This activity is linked to activity sheets CDC_HMIN_8582, CDC_HMIN_8516 and CDC_HMIN_8627.

This activity narrative describes activities proposed by John Snow Inc. (JSI) for FY07 for injection safety (IS) and waste management (WM) activities.

Plans to scale-up injection safety for FY07 are based on the experiences of JSI in supporting the implementation of IS and WM activities in Mozambique since 2004. These plans are designed to emphasize the importance of working closely with the Mozambique National Health System (NHS) and to improve JSI's effectiveness in providing technical assistance to the Ministry of Health (MoH) at the national, provincial, district, and health facility level.

In FY07, JSI proposes to expand support for implementation of Injection Safety (IS) and Infection Prevention & Control (IPC) activities to 40 districts. These sites were selected from the list of a total of 80 priority districts established by the Government of Mozambique based on vulnerability in relation to HIV/AIDS.

Main areas of support and activities proposed fall under the following categories:

1) Commodity Management and Procurement: This component is crucial to injection safety. Without adequate provision of injection commodities, in the past supplies were reused inappropriately. In FY07, JSI and its partner (PATH) will continue pooled procurement to promote sustainability in close coordination with NHS staff. JSI will also continue to support the MoH's central-level procurement and logistics subcommittee, which is responsible for the development and implementation of policies and guidelines for the transition from glass syringes to single use syringes (e.g. AD syringe). JSI will also continue to support the development of logistics management training materials and supervision tools for ensuring effective supply-chain management systems.

2) Capacity-building and Training: JSI has developed high quality training materials with previous funding from the Emergency Plan. These training materials make use of interactive and participatory teaching methods to train trainers in the "Do No Harm" Guide that was adapted for Mozambique in May 2005. To roll-out the trainings, central experts and JSI staff train provincial IS/WM trainers and supervisors, who in turn instruct district and facility level staff using on-the-job training methods. These trainings primarily take place at in-service sites, targeting doctors, nurses and allied health professionals (e.g.,laboratory, dental, pharmaceutical, X-ray and support staff). To date, hospitals and health facilities from 4 cities have participated in the IS training: Xai-Xai, Quelimane, Nampula and Maputo city (Mavalane Health Area).

In FY07, training will be expanded to new provinces and cities to reach 40 districts. To accomplish this, JSI will establish a central-level IS training and capacity-building subcommittee to strengthen collaboration and coordination with the MoH Training Department, Training Institutes, Universities, and other MoH Departments as appropriate. Training of trainers (TOT) will again be organized and conducted to ensure that at least three health workers are trained as IS trainers for each of the priority districts covered under the '07 expansion. Future trainers will be selected by MoH provincial and district authorities. The duration of the TOT course is 5 days: 3 days for classroom training and 2 days of practice at the respective health facility. While TOT courses are organized and conducted with direct support from the MoH and JSI, provincial and district trainers will be responsible for further training roll-out at district and health facility levels.

To complement on-the-job training, the JSI team will support MoH supervisors to ensure that formative supervision is in place so that every health worker targeted under this project will be following the recommended Injections Safety practices as well as the Universal Standard Precautions, including the management and proper disposal of medical waste.

3) Behavior Change & Communication (BCC): During FY07, JSI IS technical staff proposes to focus on dissemination and implementation of the IS BCC strategy developed during the previous year. Staff from the MoH health education department, located within the community health department, will participate in coordination and implementation of these

activities. The strategy will guide and support the dynamic process of attitude and behavior change of health workers as well as clients, patients and the community. An assessment, using a simple questionnaire, will be conducted to guide further improvements of the strategy and provide additional information for intervention design. The IS BCC activities will be implemented using the approach of ‘Trials of Improvements of Practices' (TIPS) also used for IS training activities.

4) Standardized System for Proper Sharps Disposal: In early 2006, a Waste Management (WM) sub-committee was formed including MoH and JSI key personnel. Main tasks of this subcommittee include the coordination of WM activities among MoH, Ministry of Environment and other relevant stakeholders. As in previous years, JSI is proposing to continue support for procurement and distribution of materials for segregation, collection, final disposal of sharps and waste, protective materials for health workers handling infectious waste and sharps. In addition, plans for FY07 include the set-up of additional needle pits and protection of waste treatment areas through fences.

5) Support of the Informal Health Sector: According to MoH estimates, around 65% of the Mozambican population uses health services provided through the informal health sector, involving consultations with traditional healers at community level. Anecdotal evidence strongly suggests that unsafe practices and the re-use of contaminated sharps and blades may be common among Traditional Healers. In FY07, JSI proposes to conduct a rapid needs assessment to gather data and learn more about current practices in the informal sector, so as to subsequently be able to plan for and design interventions targeting and working with Traditional Healers.

6) Policy Environment: The JSI team is planning to continue support and technical assistance for government counterparts to develop or review policies, protocols, guidelines, norms and standards in the areas of IS and WM. This support will be crucial to work towards sustainability and government commitment for the implementation of injection safety and adequate waste management.

7) Monitoring and Evaluation (M&E): Under this task MoH and JSI IS staff will analyze data from across health facilities, districts and provinces, assess progress, share the information during provincial and national IS working group meetings, and revise work plans accordingly. Discussion will take place with policy makers as to how to use the data generated, and to ensure that lessons learned and "best practices" are considered during the development of future plans for IS and Infection Prevention Control. Activities conducted in this area will therefore assist to bridge the gap between implementers and policy makers.