The Track 1.0 centrally managed agreement for Injection Safety (IS) administered by Initiatives Incorporated under the Guyana Safer Injection Project (GSIP) which commenced in October 2004, ended on March 31st, 2010. This project sought to prevent biomedical transmission of HIV (and other blood-borne pathogens) through sharp and other medical waste by promoting the implementation of safe injection practices and environmentally friendly medical waste disposal throughout Guyana. To date, Initiatives Inc has developed national strategies, policies, standards and guidelines related to reducing unsafe and unnecessary injections; improved provider skills in prevention infections and health care management; developed and implemented an advocacy and social mobilization strategy for increased awareness of health providers and clients, communities and managers regarding the rational use of injections; universal precautions, and appropriate waste management; forecasting and procurement of safety supplies; establishing a monitoring and evaluation system to name a few.

Despite these successes a number of challenges remain to be addressed including monitoring and supervision of facilities, access to final waste disposal options for all health facilities country-wide, addressing unnecessary injections and rational drug use among foreign doctors as well as local doctors, increasing accessibility of post exposure prophylaxis for remote health facilities, institutionalizing commodity procurement (bin liners etc.) within regional budgets and systems and ensuring sustainability of pre-service and in-service training programs.

Additional funding for this activity will enable Guyana to continue injection safety activities in a more robust way, building on the successes of the Track 1.0 program, while strengthening a smoother transition to a more country owned program that can be sustained by Guyana. This program will reinforce country ownership and strengthen the capacity and sustainability of partners to manage injection safety and infection promotion programs by strengthening quality assurance controls and improving the MOH coordination with stakeholders. This will result in significant improvements in the quality and safety of health services and a measurable reduction in the risk of transmission of infectious disease in health care settings and communities.

In FY 10, Initiatives will therefore implement an injection-safety and infection control program that establishes sustainable injection practices through the following components: (1) Training, support and capacity-building of health care providers as well as program and facility managers to improve safer injection practices; (2) reducing the frequency of unnecessary injections through advocacy and behavior change targeting health care workers and community members to develop safe injection practices; (3) management of sharps waste to reduce the disease transmission hazards associated with sharps (4) protecting health facility staff from needle stick injuries (5) promotion of injection safety and infection prevention and control standards; and (6) development of quality management systems to ensure compliance with standards. 1. Training, Support and Capacity-building a. Train and educate public and private facility health care workers in safer medical practices, including safe injection practices, universal precautions, selection appropriate waste-management options and decreasing unnecessary medical injections. b. Develop and or update institutional service-delivery policies, standards, guidelines, job descriptions, monitoring tools, etc., to reflect management practices in safe injections and in the waste management of sharps waste (in accordance with national or international standards). c. Assist and train health care workers (HCWs), phlebotomists and logisticians in safe-injection commodity forecasting, financing, procurement, logistics and supply management to ensure that both sterile, single-use injection devices for injection and reconstitution and safety boxes are available in health care facilities in sufficient quantities for the number of injections administered. d. Advise and assist program managers and facility administrators to direct, supervise and monitor activities to improve injection and worker safety within their areas. 2. Reducing Unnecessary Injections Through Advocacy and Behavior Change a. Working with the MOH Communications Unit, increase public support for injection safety among the main target audiences, which include: program managers, health facility administrators, professional associations, health workers, pharmacies, training institutions including medical schools and the general public. b. Promote the use of oral formulations among prescribers and providers and patients. c. Increase public awareness of Injection Safe health facilities 3. Sharps Waste Management a. Develop and strengthen systems to support proper disposal of sharps. Provide technical assistance in assessment, planning and leveraging support from external agencies for items such as incinerators. b. Support the development and roll-out and implementation of the National Health Care Waste Management Plan that ensures safe handling of medical waste from generation to final disposal with minimal risk of HIV/other disease transmission; c. Engage the private sector to leverage resources in support of waste management in public-private-partnerships; d. Train waste handlers and incinerator operators on waste management and safety e. Train biomedical engineers in maintenance of incinerators across the health sector; and f. Pilot and evaluate a waste management system that promotes pooled waste management across several health facilities within the same locality to share a single incinerator or other final disposal options that meets WHO standards.

4. Protecting health workers from needle stick Injury a. Assist the MOH with roll-out and monitoring of post-exposure prophylaxis (PEP) b. Assist the MOH to monitor and maintain the health worker vaccination program for Hepatitis B and tetanus.

5. Implementing standards for management of injection safety and infection prevention a. Collaborate with the Ministry of Health and other PEPFAR partners, as appropriate, to develop and/or update national and institutional service-delivery policies, standards, guidelines, job descriptions, monitoring tools, etc., to reflect management practices in safe injections and in the management of medical waste (in accordance with national or international standards). b. Advice and assist program managers and facility administrators to direct, supervise and monitor activities to improve bio-safety and medical waste management within their areas. d. Scale up the Injection Safety certification process to all health facilities. e. Develop the capacity of health facility staff and regional managers/supervisors to monitor quality, problem solve and maintain high performance standards.