Activity linked to # 7730 & #7759 in IPC JSI works in close collaboration with the Ministry of Health and Social Welfare (MOHSW) under a shared National Strategic Plan and work plan. The project also benefits from collaboration with a broad Stakeholders Coordinating Forum (SCF) that meets quarterly to review activities. MMIS Tanzania has taken a top-down approach to achieve nationwide scale-up. Program implementation began in 2004 and covered 82 facilities that include 5 referral hospitals, 12 regional hospitals namely Kagera, Mwanza, Kilimanjaro, Tanga, Dodoma, Coast, Dar es Salaam, Mbeya, Mtwara, Iringa, Kigoma, Unguja and Pemba. 42 district hospitals, 24 Faith Based organization hospitals and 4 private hospitals.

Activities implemented in 2006 include the training of 48 Zonal trainers of trainers (TOTs) in the 8 Zonal Trainers Centers (Northern, Lake, Western Southern, Southern Highlands, South western Highlands, Eastern and Central) 350 Hospital Based TOTs and 943 health workers. A total of 210,000 syringes and needles with re-use prevention and needle stick prevention features were distributed to the 12 MMIS project health facilities namely Muhimbili National hospital, Bugando Medical Centre, Kilimanjaro Christian Medical Centre, Mnazi Mmoja Hospital in Zanzibar, Mbeya Referral hospital, Kagera, Dodoma, Tumbi, Chake Chake, Rubya, Mpwapwa and Utete . In addition, 70,300 safety boxes and were also procured and distributed in respective hospitals 500 Programme Newsletters and 2000 Brochures were printed and distributed to stakeholders. The five year BCC strategy was drafted. 11,500 information and education communication (IEC) materials targeting prescribers, injection providers, and patients for reducing unnecessary injections were printed and distributed. John Snow Inc Making Medical Injection Safer (JSI - MMIS) actively participated in the MOHSW's development of the National Health Care Waste Management (HCWM) strategy and guidelines. JSI - MMIS has also leveraged with health facility administrators for increased funding for HCWM and requested funds from regional/district health councils, including capital costs for incinerator construction and recurrent costs for operation, repair, and maintenance of incinerators. JSI - MMIS has been registered with the National Environmental Management Council (NEMC) and the Vice-President's Office's Division of Environment, the health care waste regulatory authority in Tanzania. MMIS has also been appointed by MOHSW as a member of the National Steering Committee for HCWM.

In 2007, about 6,750 health workers excluding those trained by the MOHSW will be trained in 76 health facilities. The main focus will be on improving injection safety and infection prevention control practices, health care waste management, supply management and behavior change communication. The strategies will include use of hospital based TOTs to train health workers in their respective facilities.

JSI will ensure the availability of safe injection equipment and supplies at service delivery points through effective commodity procurement and in-country logistics management including the development of strategies to achieve injection device security. A total of 14,000,000 syringes and needles with re-use prevention and needle stick prevention features, 175,000 safety boxes and 10,190 Personal Protective equipment (PPE) for the 177 JSI project health facilities that include all from 2004 to 2007 will be procured. In order to strengthen the logistics management information system (LMIS) JSI will print and distribute quarterly request and order forms for all the 177 project sites in line with what is being used by MOHSW. Distribute supplies nation-wide using the indent system through Medical Stores department (MSD). Ensure that re-use prevention injection devices, safety boxes, and personal protective equipment (PPE) for waste handlers are available through MSD and the private sectors. Continue to encourage manufacturers both international and local to manufacture or import the commodities especially for the private sector. Continue the advocacy with the Local Government Authority so that district health facilities include re-use injection prevention devices, safety boxes and PPEs in their Comprehensive Council Health Plans.

JSI will promote the reduction of unnecessary injections through the development and implementation of targeted advocacy and behavior change strategies. The IEC materials that were developed earlier will be reviewed, and printed for distribution to the 177 health facilities. The materials that include calendars, posters, fliers, brochures, and job aids targeting prescribers, injection providers, patients and the community for reducing unnecessary injections includes continue to write and distribute Programme Newsletters and Brochures for the stakeholders. Participate in national and international events such

World Environment Day, AIDS Day and develop, print and distribute Information Education Materials (IEC), 5000 and 1500 participants' manuals to the health facilities through their Zonal MSDs

JSI will contribute to developing and strengthening sustainable, safe health care waste management systems through training of 354 HCWM incinerator operator staff on proper and effective waste disposal, incineration and maintenance of incinerators. Support the Environment health, hygiene and sanitation unit in the MOHSW to develop the National Environmental Health, Hygiene, and Sanitation Strategy and provide technical assistance to health facilities for management of sharps waste. Analyze data collected from the health facilities earmarked for expansion on current HCWM practices. Support the quarterly meetings of the both the National HCWM Steering Committee and Stakeholders Coordination Forum.

JSI will provide technical support to MOHSW on the construction, operation and maintenance of incinerators. Those health facilities near the Zonal Blood Transfusion Centres which have incinerators may be requested to use the facilities.

In collaboration with MOHSW, JSI to improve health care worker safety through advocacy for effective needle-stick prevention and management guidelines and policies. Support the MOHSW efforts to include Hepatitis B vaccinations and personal protective equipment in the Health Sector Action Plans 2006-2009 for acceleration of HIV prevention.

Monitoring & Evaluation of IS-IPC activities JSI will continue to conduct technical supportive supervision with the MOHSW using a unified reporting monitoring tools developed together by MOHSW and JSI to collect data and analyze it. The MOHSW, and JSI in collaboration with WHO have developed a PEP form for monitoring sharps injuries where an individual health worker is required to fill in under supervision of a selected medical doctor/clinician. MOHSW, CDC, WHO and JSI will soon jointly conduct a Health Workers Safety study in Tanzania regarding among others PEP.