahahaha…sorry for saying that out when it is visible and tacit by mere
looking at me. I am 45 years Old, serving as Head of Department…aaaaah ..I have been worked
in this capacity for the last 7 years. I am educated with a Bachelor of Medicine and Bachelor of
Surgery from Makerere University and a Master of Medicine from Umea University in Sweden.
I am a well-travelled man and focused on intellectual development….and so, I hold an array of
several online courses that I attend virtually.

IN: Thank you for the briefs describing you. Tell me briefly about blood is obtained from UBTS

MUJ: Blood is an essential medicine and the only supplies that has no substitutes…it is one of
the essential services [I mean transfusion] that determines the competitiveness of a healthcare
providing institution….so in Uganda, UBTS is our fountain of honour that supplies us with all
units of blood that we use here. By the virtue of our nearness to Nakasero, the home of UBTS,
we easily access supplies of blood. However, a rigorous process is involved that begins with
admission of a patient. After they have been diagnosed and prescriptions made part of which is
blood transfusion, our medics immediately carry out a blood group test. Results from the test are
serve as the origination of the process. The physicians report to the supervisor who them makes a
report to the head of department and then the connects to the blood laboratory. In case there are
any units, they are cross matched to determine whether the patient in question can be helped…In
case the blood group type is not available, the blood laboratory administrator makes a loop to
UBTS and places an order. UBTS makes an immediate searching and once confirmed, we are
given an immediate call to parachute to Nakasero for the same. Aaah, any way…..yahh, this
procedure is followed in situations when a patient is not yet in a vegetative state….at the casualty
unit where tragic accident victims are dropped by police patrol vehicles, we immediately order a
blood test, make an instant order and pick units to expedite a surgery. We use the plus 1 formular
to ensure that we obtain adequate blood to transfuse the victims or perform a surgery.

IN: Oh, thank you for this elaborate protocol followed in ordering blood from UBTS. Given your
position as the HOD for transfusion services institution wise, tell me how the blood transfusion
process is administered in the hospital.

MUJ: Young man..!!!!!!!!! the transfusion process in this health facility is an advanced service
that follows certain procedures. I begin by letting you know that when the actual blood units
have been received from UBTS, the doctor in charge of the patient is notified by the supervisor
to ready the patient and then later, leave the patient under the chaperone of the nursing aid. The
doctor is then cleared to go to the blood laboratory and pick the requisitioned units of blood to
transfuse into the patient….In case the units are more than one, them the supervisor must be
informed by the Doctor that a successive unit is required by the patient. This is followed by a
clearance of the same Doctor to pick the second and so on units from the blood laboratory.

IN: Okay. Is this the standard operation procedure across the hospital?

MUJ: aaaaah, no no thank you. Fast backward, I mentioned that the casualty unit does not
normally follow this protocol especially when they are handling victims of tragic accidents
where immediate transfusion is the first aid that must be administered……by the way, Casualty
Unit is the number one user of blood units in MNRH and uses more than 65% of the daily,
weekly and even monthly requisitions of blood from UBTS.

IN: Oh I see.. the ecological location of the hospital in the city and the many accidents that
happen every minute puts the Casualty Unit in a high demand for blood… I agree with you. But
then, how is the blood requisitioned and supplied to you tracked and monitored by your Office?

MUJ: From the preamble that I made, blood is an essential blood supplies like other medical
supplies including drugs. To your notice, this hospital has protocols that are followed in
receiving and issuing out medical supplies…. In the first place, the entire blood transfusion
process is documented using HMIS forms. So basing on the data input and decoded from these
forms, we are able to tell the levels of blood transfusion vis-à-vis what were supplied with by
UBTS.
IN: What is your opinion, regarding the information communicated by the HMIS forms? I mean,
are convincing me that the data fed in the forms is circumstantial enough to enhance the genuine
reconciliation and auditing of the blood units supplied and what is transfused by you?

MUJ: Ah well well well… I must admit that much as the name confuses someone to think that
we have HMIS forms in use, the system is not automated. The entries are manually done by the
data entrants in the hospital. Therefore, on this account, I cannot rule out the fact that errors and
omissions must arise. But given that the data is fed in DHIS2, aaaaah, you are troubling me to
check and compare whether our submissions to the tool correspond with those of UBTS…By the
way, I must admit that I have not laboured to make that comparison. But nonetheless, I am sure
that our compliance officers report the factual information about the usage of blood…..in my
office, I have handled around 10 incidences of diverted blood from the ghost patients but that
challenge is not so acute as is with other hospital service activities.

IN: Thank you for the analogy… but then, you are a centre of excellency in the region and
premier in Uganda…your portfolios should be automated with computer systems as I assume in
the case with the blood laboratories. Am I speaking something real in this institution?

MUJ: Yes, you are…. we are using computer systems in the routine administration activities.

IN: A question to you on computer systems again; do you use them in generating reports? Are
your staff handling blood transfusion services computer literate?

MUJ: Beginning with auto generation of reports, a few departments in this hospital are running
such systems. To be specific, I know of only the departmental laboratories which generate and
transmit reports of tests results to any referral point in the hospital where a client should be
served. So is the accounts department where the accounting systems are automated. However,
even them, the comprehensive reports written to the Heads of Departments are typeset in Ms
Word. So, in my department and the entire blood transfusion function, we donor generate reports
using computer systems. If at all, the hard copy HMIS forms that we use for reporting are not
automated themselves. Regarding the literacy levels of staff, well, most of our staff are computer
literate but they only know basic knowledge. Engaging them in comprehensive computer
operations would call for continuous refresher training to indoctrinate them in the using of the
computer systems.

IN: In your opinion, would the full-scale use of computers systems in blood transfusion process
enhance tracking and monitoring of all the blood units received and transfused?

MUJ: Why not? I give that a big YES yeah yeah yeah yeah………………………………………

IN: Now that you are not using them apparently, tell me the procedures you are following to
track and monitor blood transfusions in the entire hospital
MUJ: My office is a reporting centre. So, on a daily basis, I receive reports from the supervisors
of all the transfusing centres and the issuing unit- the blood laboratory from where the received
supplies are stored. So, by analyzing the reports and the stocks in the laboratory, I am in position
to track and monitor the blood transfusions in this hospital.

IN: Could there be any challenges you face in tracking blood transfusions in this hospital?

MUJ: Ayayayayayayaya…..a hell of them….1. Till to date, I have failed to understand why
there is no computer mediated platform that would possibly enable us to make an as is request to
UBTS and get an as is feedback. With internal reporting done by each institution, it is impossible
to reconcile the supplies made to us and the actual transfusions by our medics.

2. I have a feeling that some blood disappears between Nakasero and MNRH. Yes, because at
times, the claims of blood units transfused by or medics are always less by a big proportion and
yet UBTS insists they supplied with more units than we report. The beginning question is? Who
is lying to who? This is the million-dollar question that I have failed to get answers for during
my tenure of service.

3. In every strategic meeting, I am asked to throw light about the unending complaints of patients
paying hefty sums for blood units and yet UBTS supplies it to us toll free. Don’t misquote
me……hahahahahha…..I guess, there is some collusion between doctors, nurses and laboratory
staff to create ghost patients and smuggle the blood units to undisclosed locations….munange
eyo ye Uganda yaffe…..bibaawo…..strange but true

4. Often, patient die from healthcare facilities that are not prequalified to transfuse blood…..kino
kikka………..then if blood is not synthetic, then where do they get if from? I am forced to thinks
that some of our doctors and nurses put on two coats, the clinical and the business one…..they
must be engaged in blood business here [ I am sounding organic, because this issue is a thorn in
my neck]…I leave it at that…if at all, I am not mentioning names….

5. The decision to fill HMIS manually attracts a cornucopia of loopholes. Because We do not
have strict follow ups to make comparisons between the data inputted by UBTS and MNRH.
This makes the entire tracking and cross checking of the records more time consuming and
laborious.

6. It is a common problem that during certain periods, some blood groups have not units in stock
at UBTS. Donor recruitment by ailing patients is a troublesome activity. At times, it is tricky to
get blood groups such as O- because this has higher demand than any other blood groups.

IN: In your opinion, how can the gaps you have just mentioned to achieve better tracking and
monitoring results?

MUJ: As the old adage goes that the biggest room ever available is one for improvement………
I have faith that the above challenges are casual. In my prescription, I would go for
computerization of the blood ordering and transfusion processes…….this would minimize the
errors involved in using manual HMIS forms. Secondly, real time information sharing between
MNRH and UBTS would iron out [ to some degree…] the collusive relationships that encourage
creation of ghost patients…………..and then, the patients themselves should not be kept at the
receiving end….they have a key role to play in providing correct information in case impromptu
checks are made. I crown it all by urging MoH to ensure that MNRH and UBTS are using a
universal system [ may be a connection or link] that ensures anytime information sharing
between them. Basically, I would think that this would greatly improve on the blood transfusion
and supplies in MNRH and UBTS.

IN: I am very grateful for these beautiful insights……. thank you for your time. I expect to be
back in a week’s time to share with you the themes that will emerge out of the interviews with
you and the rest of my interviewees….I must be observe this protocol because REC requires
researchers doing interviews here to do so….I will request for only 5 minutes that day. See you
then Dr.

MUJ: You are welcome. I am honored to have been selected to participate in this study. I am
hoping that you will come with a solution for us……. Until next time, Bye bye!

Interview ended at 02:42 pm.

 TRANSCRIPT 2 (UBTS)

Interviewee: Pentium III

Interviewer: Muzahuzi George Ochieng

Date of Interview: 23 June 2021

Location of Interview: Uganda Blood Transfusion Service Headquarters, Nakasero

List of Acronyms: PENTII = Pentium II, IN = Interviewer

[Begin Transcript 00:00:06] Interview starts at 03:20 PM.

IN: Good afternoon, Officer, I am called Muzahuzi George Ochieng. I am a Master of

Information Systems student of Makerere University in the Department of IS, CoCIS. In respect
to the norms of the institution (Makerere), every Masters Student who opts for Plan A of
Research is mandated to carry out research that connects theory and practice. It is for this reason
that I choose a study titled “A framework for tracking and monitoring blood transfusion
Services”. As you know, a mention of blood transfusion cannot exclude UBTS as the only
source of blood and blood products transfused in any healthcare setting in Uganda. Following
this dictum, you have been selected to participate in this study. The study was ratified by UBTS
REC and is purely for academic purposes. Since I am a little slow in writing, I may not be able to
match the speed of our conversation. Therefore, I kindly request to use a recorder so that I do not
miss out any detail. Is that okay with you madam?

PENT III: Oh yeah, no worries, go ahead and set your recorder before the conversation starts.

IN: I am very grateful for this offer. Thank you indeed. Briefly, tell me about yourself?

PENT II: I am an administrator in this institution charged with supervising blood supplies to
healthcare centres in the areas served by this unit. This is my 12 th year in the same position. I
hold Master of in Healthcare Management from University of Pretoria. A common mistaken
belief among women and girls regarding disclosing their age….I hope I am not sounding
funny….I am 55 years old, and a proud mother of 4 adults now…..yeah.

IN: Okay, thank you for this succinct description. How do you go about issuing blood to the
transfusing centres? I mean, what procedures are involved?

PENT III: By default, UBTS is not an open market where there is free entry and exit of
buyers….I am sorry for using business jargon…but what I am trying to mean is that not every
Tom Dick and Harry comes to UBTS for blood supplies. First of all, we have prequalified
institutions by MoH which are registered with us…These are the only institutions which are
mandated to requisition for blood. The rule of the thumb is that we must first confirm that there
is need for blood transfusion before we respond to their request. The transfusing units make
requestions by blood type and quantity, which enables us to crosscheck and inform them of the
availableness of the blood units requisitioned. Once their ambulances have come to UBTS, they
are supposed to go through 6 stages of clearance before the blood units are finally issued out..

IN: From your explanation, the exercise of issuing out blood supplies seems to be hectic. Do you
use computer systems to ease work?

PENT III: Since my day one at UBTS, we have always used computer systems in blood
handling and distribution. Everything is automated right from the blood donations to blood
issuing….as a result, mere clicks of the computer provide one with cross matched information
between the stores, blood laboratories…so whatever we give out is auto-debited by the system.
This has even eased reporting to HMIS because the computers help in generating reports about
stock levels and matching of the units supplied by each prequalified institution. With the
computer systems used at UBTS, the stock levels are monitored by the Systems Administrator,
Quality Assurance Manager and the Operations Manager remotely as push notifications pop up
at their workstations informing them about the stock levels at hand whenever a supply has been
made

IN: Aah, okay. So in your opinion, are you able to track and monitor how blood supplies are
used by in transfusing centres?

PENT III: Absolutely No, I cannot assure you that our systems are capable of doing so. What I
am sure of is that at UBTS, we operate a LeanAgile system of supplies management which
among others aims at reduced supply lead times and precision in whatever we are doing for
purposes of ensuring that we save life especially in times of emergency. That is why the
management of UBTS has sunk colossal sums of money in automating the blood management
activities to ensure that we have nothing like any delays here. So in our institution, we are ably
track and monitor every unit of blood that is cleared and declared fit for storage pending
transfusion by picking institutions. However, for heaven’s sake, our systems work within our
institution and not anywhere beyond our gates. I conclude by saying that the leanness of our
supply processes may not presuppose leanness in the transfusing centres since we operate
different Information Systems and observe different protocols.

IN: Awesome, what an amazing institution UBTS is! Why then do we have unending complaints
from the public about you? Are you aware that the public out there is sure that failure of
transfusions in hospitals is originated here?

PENT III: Hahahaha….this is unbelievable…to the best of myself, I, in affirmative [sorry to use
this rude word] rubbish this claim because we are not charged with transfusion processes. Our
jurisdiction ends with availing the supplies and even at present, we do not have RFID system as
commonly used in Germany, the Netherlands and Australia [I have attended vestibule trainings
in these areas on blood supplies and transfusion management] where the blood centres monitor
the supplies up to the transfusion beds in the near and distant hospitals. So I think, there must be
something fishy taking place between the medics in transfusing centres because utmost, we
always try by all means to ensure that whatever is requisitioned is supplied [as long as we have it
in stock]. So I am not sure why there are complaints at transfusing centres and among the publics
and yet most often, what is requisitioned is what is supplied to the centres. What I may say is, we
have discovered some rot among the transfusing centres where at times, blood units supplied to
transfusing centre D are appearing in the reports of both transfusing Centre D, Q and H. By
implication, this is indicative of the foul play in the blood transfusion services rendered by the
transfusing systems. For example, time and again, we have always sensitized the public out there
that blood is a free medical supply and therefore, no one is supposed to pay for it. Then , why
would someone say they were not transfused with blood because the charges were astronomical?
Really?

IN: Okay, thank you for this information. Now, you seem to say that transfusing centres are not
operating on the same page with you. How come this happens that way and yet they are stocked
with versatile computer systems like you?

PENT III: Not all that glitters is Gold! Myself, I have been part of the committee tasked by
MoH to audit the service levels and performance management of different public hospitals in
Uganda including MNRH. It defeats one’s understanding to hear a hospital administrator
advancing a reason that the reports will need some updates because they were prepared hurriedly
due to large pools of manual reports that had to be typeset. You wonder whether the computer
systems are merely for decorating the offices. To my dismay, MNRH is number one in
complaining about performance monitoring using computer systems and yet their budget for
LAN management and computer systems maintenance annually is in nine digits. Therefore, I
cannot rule out that the claim that MNRH might not be using her computer systems in the
management of transfusion services including blood tracking and monitoring.

IN: Oh I see…..there seems to be a blame game here.

PENT III: Absolutely.

IN: What advice would you provide to any person or entity seeking to ensure there is leanness in
the blood administration processes between UBTS and transfusing systems?

PENT III: I begin by insisting that transfusing centres should model their operations to mimic
what UBTS is doing. They need to automate their transfusion processes and connect them to our
IS. However, this should be preceded by a change management process in which training should
be key to prepare the staff to use the new systems. Once this is done, I predict that there will be
real time communication and sharing of information in the supply chain. Secondly, as long as
there are information asymmetries in transfusing centres, the system of UBTS and these centres
connecting will not help in anyway. To be explicit, I mean the internal systems of the transfusing
centres should be automated such as the connectivity between the blood supply points, patient
registries and bedside services. By doing so, the systems will eliminate the inefficiencies that are
apparently wrecking the supply chain processes especially at the transfusion points. Thirdly,
computer systems evolve every now and again. Therefore, the staff must be supported to keep
abreast with the developments so that they are not intimidated by the technologies.

IN: Thank you for sharing your opinion and reserving this time to share with me.

PENT III: The pleasure is mine.!

Interview ended at 03:58 pm.

 TRANSCRIPT 3 (PATIENT)

Interviewee: Patient G

Interviewer: Muzahuzi George Ochieng

Date of Interview: 21 June 2021

Location of Interview: Mulago National Referral Hospital

List of Acronyms: G = Patient G, IN = Interviewer

[Begin Transcript 00:00:04] Interview starts at 04:00 PM.

IN: I am Muzahuzi George Ochieng, a student of Makerere University carrying out a study titled
“A framework for tracking and monitoring blood transfusion Services”. This study is for
academic purposes but is resigned to ensure that we have the best blood transfusion services in
hospitals in Uganda. Part of the goals of this study is to come up with a solution that will enable
us to reach there. Therefore, your honest responses are vital to this study as they will inform the
policy makers on how best we can go about improving the blood transfusion services delivery.
By respecting your choice to take part in this study, I will also let you know that I will be
recording your voices. However, I am the only person who will replay and listen to them. So
nothing like your identities will be divulged to anyone. This is why I am choosing to call you
Patient G. Can I go ahead and start the decoder?

G: Yes,

IN: How old are you?

G: I am 34 years old.

IN: When was blood transfused to you?

G: Last month (May 2021). It was not me personally, I am a caretaker of an accident victim who
sustained grievous body injuries along Maya on Masaka road and was picked by ambulance right
to Mulago here. Being in a coma, I was the person charged with ensuring that the services are
delivered to us including the blood transfusions.

IN: Do you remember the procedures that were taken before transfusing you?

G: Yes, the doctors upon diagnosing Musisi established that he needed a back surgery which
required three blood units. The doctors then went to their rooms and came with one blood unit
after 3 hours. This was followed by an operation

IN: Oh I see, okay. You mention one blood unit and yet right from the beginning, you hand
mentioned 3 what happened to other two?
G: I think the doctors realised along the way that only one unit would be enough for the surgery.
So the two units must have been given out to other patients because throughout the two months
we have been here, there was no any other transfusion administered. The only thing that
disturbed my understanding is that on all the documents [that I have on me], the doctors continue
to mistakenly record that three units were administered. So I really don’t know since my role
stopped at reminding them about the impending surgery.

IN: How satisfied were you with is process?

G: I think I am happy because my son is recuperating now. But at the beginning of the process, I
was fuming as the doctor seemed to want me to pay for the blood. What saved me was that one
of the hospital administrators is my relative. So they were dealing together on phone.

IN: In your opinion, kindly tell me what you think should be done to enhance patient satisfaction
with transfusion services in MNRH?

G: Yes, I am wondering why doctors are not comfortable to share all the information about the
transfusion with us. I think this is stressing because we seem to be taken for granted that the
doctors dictate and we only dance to their tune. In the first place, I would have asked the blood
administration why I have 3 units on my papers and yet only 1 was administered.

IN: Thank you for participating in this interview

G: You are welcome my brother.

Interview ended at 04:15 pm.