TITLE: Making Medical Injections Safer (MMIS).

NEED and COMPARATIVE ADVANTAGE: Currently the working environment in health facilities still poses

risks for health workers and the general community of acquiring blood borne infections such as HIV and

Hepatitis B and C. In order to combat these risks, improved injection safety practices must be implemented

through training of health care workers regarding infection control, management of safe injection equipment,

and supplies at service delivery points. There is a need to support the hospital-based training of trainers

(TOT) to continue training the wealth of workers in hospitals and dispensaries who have yet to receive

training. Institutional initiative on spot supervision is lacking, therefore, hospital management teams must

receive training to effectively monitor and supervise their facilities. For sustainability purposes, MMIS must

include infection control/injection safety in health college curricula, in addition to TOT in pre-service

colleges. An integrated monitoring and evaluation (M&E) tool will be required for all facilities to ensure

correct implementation of best practices, ensure adherence to local and national guidelines, and to possess

documentation of arising issues and improved performance.

ACCOMPLISHMENTS: In Tanzania, MMIS has successfully trained 35% of health workers in injection

safety practices utilizing 51 and 870 zonal and hospital-based TOT respectively. In addition, MMIS has

procured and distributed roughly 12 million auto disable syringes and over 237,000 safety boxes to

hospitals. MMIS has also designed, developed, printed, and distributed advocacy and behavioral mass

media communication to individuals, communities, and facilities. In collaboration with the Ministry of Health

and Social Welfare (MOHSW), MMIS developed and printed 1020 training IPC-IS slide manuals. In addition

to the Do No Harm facilitators' guide and health workers manual, MMIS printed 1500 copies each of

national standards and procedures for healthcare waste management (HCWM), HCWM national policy

guidelines, and HCWM monitoring plans. In collaboration with the MOHSW, integrated supportive

supervision checklists were developed, and in March 2007, a mid-term review on the IPC-IS program was

conducted. Finally, MMIS supported the MOHSW in printing 2000 t-shirts and caps for the World

Environment Day cerebrations and the launch of HIV/AIDS prevention awareness in the workplace.

ACTIVITIES: During FY 2008, funds will be allocated to improve injection safety practices through training

and capacity building of health care workers. This will include: supporting the MOHSW with finalization,

printing, and dissemination of training materials; training of health workers in all public and private health

care facilities focusing on lower level facilities; collaborating with the MOHSW, regional health management

team (RHMT), district health management team (DHMT) and the National AIDS Control Programme

(NACP) to support the inclusion of the PEP policy and monitor implementation of strategies at facility level;

training hospital management teams (HMT) effective on-site supportive supervision.

Safe injection equipment and supplies must always be readily available; therefore, effective commodity

procurement and in-country logistics plans must be in place, including the development of strategies to

achieve injection device security. Additionally, MMIS will support Medical Stores Department (MSD) in

custom clearance of safe injection commodities through pooled procurement of non re-usable injection

devices, safety boxes, and personal protective equipment. Collaboration with national regulatory authorities

is essential to efficiently and accurately provide updates on specifications, technologies, good

manufacturing practices, and highlight the importance of controlling the quality and appropriateness of

products being imported.

MMIS will contribute funds to develop and strengthen sustainable and safe healthcare waste management

systems by advocating and leveraging resources to ensure maintenance of incinerators. Additionally, MMIS

will develop a hired position whose sole responsibility it is to support staff in collecting and handling health

care waste in a health care environment. Collaboration between MMIS and MOHSW in positioning health

officers at health facilities to assist in HCWM will allow more effective monitoring and ensure better

adherence of standards. In addition, MMIS will print and disseminate policy guidelines, plans, and

standards related to HCWM to all health facilities.

Other activities include: developing and strengthening sustainable safe health care waste management

systems and reduce unnecessary injections through targeted IEC/advocacy and behavior change

strategies; expanding the scope of communication and advocacy efforts to the general public through

audience segmentation and strategically sequenced activities; improving health care worker safety through

advocacy for effective needle stick prevention and management guidelines and policies. In addition,

activities will continue to advocate for the provision of post-exposure prophylaxis and vaccination against

hepatitis-B for health care workers and guidelines to be put into place regarding the provision of personal

protective equipment (PPE). Continual support to all facilities will be funded in FY 2008, supporting needle

stick prevention implementation, post exposure prophylaxis (PEP), documentation of needle stick injuries

including the requirement of PPE. MMIS will collaborate with the MOHSW to conduct an evaluation of the

IPC-IS training program for health workers at all levels and disseminate findings to stakeholders.

LINKAGES: MMIS works closely with the MOHSW programs and units that include health services

inspectorate works using a mutually accepted work plan. Education updating health workers on a continual

basis link with adult learning techniques as thematic groups that include JHPIEGO. Injection safety

applicably links with environment health and hygiene surrounding health care waste management.

Additionally, the NACP collaborates with existing partners to design and develop information educational

communication materials. Similarly, reproductive and child health (RCH) is invested in the safety of

injections administered to children. The World Health Organization (WHO) gives technical support on

incineration of medical waste. Furthermore, the Department of Human Resources Development links with

MMIS to TOT using the Zonal Training Centers.

CHECK BOXES: Training of in-service health workers in hospitals, dispensaries, and health centers to

ensure capability, to maximize prevention control, disseminate information regarding injection safety

practices. Activities also address health care waste management, IEC/behavioral change, training of

hospital management team and DHMT on best practices to deliver supportive supervision and maintain a

sustainable level of commodities within all health facilities.

M&E: In collaboration with the MOHSW, a draft checklist has been developed with the aim of integrating the

tools into one master tool. The tool will be used by the program, the health management, and the DHMTs.

Evaluation will be completed at the middle and at the end of the program. Key measures to be assessed in

the M&E should include the achievement and challenges of the program activities, sustainability, safety

Activity Narrative: adherence, and the impact of the program to Tanzania as a nation.

SUSTAINAIBLITY: The program, in collaboration with the MOHSW, the Tanzania Food and Drug Authority

(TFDA), and TBS has encouraged private importers to import the non-reusable injection devices and other

injection safety commodities. A factory known as Emunio-Tanzania Ltd will begin production of non-

reusable syringe/needles and assemble safety boxes for use in health care facilities in Tanzania. In

collaboration with the MOHSW, MSD, and the Prime Ministers Office Regional and Local Government

(PMORALG), injection safety programs will advocate the inclusion of non-reusable injection devices in their

comprehensive council health budgets.