SUMMARY:

The Making Medical Injections Safer (MMIS) project conducted by John Snow Research and Training, Inc.

(JSI) aims to bring about an environment where patients, healthcare workers and the community are better

protected from the transmission of HIV and other blood-borne pathogens through medical practices. The

project targets healthcare workers and the population at large. Emphasis areas include training and human

resources, development of policy and guidelines as well as commodity procurement.

BACKGROUND:

The project's initial stages have moved from a pilot to a full geographical scale implementation by its mid-

term. The review conducted in 2007 and its findings will guide implementation of priority interventions

towards the second half of the funding cycle building up to September 2009. To this effect the fiscal year FY

2008 will focus on ensuring that the remaining resources allocated to this project are used to maximize the

opportunities to lower risks of transmission. To this end a particular focus will be placed on linking current

injection safety activities to phlebotomy. Discussions to this effect have been embarked upon with the

NDOH unit responsible for the coordination and implementation of the country's Comprehensive Plan for

HIV and AIDS Care, Management and Treatment as well as the South African National Blood Services

(SANBS), a South African organization partially funded by PEPFAR. Such a focus will also strengthen the

MMIS project's ability to support the effective implementation of the newly launched HIV & AIDS and STI

National Strategic Plan, 2007-2011 in its chapter on Accelerated Prevention.

MMIS in collaboration with the National Department of Health (NDOH) completed the first national injection

safety and infection control survey in public facilities in South Africa in 2007. The results indicated that there

were gaps in training in the areas of waste management and injection safety. During 2007 MMIS addressed

recommendations emanating from this survey through training and ongoing behavior change

communication (BCC) activities. The BBC activities address issues such as safe phlebotomy procedures,

the appropriate use of multi-dose vials, reducing the current rate of recapping of needles after injections, the

overflowing of sharps containers and other survey findings requiring attention and action. The NDOH and

the KwaZulu-Natal Department of Health have retractable syringes available on the national and provincial

tenders, adopting them for use and making sustainable financial allocations from the fiscus to cover related

costs in their Mid-Term Expenditure Framework spanning 2007-2009.

A similar approach remains an option for the other provinces as far as the national tender is concerned and

MMIS will continue to play an advocacy role towards such policy decisions to be considered in the interest

of self-sustainability.

ACTIVITES AND EXPECTED RESULTS:

ACTIVITY 1: Healthcare Workers' Training

More healthcare workers will be trained in FY 2008 to reach the target of 3,975 set for the said fiscal year.

Senior and middle managers, clinical staff as well as waste handlers will be trained to increase the public

health sector's capacity in injection safety and infection control. This will continue to be done in partnership

with organizations such as MINDSET Health, BroadReach Health Care and the Democratic Nurses'

Organisation of South Africa. Following discussions initiated in FY 2007, MMIS will together with other

PEPFAR funded projects continue to work towards the improvement of monitoring tools aimed at measuring

the use and effectiveness of its tele-education through the MINDSET Health Channel. The project is not

intending to provide additional support towards the expansion of the said channel but will benefit from such

expansion (as made possible by the South African Government as well as other PEPFAR partners) as

these will increase the reach and accessibility of MMIS Injection Safety content to additional health facilities

in the country. The current reach of the Mindset Health Channel covers 300 facilities, 79 of which were

connected by JSI through its MMIS project. The rest of the facilities networked with PEPFAR partners as

well with individual provincial departments of health. In addition, the project will continue to work closely with

the NDOH's Quality Assurance and Environmental Health Directorates to have trainers trained during past

fiscal years cascade the training in their districts and facilities. Training of trainers will also take place

together with an increased focus on phlebotomy. MMIS trained more than 2,000 healthcare workers in FY

2007.

ACTIVITY 2: Behavior Change Communication

FY 2008 funds will be used to continue to disseminate educational materials to healthcare workers and the

communities they serve. The community outreach program will form part of the South African government's

Khomanani campaign whereby community outreach workers visit 100,000 persons each month to

disseminate health information. From FY 2008, MMIS content will officially become part and parcel of this

campaign, at no additional cost from JSI. The visits will not only serve to educate and inform community

members, but safety boxes for disposing of used medical injections at home will also be distributed where

necessary.

ACTIVITY 3: Logistics and Procurement.

MMIS finalized a national Logistics and Procurement strategy in 2007. The key focus of the strategy is to

increase sustainability in provinces and local government efforts to acquire commodities such as safety

syringes that are now available on national and provincial tenders. Where needed, JSI will use PEPFAR

funds as bridging funds to ensure transition to this effect. In Ethekwini such funding will be provided until

March 2008 while the municipality goes on tender for sustained procurement beyond this period. In the Free

State information from a 2007 analysis will be used to procure protective equipment for healthcare workers

in FY 2008 to ensure an uninterrupted supply. In addition, special courses for logisticians and senior

managers will be run to address weaknesses related to ensuring the uninterrupted supply of commodities

such as sharps containers. Such courses will aim to increase skills and competencies for effective and

efficient stock management for the first target group. They will also be aimed at improving contract

management skills for the latter.

ACTIVITY 4: Norms and Standards.

Activity Narrative:

MMIS will work with the NDOH and the Council for Health Service Accreditation of South Africa to

implement norms and standards on injection safety policy and waste management. A supervision check list

will be developed to allow the structuring of mentoring and supervision of activities related to injection safety

and infection control in healthcare facilities.

The Making Medical Injections Safer activity contributes to meeting the vision outlined in the USG Five-Year

Strategy for South Africa by strengthening the health sector's capacity to provide safe medical injections

and thereby represents an important prevention activity. It is a sustainable program that it is building human

capacity and working closely with the South African government to implement long-lasting policies for

injection safety. It also supports PEPFAR's goals of preventing seven million new infections.