This narrative is for both Track 1.0 and Track 2.0 John Snow Injection Safety activities.

ACTIVITY DESCRIPTION:

By the end of COP07, Making Medical Injection Safer (MMIS) will have implemented injection Safety (IS)

programs in five states (Anambra, Edo, Cross River, Lagos, Kano) and the Federal Capital Territory (FCT)

and individual USG and GON health facilities across another seven states (Bauchi, Benue, Nassarawa,

Niger, Plateau, Kwara and Ogun). During this period, MMIS will have conducted training of trainers for

PEPFAR implementing partners (IPs) in additional states. In COP 08, MMIS will expand to 60 new sites in

a total of 5 additional States.

The significant change in MMIS activity from COP07 to COP08 is the expansion strategy within selected

sites as directed by USG and GON to include covering activities in the rest of the hospital in addition to HIV

related service departments. JSI/MMIS will continue to be the key support in Government of Nigeria (GON),

faith based and private health facilities where other IPs are not present. MMIS will continue to lead IS

training for the GON and USG supported sites. MMIS will coordinate the supply of safe injection

commodities for COP08 after completion of facility training. MMIS will also support the setting up of

supervision systems at site level in all sites where injection safety activities are being implemented.

MMIS will continue to build capacity in the four technical areas: capacity building, behavioral change of

healthcare personnel to promote safe injection practices and communities to promote oral medication where

possible, ensuring availability of equipment and supplies, and appropriate healthcare waste management at

the 789 previously supported health facilities. In addition MMIS will extend its activities to approximately 60

supported public and private health facilities through ad hoc partnership with corresponding IPs and GON.

As of June 2007 MMIS provided training to 6,334 individuals, slightly above their COP07 targets at the time

by 334. In COP08 MMIS will provide IS training to a total of 8,000 individuals using FMOH adapted

WHOAFRO/JSI training curriculum. MMIS will institutionalize supportive supervision systems and

strengthening infection prevention committees at tertiary and secondary health facility levels.

MMIS will also promote safe injection practices, and oral medication to reduce unnecessary demand for

injections at community level through Community Based Organization (CBO) interventions and the mass

media in collaboration with INTERNEWS/ENHANSE. Advocacy and behavior change communication (BCC)

efforts include periodic advocacy meetings with policy makers at all levels of healthcare management and

dissemination of BCC materials, tools, job aids, posters and pamphlets to healthcare providers and

community based strategy. Collaborative BCC work will continue with national and local

institutions/organizations such as NAFDAC, and local/community and religious organizations. Community

outreach activities which will commence immediately after training is expected to foster community

engagement on issues of health with emphasis on injection safety issues as it affects communities in

Nigeria. MMIS will work to develop and maintain grassroots coalitions and encourage those coalitions to

advocate for injection safety with focus on the reduction of the demand for unnecessary injections,

promoting available and necessary oral medication and proper healthcare waste management to the

relevant health authorities and government. MMIS has subcontracted BCC activities to AED (Academic for

Educational Development).

MMIS will continue to work towards commodity security. MMIS is procuring IS commodities such as safe

injection devices and safety boxes through its sub-contractor; PATH (Program for Appropriate Technology).

Commodities are stored at the Government Central Medical Store in Oshodi (Lagos) and distributed by UPS

to the focal States' Stores. MMIS has a tracking system to collect data on consumption and stock levels

along the supply chain. This system will be expanded in COP08 to ensure all implementing sites are

empowered to accurately forecast injection commodities and track consumption data.

MMIS will work through the Federal Ministry of Environment and the National Prevention Technical Working

Group with other partners to map out the HCWM microplan for selected HF sites, and adapt the National

adopted HCWM Plan and policy at the lowest service delivery points. MMIS will procure IS commodities

through SCMS for the USG partners in FY08 and will continue full support to her focal sites and provide

support to USG sites.

MMIS will support healthcare waste management through provision of seed waste segregation commodities

and through building infectious waste pits and encouraging the building of incinerators for proper disposal in

accordance with WHO standards such as encapsulation in rural areas. We will also support the repairs,

maintenance and running cost of incinerator whenever possible where applicable.

MMIS will continue to work with the Federal Ministry of Health (FMOH) and other major stakeholders (such

as the Nursing Council of Nigeria and Medical and Dental Council of Nigeria) and training health institutions

(such as Medical, Dental, Pharmacy, Nursing and Midwifery schools and Schools of health technology) to

review, include and update safe injections issues in their various curricula. In addition, on the job training

will continue to take place at supported sites mentioned above (old or new) and a new training package for

new entrance health workers into the healthcare system will be developed and distributed for

implementation to capture new health care workers intakes after completion of site trainings.

The new National Policy on Injection safety and Health care Waste Management will be disseminated

widely through USG supported sites and professional stakeholders. The adoption of safe syringes action

plan development will be supported toward the August 2009 ban of disposable syringes by NAFDAC.

CONTRIBUTION TO OVERALL PROGRAM AREA:

This activity will maximize the impact of integrated HIV/AIDS programming and will contribute to the

prevention of 1,145,545 new HIV infections by 2010 and contribute towards the PEPFAR global

achievement of the 2,7,10 goals. This will also improve the equity in access to HIV prevention services to

the communities most in need; both rural and urban by reducing the risk of transmission to the community

as well as to health care workers. These activities would contribute substantively to NACA's 5-year Strategy

Framework implementation; develop strong links between MMIS services and other service provides such

as PEPFAR IPs, National Primary Health care Development Agency (NPHCDA), UNICEF, the World Bank

and WHO, working on HIV/AIDS issues, IS and healthcare waste management.

LINKS TO OTHER ACTIVITIES:

Activity Narrative: This activity also relates to activities in HIV Counseling and Testing, Laboratory, Palliative Care, TB/HIV,

ART Services, Blood Safety and OVC. Health care workers involved in these programs will benefit from the

training program in injection safety and the adoption of utilization of single syringe and needle, needle stick

policy and PEP protocol, all which will improve the safety for workers safety involved in these other

programmatic activities.

POPULATIONS BEING TARGETED:

Targeted population includes healthcare workers at focal health facilities; which include doctors, nurses,

pharmacists, laboratory scientists, phlebotomists, store keepers and waste handlers. Religious and

community leaders, community-based organizations are also targeted within the community. In addition,

heads of service and administrators need to be aware of the policies put in place to limit medical

transmission of HIV. Government policy makers, line ministries and National AIDS Control program staff are

also targeted for advocacy to leverage policy decisions, national guidelines and sustainability issues.

Furthermore, these activities will target the general population through the community outreach program, as

they will be provided with safer injection practices.

EMPHASIS AREAS:

Through these activities, emphasis is placed on training of staff and capacity development of 850 supported

sites. This program will provide the basis for a workplace program through professional medical

associations that will ensure that the all treatment and laboratory specimens are handled safely, with

minimal risk to healthcare providers.

Stigma and discrimination also occur in healthcare settings, and this has been reported in Nigeria. As

HIV/AIDS treatment and care programs have been initiated, the training of all levels of healthcare providers

in universal precautions and the risks of medical transmission have helped reduce the stigma and

discrimination that can occur in these settings due to fear of occupational hazard.

ACTIVITY DESCRIPTION :

This activity relates to the injection safety (3.3.04) program area. In COP08 the MMIS project will continue

advocacy and policy dissemination efforts with the Federal Ministry of Environment concerning health care

waste management.

The national baseline injection safety assessment completed in 2004 by the Federal Ministry of Health and

the Making Medical Injections Safer (MMIS) project identified gaps in facility level health care waste

management (HCWM). For example, only 2.5% of health facilities had general injection safety policies and

none had health care waste management policies in place. The assessment also revealed that sharps

were present around 65% of the surveyed facilities and that 96.2% of the secondary and tertiary level

facilities had improper waste disposal. Less than 4% of the facilities had high temperature incinerators, and

so most sharps and clinical waste were disposed via open dumping in municipal sites or via unsupervised

open burning.

MMIS has been addressing these issues through support for the formation of a National Technical HCWM

working group, under the leadership of the Federal Ministry of Environment in partnership with the Ministry

of Health. Plans are underway for the creation of a national level HCWM Steering Committee that will be

tasked with the implementation of HCWM policies, guidelines and plans for action developed by the working

group.

MMIS will continue to work with the Federal Ministry of Environment and state health waste management

agencies at the health facility level to improve health care waste management throughout Nigeria. During

COP08, efforts at the national level will include the continued support for the HCWM working group, which

will expand to include state level and UN stakeholders as well as interested NGOs. MMIS will facilitate the

development and adoption of policies, guidelines and action plans through national workshops, for eventual

legislative consideration by the GON. At the state level, the Lagos State Waste Management Authority

(LAWMA) will continue to receive technical support from MMIS to serve as a role model for other states

looking to effectively address sharps waste management issues through state and facility level waste

management policy development.

MMIS will also work to disseminate and implement the WHO standards of practice for waste segregation,

storage, transport and environmentally appropriate final disposal as well as the dissemination of any new

legislative actions resulting from the HCWM working group's efforts. These dissemination efforts will be

accomplished via statewide HCWM summits and trainings for all levels of policy makers and waste

handlers.

CONTRIBUTIONS TO OVERALL PROGRAM AREA:

MMIS assistance to the Ministry of Environment will support the development and implementation of health

care waste policies and practices, leading to the appropriate handling of health care waste and the related

reduction in risk of infection due to exposure to sharps and other hazardous waste by health care

professionals, waste handlers, and the general community.

LINKS TO OTHER ACTIVITIES:

These policy level efforts are linked directly to the full range of activities occurring under safe injection

program area. The wider impact on health care waste management will also be seen at the facility level

implementation of activities in the areas of blood safety, HCT, lab and others where health care waste is

produced.

POPULATIONS BEING TARGETED:

This activity targets leaders within national ministries and government parastatals.

EMPHASIS AREAS:

This activity includes an emphasis on institutional capacity development and on building human resources

and quality services as detailed in the activity description above.