A designer’s perspective on blood donation in India

This article collects learnings I made while collaborating as a service designer for BloodLink,at a pilot we ran in India in June 2018.

The Indian context

Many countries in the West fulfil their blood demands through voluntary donations. This is not the case in India, where a significant amount of blood needs are covered with replacement donation and still, there is not enough blood supply to cover all demands. Blood is a living tissue with a limited amount of shelf life; hence, a flexible and abundant donor mass is required to ensure stock and avoid wastage.

There are some public hospitals in India, but they are overloaded with patients. More often than not, patients of all economic backgrounds have to pay privately for medical treatments. When it comes to blood units, patients have to pay a fee to cover the testing and processing of donated blood.

In India it is not legal to pay a person for donating blood, but the shortage of blood has made room for a big black market, with all the health, safety and human exploitation issues that come along with it.

From a service design point of view, the challenge of improving blood donation in India is a pharaonic one;

• A complex constellation of stakeholders: donors, patients, families, hospitals, blood banks, NGOs, public institutions, Corporate Social Responsibility (CSR) and private companies.
• A highly regulated sector, and parallel to it, a big black market that doesn’t follow rules or conventions.
• A shy, mistrustful, hierarchical and wonderfully diverse culture; really complex to grasp.

The project

BloodLink believes that digital tools can be used as facilitators in the complex ecosystem around blood donation in India.

One of their services connects regular companies to blood banks so that they carry out donation camps together. In summer 2018, a team was sent to India to pilot the service at 6 donation camps and perform extensive research. We visited all facilities and talked to all actors involved: donors, non-donors, company stakeholders, blood bank staff, hospital staff. We shadowed all events and processes.

A donor mindset segmentation

We can say that India is relatively young in terms of people’s mindset towards blood donation. The basic knowledge about how the process works has not reached yet the mass of the population, so there’s plenty of rumours and superstition around it (The superstitious).

“My small brother donates every 3 months. I used to scold him for it and he still did it in hiding.”

The topic of blood donation stirs up conflictive feelings. On the one hand, there are the beliefs around doing good and karma, the awareness of need in their society and other elements that create a general cultural draw to give (The Evangeliser).

“Because of my donation, there will be light in someone’s house.”

On the other hand, there is a rough society, in which everyone has a collection of experiences where they were taken advantage of, where justice is a luxury; where one has to take care of oneself (The Mistrustful).

“My previous experience was bad, it was a camp organized by a politician who did not donate nor did he care about the camp.”

There’s a worryingly high proportion of people that understand that if they are donors, they are entitled to priority access to blood (The Transactional). This behaviour leads to extra pressure on the already poorly stocked blood banks, wrong expectations and disappointment in donors, and ultimately feeds a culture of “giving means losing”. A very experienced blood bank worker put this across to us:

“In India giving means losing. They say donation for the name’s sake. But their mentality behind is that it is an investment — If I am giving, I should get.”

Steps to becoming a donor

Common to all donors, regardless of their persona, are the three factors that any donation campaign must meet:

Convenience: Minimum amount of time and effort to get to the donation spot and complete the donation process.

Trust: Is the blood going to the right place?

Safety: There’s a big concern around hygiene; open air camps and messy camps are avoided.

“Conditions are very important. Camps on the street, during crowded festivities are scary.”

The companies

Motivation vs. pressure

Companies are very good environments to foster blood donation in India. We have seen donors who were terribly afraid (The Fearful), being supported through the whole experience by their peers. They were very grateful to their colleagues for nudging them to overcome their fear.

“I was hesitating until the last minute, hoping for something to come up and make me go back to work. But fortunately, nothing happened. It took me five minutes and it was a painless experience.”

All companies profit from making good PR out of donation camps. Employees are in general expected to make the effort to donate, but in some cases, they also are pressured to do so. A management structure that is authoritarian in everyday work, tends to maintain its attitude in other activities. It’s a tricky phenomenon to prevent from an external position.

Companies also have mindsets

The transactional company establishes a close relationship with one blood bank and may use its position to extort the blood bank with blood privileges for their employees in exchange to keep organising camps.

The Doer and Strategic profiles do donation camps as part of the CSR activities, from a more altruistic perspective. Doers like getting their hands dirty in organising activities, whereas Strategics have a global strategy and value partners that can get things done for them.

The blood banks

Of all the parts involved, blood banks are probably in the most difficult position. They are considered accountable for recruiting donors. They take the blame when patients have to pay for blood units, when this is more an issue of the health system in the country. They are blackmailed by companies which assume that offering donation camps entitles their employees priority-access to blood. Due to their role in the system, blood banks are also closest to the blood black market.

“It will take a few generations to change this mindset, because people still think that blood donation is an investment.”

Watching a blood bank set up and carry out a donation camp is something else. It’s a choreography of 10+ professionals, each one with a distinctive role, transforming virtually any space in a donation room: canteens, corridors, meeting rooms, even elevator halls. We’ve seen a team collect over 200 donations in three hours, carefully taking each and every donor in their journey by the hand.

When blood banks first organise donation camps at a company, they build a relationship with the decision makers in the enterprise. As successive camps take place there, this turns into one-to-one relationships with each employee-donor, these often having a “transactional” mindset on blood donation. Hurting a relationship with an individual donor can escalate to a confrontation with the whole company, with devastating consequences for organising further camps. This is a heavy burden on blood banks.

Most of the blood banks focus on the medical aspect of their business and lack strong business development and communication skills, that would help them to prevent getting into bad situations with companies and donors, as well as increasing the number of partner companies to do camps with. An experienced blood bank worker told us:

“The economic status of people doesn’t make any difference. Awareness and education make the difference.”

A reflection on social enterprises

There are uncountable not for profit organisations in India that intermediate between blood banks and companies to organise donation camps. BloodLink differentiates itself from them in two main factors:

• It aims to be a profitable company instead of financing itself through donations and NGO funding.
• It believes in digitalising much of the today manual activities of connecting companies and blood banks, to gain a much bigger scale that could really solve the problem.

BloodLink is a small initiative making its way in the harsh start-up world: pressure for making a profit, ROI rationales and crazy timings are some of the everyday challenges they have to deal with.

Today’s aggressive start-up culture strangles initiatives seeking structural, cultural and systemic changes. These initiatives are not just another home delivery service, they are not another start-up jumping on some trendy wave; they are neither the silver bullet one hero came up with. Instead, they are a long distance run in which uncountable people contribute to the cause throughout time.

These initiatives work with the essence of the forces that drive human behaviour, deep down inside ourselves, where personal experiences, cultural biases, aspirations and fears create an entangled decision making machine that is ever changing. It requires us to identify very sophisticated handles to influence it. It touches on the most sensitive, delicate and fragile of the human being.

Social enterprises can only succeed if they are given room for long term vision; if they are provided with different investment models and different success measurement points. I’m eager to see a truly new start-up scene emerge that breaks today’s monolithic start-up environment and that allows social enterprises to make the impact we want them to.

Thank you to the Bloodlink team for making me part of this beautiful project. Thank you also to Soumya Ravikumar, Beatriz Belmonte, Paola Camacho and Joumana Mattar for helping me give shape to this article. Read another article about this project here.