Making Medical Injections Safer

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

In FY08, this program has implemented a set of activities related to Commodity Management and

Procurement, Capacity building and Training, and Behavior Change & Advocacy in the context of enhancing

injection safety. During the same fiscal year, MMIS trained 1,438 health workers on injection safety

practices. This is a centrally awarded activity receiving country funds.

COP 08 NARRATIVE:

This is a continuing activity from FY04-FY07. This is a centrally managed Track 1 award.

Unsafe injections are reported to be responsible for the transmission of various blood borne infections in

Ethiopia, including HIV/AIDS, and Hepatitis B and C. In FY04 and FY05, MMIS developed and implemented

pilot programs to rapidly increase the safe and appropriate use of injection equipment in Ethiopia. Based on

the pilot programs, a multi-component approach to improve injection safety has been implemented. The

core components of the MMIS program include: (1) commodity procurement and management; (2) training

and human capacity building; (3) behavior change and advocacy; (4) standardizing systems for proper

waste management practices; (5) addressing private providers and the informal sector; (6) policy

development; and (7) monitoring and evaluation.

(1) Commodity procurement and management are critical steps to assure safe injection practices. MMIS is

working to assure both an adequate supplies of injection devices as well as appropriate use and

management of stocks at different health service facilities. MMIS has provided and/or distributed syringes,

personal protective equipment, color coded waste bins with proper biohazard labeling, and other waste

management commodities. FY07 SAPR data show 86 health centers and 366 health posts covered with

supplies. The commodities are efficiently distributed through a central warehouse in Addis as well as

regional warehouses in Dire Dawa and Harari. Regional Health Bureau (RHB) storage capacity is also

being built. To manage the commodities, consumption of syringes has been monitored in several districts to

help assure appropriate level of stocks in different settings. MMIS also contributed to MOH sponsored

national HIV/AIDS 5-year forecasting workshop. MMIS also helps to develop memoranda of understanding

between RHB and hospitals to use the revolving drug fund (RDF) in line with government policy promoting

health care financing as a means of sustainability. MMIS is monitoring these MOU and making adjustments

as effectiveness is assessed. These MOU are also occurring between health centers and the District health

bureaus.

(2) MMIS conducts injection safety training in Ethiopia to improve the technical competencies of health

workers responsible for injections. Four categories of health workers are seen as having critical training

needs: injection prescribers, injection providers, sanitarians and pharmacists. Prescribers are trained to

reduce unnecessary injections and promote rational use of drugs. Injection providers are trained on

practices and procedures for safe injection administration. Sanitarians are trained in sharp waste

management practices, including the use of personal protective equipment. Pharmacists are trained in

managing the supply of and forecasting the demand for injection devices. In the FY07 SAPR alone, MMIS

had facilitated the training of 2014 health workers in 25 districts, covering 86 health centers and 366 health

posts.

(3) MMIS also addresses behavior change regarding injection practices as well as advocacy for safer

injection practices as part of their package of services. In order to facilitate and support behavior change

among health workers regarding injection practices, MMIS distributes communication materials (leaflets,

posters, pocket size reference guide, quarterly newsletter, and documentary film on safe injection practices)

to all new expansion sites other materials as needed. On the advocacy front, in collaboration with MOH,

MMIS is encouraging other donors and international organizations to create a national level initiative to

highlight and address injection safety across all HIV/AIDS programs where injections are an issue. MMIS is

also working in collaboration with the MOH and other donors who are refurbishing health centers to assure

high quality infection prevention, universal precautions, blood safety, and injection safety issues including

the maintenance of incinerators and the provision of waste receptacles.

(4) MMIS also helps to guide the development of standard systems for safer waste management practices.

MMIS organizes workshops for RHB, hospital, and other health administrators to address the issues of

health care waste management (HCWM) in a systematic way. The workshops present standards and

options for appropriate HCWM, and support the development of roles and responsibilities for different

entities in supporting a set of HCWM standards. Through these workshops, a minimum set of standards

have been developed in the hopes of applying a standard set of minimum provisions for HCWM throughout

the country.

(5) Beyond the injection safety needs of the public-sector health network, MMIS also addresses injection

safety issues among private providers and the informal health sector. As a result of a literature review

revealing a high demand for injections through the informal sector, MMIS is attempting to address the

informal sector through national strategic frameworks, guidelines, communication, and advocacy strategies,

strengthening policy development serving both the formal and informal sector, and attempting to reduce

demand in the public for injections in the informal sector by raising risk perceptions related to this practice.

MMIS is also working with Ethiopia's Medical Association of Physicians in Private Practice (MAPPP) to pilot

some standards for injection safety and IP/UP in private practice, including a centralized incineration

system.

(6) In addition to the development of standard systems at various sites, MMIS is supporting efforts for

national level policy on waste management guidelines. Policy options have been presented to the FMOH

Activity Narrative: and the State Minister, including options for health facilities at all levels to tailor plans to their particular

circumstances.

(7) MMIS regularly conducts monitoring and evaluation of health facilities in order to measure progress and

address problems. A supervisory checklist serves as a standard data collection tool as a way to compare

progress in the aggregate, while onsite analysis during monitoring visits can result in additional trainings,

etc.

In FY06, MMIS services covered 392 health centers and 1,335 health posts, as well as a number of private

clinics. Collaboration with the MOH and regional health bureaus to carry out behavior change, advocacy,

policy and guideline development was also achieved. In FY07, MMIS services are covering 23 hospitals, 66

health centers, 86 nucleus health centers (these are health posts that have been upgraded to health

centers) and 677 health posts. Where MMIS is working at the hospital level, they are collaborating with

JHPIEGO to assure that injection safety activities are not duplicated. At hospitals where both partners are

present, MMIS focuses on commodity supply, and waste management with all relevant employees, where

JHPIEGO focuses more on training on infection prevention for clinicians.

It should also be noted that there was a drastic cut in central funds in FY07, planned expansion of MMIS

activities was significantly curtailed, some commodities were not delivered, and several trainings were

cancelled.

In FY08, funding is expected to be restored to '06 levels, allowing the expansion of sites as well as trainings

and commodity delivery to resume to normal levels. The restoration of funds will permit an expansion of

activities to an additional 4 federal hospitals in Addis Ababa, 100 additional health centers and 500

additional health posts. At each level of the healthcare system, MMIS will work with other providers working

in sites to avoid duplication of efforts and to leverage each partner's strengths. Collaboration with JHPIEGO

and other partners engaged in injection safety and waste management will continue.

Contribution to the overall program

Injection safety relates to all invasive procedures in testing volunteer samples, treatment of patients for any

medical reasons including treatment of opportunistic infections. Proper forecasting of injection safety

supplies coupled with proper handling of sharp and infectious wastes contribute significantly to the reduction

of medical transmission of blood borne pathogens including HIV. The activity will continue to support the

PEPFAR Ethiopia program by expanding training to all health centers, health posts and selected private

clinics within the ART health network. The implementing partners will collaborate with other PEPFAR and

USG partners working infection prevention and control activities.

Population being targeted

The activity trains several categories of health professionals in the public, private, and informal sectors:

prescribers, providers, sanitarians, health care facility waste handlers, and facility management. The

ultimate beneficiaries of the activities are individuals who require medically invasive procedures and

injections.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16556

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

16556 5598.08 U.S. Agency for John Snow, Inc. 7465 619.08 Track 1 $3,032,417

International

Development

8094 5598.07 U.S. Agency for John Snow, Inc. 4700 619.07 Track 1 $422,744

International

Development

5598 5598.06 U.S. Agency for John Snow, Inc. 3764 619.06 $3,032,417

International

Development

Table 3.3.05: