ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS FROM COP 2008:

1. Supplemental funds to JSI-MMIS from COP will facilitate:

+JSI-MMIS will work with MOH to train health workers and waste handlers/incinerator operators in 25

districts to ensure that the principles of waste segregation, storage, treatment and disposal are adhered to.

+25 Districts with defective small scale incinerators will be identified and the incinerators rehabilitated in

collaboration the District Health management leadership.

+Assessment and renovation of the six National Blood Transfusion Service (NBTS) incinerators will be

conducted.

+Advocacy for rational use of injection medication will be intensified through working with professional

medical associations.

+NO injection commodities will be procured with COP funds.

2. Using Track 1 funds, JSI-MMIS will train 6,000 health workers in seven districts of Eastern Province and

provide injection safety commodities to ensure that no stock-out occurs.

SECONDARY CROSS-CUTTING BUDGET ATTRIBUTIONS

Three of six incinerators situated at Regional Blood Transfusion Centers in Nairobi, Mombasa, Kisumu,

Embu, Eldoret and Nakuru are non functional. An assessment will be conducted and all six incinerators

repaired to full functional status. Incinerator handlers will be trained and the NBTS advised to institute a

service maintenance contract. These incinerators will handle huge volumes of sharps waste generated at

the provincial /Referral hospitals. Waste management experts in JSI-MMIS will also strengthen practices for

the Blood Safety Program.

Working closely with the Ministry of Health, training and provision of safe injection commodities targets

health workers in the public, faith-based and private sectors. This ensures that all service delivery points for

PEPFAR implementing programs (CT, Care & Treatment, PMTCT) benefit from this activity. JSI-MMIS has

introduced safe injection practices to 6 Provinces covering over 48 Districts through training and supply of

re-use prevention syringes and safety boxes for sharps waste management. To date approximately 70

percent of the country's population has been covered by the MMIS Project. Training in rational injection use

at the Embu Provincial Hospital in 2007 resulted in a dramatic 90% reduction in injection prescription at the

maternal child health clinic (MCH) over a six month period.

COP 2008

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

(including Expanded program for Immunization - EPI, Laboratory and Public Health) 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

Activity Narrative: equipment.

Significant changes in FY09 include scale up of activities to 55 facilities in Nairobi province and nine districts

in eastern Province. 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. In FY09 JSI-MMIS will use Central funds

to conduct training in a remaining four districts of Eastern Province. Health workers in Nairobi City Council

facilities and MOH beyond Kenyatta National Hospital remain untrained. Prioritization with focus on

population density, logistics 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. Additionally, JSI-MMIS, WHO and other partners will collaborate to develop capacity to

address health care waste management (HCWM) issues through the National HCWM Working Group.

Advocacy for rational and safe injection use amongst medical professional associations will reach major

policy/ decision makers within the country.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This activity will avert at least 5% of HIV transmission in Kenya. To date over 18,000 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 six provinces (Central,

Nyanza, Western, Eastern (part), Coast and the Kenyatta National Hospital. In FY09 an additional 6,000

health care workers will be trained in Eastern province.

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.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Health-related Wraparound Programs

* Safe Motherhood

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $80,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Program Budget Code: 06 - IDUP Biomedical Prevention: Injecting and non-Injecting Drug Use

Total Planned Funding for Program Budget Code: $500,000

Total Planned Funding for Program Budget Code: $0

Table 3.3.06: