SUMMARY: The main goal of this project is to reduce the transmission of HIV/AIDS by promoting safe

injections through implementing the three-part strategy recommended by the Safe Injection Global Network

(SIGN): 1) Change behavior of health care workers and patients to ensure safe injection practices and

reduce demand for unnecessary injections, 2) Ensure availability of safe injection equipment and supplies,

3) Manage sharps waste safely and appropriately. In FY08, JSI will expand the program to nationwide

coverage.

BACKGROUND: The Safe Injection project started in Haiti in July 2004 with funds from PEPFAR. This

project is commonly known by the abbreviated project name Making Medical Injections Safer (MMIS). The

main goal of this project is to reduce the transmission of HIV/AIDS by promoting safe injections through

implementing the three-part strategy recommended by the Safe Injection Global Network (SIGN). An

assessment of injection safety and waste management issues was conducted in 2004, and the results

revealed that there were no norms and standards for injection safety. Specifically, the problems were

associated with the following identified issues: non-motivated, non-trained staff unaware of the risk

associated with unsafe injections; lack of injection materials in health facilities; lack of infrastructure for

waste collection, treatment and disposal which included no municipal waste disposal, and lack of

supervision of health facilities.

These factors resulted in waste being accumulated on the grounds of the health facilities because of a lack

of knowledge, lack of high performance incinerators, and lack of transportation and a municipal waste

disposal system. Since the initiation of the PEPFAR funding for safe injections, JSI has been working to

address the identified issues through training health care workers regarding safe disposal of shapes waste,

distribution of wall mounted disposal boxes, supporting and strengthened the MOH to develop regulations,

coordinating installation of incinerators throughout Haiti, and implementing a behavior change

communication program targeted at health care workers and clients to reduce the demand for unnecessary

injections.

ACTIVITIES AND EXPECTED RESULTS

The strategy for 2008 will be to strengthen what has been done in previous years while increasing the

project's expansion to national coverage. This year MMIS will work in all ten (10) departments of Haiti.

Activity 1: Strengthen the MSPP's (Ministry of Health) capacity to implement safe and necessary injections

as a quality standard in the curative sector. JSI will support dissemination of policies and norms, provision

of technical and financial support to the National Task Force/MOH to conduct periodic meetings and field

visits for supervision, improvement of awareness and advocacy for safe injection practices. Training will be

conducted with health personnel and support staff in all health facilities at the departmental level. The

training will cover safe injection practices, use of safe injection devices, improved waste logistics

management training as well as interpersonal communication. Training will be conducted on a large scale in

order to achieve nationwide coverage. Thus training will be conducted with, training of trainers, students at

INSHAC and Nursing schools, prescribers, frontline health care providers, waste handlers, and supply

managers in the four departments not yet covered.

Activity 2: Planning workshops will be conducted at the departmental level in the expansion departments

(Artibonite, centre, Nord-Oeust and Oust) to improve injection safety and waste management in the

facilities. This activity aims at designing and implementing plans for training roll out, supervision, logistics

and supply (mainly syringes and safety boxes), BCC and sharp waste disposal. In FY08, MMIS will

distribute wall-mounted safety boxes to an additional 7 sites.

Activity 3: Implementation of a behavioral change strategy to reduce unnecessary injections and promote

safe injection practices. BCC materials produced during the FY07 will be disseminated. They were

elaborated with the participation of BCC staff in all 10 departments. They consist of flyers, posters, radio

and TV messages.

Activity 4: Strengthening systems to improve waste management in target areas. MMIS will continue to

promote the need for a national waste management plan, will work with target department for the

elaboration of waste management departmental plan, will help build two waste storage sites, will work with

MOH and UNICEF for the installation of the new incinerators and ensure that the staff is properly trained to

use them correctly.

Activity 5: Improvement of the logistics system for continuous supply of injection supplies: Procurement of

injection safety materials for FY08 through the centrally-funded pooled procurement of MMIS, allocation of

basic injection safety and waste disposal materials and equipment to all partner facilities, periodic collection

of consumption data of IS materials, distribution of IS materials according to the national distribution plan of

IS materials, and addressing specific implementation problems such as how to continue provision of

essential materials to facilities. MMIS will work with the MOH procurement authorities to improve the

logistics information system, MMIS will continue to sensitize the private sector suppliers and import

authorities to the issues associated with injection safety equipment, and promote national procurement of

safe injection equipment through partnership with the MOH, USG, PAHO and other donors and

development partners.

EMPHASIS AREAS:

Commodity procurement

Logistics

IEC

Training

TARGETS:

1500 persons trained in Injection Safety (Prescriptions: Doctors and Nurses; Injection Providers: Nurses;

Phlebotomists: Nurses and Laboratory Workers and Waste Handlers)

COVERAGE AREAS: National