ACTIVITY UNCHANGED FROM COP 2008

1. ACTIVITY DESCRIPTION

The Partnership for Supply Chain Management (SCMS) will support all of PEPFAR Kenya's service delivery

activities through provision of an uninterrupted supply of HIV/AIDS- related commodities. Under Blood

Safety, SCMS will procure equipment necessary for safe storage of blood and blood products at hospitals.

The National Blood Transfusion Service (NBTS) made a decision two years ago for one million USD from its

Track 1 allocation to be allocated directly to SCMS. These funds will support centralized testing of blood

which will involve pooling of samples from the 6 regional blood banks to one or two facilities. This activity

will support the NBTS to procure reagents and equipment for centralized blood testing achieving economies

of scale through multicounty procurement. To improve hospital transfusion practice SCMS will procure

essential blood banking equipment such as platelet mixers, hospital blood bank fridges and freezers for

storage of blood components.

2. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This activity will contribute to prevention of HIV through blood transfusion. Kenya aims to collect 180,000

units of blood from low risk volunteer blood donors. All the blood will be tested for HIV, hepatitis B, Hepatitis

C and syphilis. This activity will facilitate blood component preparation through procurement of equipment.

Components will increase blood availability through appropriate use and also reduce the occurrence of

adverse transfusion events. Blood donors will be notified of their test results and given information to

promote healthy positive living so that negative donors become regular repeat blood donors. HIV positive

donors will be counseled and referred for evaluation care and treatment as appropriate. Appropriate blood

use will minimize unnecessary transfusions which may expose healthy individuals to HIV infection. The

World Health organization estimates that 10% of HIV may be attributed to transfusion with infected blood.

3. LINKS TO OTHER ACTIVITIES

This activity relates to all service delivery activities by SCMS which will enhance efficiency by maximizing on

economies of scale achieved through mass procurements and timely delivery of commodities. This activity

also links to Cooperative agreements with NBTS and American Association of Blood Banks (AABB) for the

provision of safe and adequate blood supplies.

4. POPULATIONS BEING TARGETED

This activity targets procurement of equipment, laboratory supplies and reagents.

5. EMPHASIS AREAS

The major area of emphasis for this activity is commodity procurement.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16432

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

16432 16432.08 U.S. Agency for Partnership for 7427 7427.08 $1,000,000

International Supply Chain

Development Management

Table 3.3.04:

1. ACTIVITY DESCRIPTION AND EMPHASIS AREAS

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

handlers and the community. It is estimated that up to 5% of HIV infections arise from unsafe injections

given in health care facilities. Injection safety can be enhanced by rational injection use, improved injection

practices and proper disposal of medical sharps. Every year, close to five million blood draws and finger

pricks for blood collection are performed within the public health care sector in Kenya. The expansion of HIV

testing and care has resulted in a dramatic increase in blood collection for the purpose of HIV testing and

monitoring of those with HIV infection. In this activity Supply Chain Management Systems will procure

safety boxes for disposal of medical sharps, color coded waste disposal bins, bags and transfer trolleys,

safety lancets and safe lock needles. Blood and Intravenous fluid giving sets will also be procured. These

will facilitate safe injection practice, segregation of health care waste and its appropriate disposal. These

supplies will be distributed to health facilities through various partners in the Kenya Injection safety program.

Safe injections and sharps waste management will contribute towards reduction of HIV transmission. A

Policy for safe injection practice was launched by the Ministry of Health in 2007. 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. These supplies will only serve to ensure that stock outs do not occur. 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 several countries including Kenya. 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 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. Injection safety activities in Kenya commenced in 2004 under PEPFAR. The

aim is 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 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. This activity has a major emphasis on procurement.

2. 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 8,000

health care workers will be trained in Nairobi (City Council clinics and hospitals) and Eastern provinces.

3. POPULATIONS BEING TARGETED

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

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.05: