THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS UNCHANGED EXCEPT FOR UPDATED

REFERENCES TO TARGETS AND BUDGET AND AN INCREASE IN GEOGRAPHIC COVERAGE TO

COVER ALL PROVINCES.

1. LINKED ACTIVITIES

The injection safety initiative is linked to all PEPFAR HIV Treatment, Care and Prevention programs and to

the Ministry of Health's National AIDS and STD Control Program (NASCOP) Injection Safety activity. Other

Kenyan stakeholders in the area of injection safety have been mobilized including the country World Health

Organization (WHO), National AIDS Control Council (NACC) and local training institutions including the

University of Nairobi and Kenya Medical Training College. A National Injection Safety Steering Committee

has been established at the Ministry of Health chaired by the Deputy Director of Medical services and Head

of Preventive health services. Membership to this committee is drawn from all the programs at the MOH and

incorporates the National Environmental Management Authority (NEMA), World Health organization (WHO),

National Aids Control Council (NACC), University of Nairobi and Kenya Medical Training College.

2. ACTIVITY DESCRIPTION

This activity relates to the prevention of HIV transmission among health care workers, medical waste

handlers and the community. John Snow, Inc. - Making Medical injections Safer, (JSI-MMIS) partners with

Academy for Educational Development (AED) and Program for Appropriate Technology in Health (PATH) to

implement the three-step strategy recommended by the World Health Organization (WHO) and the Safe

Injection Global Network (SIGN) to implement the PEPFAR Injection Safety program in the following

countries: Kenya, Botswana, Cote d'Ivoire, Haiti, Rwanda, South Africa, and Tanzania. These funds will

enable JSI-MMIS in Kenya to scale up injection safety interventions through activities that build on

internationally accepted strategies to health care facilities in Rift Valley and Nairobi provinces. The world

Health Organization (WHO) estimates of global burden of disease suggest that unsafe injections around the

world account for 5% of HIV infections. A 2004 survey by JSI-MMIS in Kenya revealed that over 70% of

respondents received an average of 1.5 injections per year. Needle stick injuries within the previous six

months were reported by 58% of health care workers. These findings supported those of an earlier study by

the University of Nairobi among 214 nurses in Nairobi, which reported 61 % needle stick injuries in health

care workers over a three-month period. Needle recapping accounted for 46% of the injuries while 12%

occurred during disposal of sharps. A majority of health facilities surveyed reported having experienced a

shortage of disposable injection supplies in the 12 months prior to the survey, particularly in the curative

sector. This reflects a less than optimal logistics system for forecasting, procurement, distribution and stock

monitoring that may contribute to re-use of injections. Analysis of the status of injection logistics in the

country revealed that there was no data to support rational forecasting of injection requirements.

Procurement was based on previous consumptions. Appropriate product selection was poor due to lack of

national standards for injection devices, registered suppliers of injection equipment and an appropriate

board to handle non-pharmaceutical equipment. The JSI -Making Medical Injections Safe (JSI-MMIS)

activity commenced in Kenya in 2004 under PEPFAR. The activity aims to: • Improve training of health

workers and managers on safe injection practices, infection control and disposal procedures. • Institute an

advocacy strategy to decrease demand for injections by the population. • Establish reliable estimates of re-

use prevention injection device equipment requirements, minimum stock levels and effective supply and

distribution systems for re-use prevention injection device equipment. • Institute monitoring and supervision

procedures to ensure adequate supplies at all levels and correct practices by health workers. • Ensure safe

disposal of used injection equipment through the progressive introduction of appropriate incinerators. •

Secure the required budget for injection safety and infection control including safe disposal of used

equipment. Significant changes in FY08 include scale up of activities to Rift Valley and Nairobi provinces. In

FY 06 and FY07 JSI-MMIS received country funds to facilitate faster expansion towards national coverage.

It was expected that national coverage would be achieved in FY 08 through this intervention but this will not

be possible with current funding levels. Prioritization with focus on population density and HIV prevalence

precludes intervention in the North Eastern Province. The Ministry of Health has committed to increase

procurement of auto- disable injection devices and health care waste disposal containers as well as

increased guidance and supervision for injection safety and infection prevention and control at health care

facilities. Significant reduction in prescription of injections and regular use of sharps disposal containers has

occurred in all health facilities that have benefited from this intervention regions.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This activity will avert at least 5% of HIV transmission in Kenya. To date over 13,000 health care workers

(clinicians, logistical officers and medical waste handlers) have been trained in safe injection practices and

medical sharps waste management. Interventions have been implemented in four provinces (Central,

Nyanza, Western and Coast) and part of the Kenyatta National Hospital. In FY08 an additional 6,000 health

care workers will be trained in Nairobi and Rift Valley provinces.

4. POPULATIONS BEING TARGETED

• Health care workers • Community • Medical Waste handlers • Policy makers.

5. EMPHASIS AREAS COVERED

This activity has major emphasis on training to impart improved skills, knowledge and attitudes regarding

safe injection practices to healthcare workers, waste handlers and the community. This activity will also

guide the development of policies to ensure adequate supplies of appropriate injection supplies at health

care facilities and their use thereof.