In FY 08, GSIP will hold celebratory launches in Region 3 and 7 to allow the regions to showcase

achievement of at least 90% of indicators of success. We will initiate activities in region 4, Guyana's

largest region, by conducting a situational analysis to inform the inputs for a collaborative Memorandum of

Understanding. A separate strategy for reaching the sparsely populated and remote hinterland regions,

namely 1, 2, 8 and 9, will also be developed. Interventions will focus on training of nurses, waste handlers,

supervisors, logistics staff, prescribers and community health workers in the areas of safe injection, waste

management, commodity management and behavior change. In addition systems will be established to

enable pre and post exposure care, needle stick injury analysis, segregation of waste and proper ordering

and distribution of supplies.

The emphasis on sustainability will continue in this penultimate project year. For IS training, GSIP will

continue working with the nursing schools to ensure injection safety is fully integrated into the curriculum;

efforts to build in-service training capacity will center on working with the Ministry of Health Annex - Health

Sciences Education. All GSIP pre and in-service training modules will be edited, formatted and presented

to the Ministry for future training. In the area of waste management we will finalize sharps waste

management guidelines for private and public sector health facilities as well as PMTCT and VCT sites.

In addition, we will work with the Standards and Technical Services Unit to ensure injection safety

equipment, especially safety boxes, needle removers and retractable syringes for high risk wards, are

approved and incorporated as line items into facility and Ministry budgets. We will focus on similar line

items to ensure regions and facilities have funding for protective gear and bin liners for proper segregation

of waste.

In FY07, GSIP completed phase one of a prescription record review, the findings of this study were used to

develop interventions to encourage rational use of injections and patient adherence to oral medications.

Training in counseling for pharmacists, community outreach and rational injection use for prescribers are

the main interventions. We will conduct the follow up phase post interventions in FY 08. We will also share

the results of an insulin home use study to ensure patients receive counseling on syringe use and disposal

and work with MOH to strengthen home insulin use safety. Working with MOH and medical associations,

we will determine the need for and facilitate the development of new or strengthened protocols emphasizing

oral medications.

We will continue partnering with the Public Sector Union to advocate for pre-exposure injections for all

health care workers and use and maintenance of protective gear for waste handlers. Systems for

vaccination and NSI injuries will continue to be set up at each facility.

We will use lessons learned from our partnership with CIDA/MGMP in regions 6 and 10 to develop a

community outreach plan for region 4 and the hinterland regions. The focus will be on using NGOs to

spread messages on reducing demand for injections and improving waste management in the public and

private sector. To promote best practices across regions, we will hold a sharing meeting with

representatives from all intervention regions.

We will continue to work with facilities and regions to support their ability to supervise and monitor

performance. Instituting or reawakening Quality Improvement committees where possible to review and act

on data to solve problems related to injection safety.

In line with our contract mandates, we will conduct a midterm assessment of practices in our two sentinel

regions, 6 and 10.