JSI-Making Medical Injections Safer (MMIS) is a USAID funded project aimed at reduction of medical

transmission of HIV and other blood borne pathogens through the rapid reduction of unsafe and

unnecessary injections. In FY08, project interventions which include; training, on job supportive

supervision, provision of waste management commodities, and cross unit visits will cover a total of 25

districts, benefiting 1225 health units. A total of 2500 health workers will be trained. During the training,

policy documents and norms and standards on injection safety and health care waste management will be

widely distributed and standard precautions on infection prevention and control will be emphasized. The

benefiting districts will receive a total of 7,877,900 needles and syringes with re-use prevention features and

88,875 safety boxes. Waste segregation bins, bin liners, and protective gear for waste handlers will be

provided. The project will continue to create public awareness through radio messages, house to house

education of family members by village health teams, drama shows, and through film, and radio talk shows.

Local political and civic leaders will be involved in most of the awareness activities. Supervision data

collected so far shows that there is improved knowledge and skills of health workers, reduced exposure to

needle stick injuries and a significant reduction in unnecessary use of injections.

Contributions to overall program: According to the figures for distribution of commodities, the average

number of injections per person per year has dropped from three injections per person per year in 2005 to

1.5 - 2 injections per person per year in 2007. PEPFAR implementing sites have a cleaner working

environment with over 80% of the health units within the project area having medical waste/safe injection

programs in place. Findings of observations made during supervision show that 100 % of injection devices

used on clients come from new sterile packs. In consistency with the Ministry Of Health (MOH) plans of

introducing syringes with re-use prevention features nation wide, in FY 2008, the project will scale up

interventions in five expansion districts while sustaining desired practices in the FY 2007 twenty five

districts. An additional 450 health units with 2500 health workers will benefit from this expansion. All

information collected will be shared with the district health teams and individual feedback will be given to

each facility supervised by the project staff.

Intervention areas: Interventions used for the MMIS program include improving skills of injection providers,

ensuring full supply of injection commodities therefore eliminating the need to re-use, conducting behavior

change campaigns; promoting use of oral formulation, (this enforces compliance with oral treatment

regimes including ARVs and anti- TB drugs), and enhancing health care waste management. All

interventions are conducted by working within existing structures, improving program efficiency by looking

for cheaper alternatives, and using strong advocates. All health workers regardless of specialty are targeted

for behavior change.

Training:

It is estimated that there are 2500 health workers in the expansion areas targeted for 2008. The project will

work closely with the Ministry of Health to train 85% of all the workers both in public and private facilities in

safe injection practices, appropriate health care waste management, logistics management and

communication and behavior change. This will be achieved through the creation of a central team of trainers

who will train a team of district trainers in each district. The district trainers will then train health facility

based health workers within their districts. The W.H.O./AFRO/JSI facilitator's guide which was adapted in

the country will be used as the basis for all trainings. Desired practices will be further enhanced through on

job support supervision and cross unit visits. Targets for the training will include public and private health

workers including doctors, nurses, clinical officers, nursing assistants, waste handlers, logisticians and

cleaners.

Provision of technical assistance to districts to ensure injection device security:

Using a ratio of 1.5 injections per person per year; MMIS will assist the districts to order for adequate

needles, and syringes with re-use prevention features using their credit line funds. The project will improve

the districts' logistics capacity with the aim of ensuring that 80% of health facilities in the project districts

report no stock-outs through out the year. For facilities that may happen to get stock-outs, the duration of

stock-outs should not last more than 28 days. This will be achieved by training the health unit store

managers on timely forecasting and proper management of stores, and by liaising with Uganda national

medical stores (NMS) to streamline the distribution of commodities. This will give the project an opportunity

to strengthen the existing logistics system. Client exit interviews will be done from time to time to check

whether the last needle and syringe used on them came from a sealed pack.

Other planned activities:

All efforts will be put in place to establish an environment where health workers, patients and communities

are better protected against transmission of blood borne pathogens. Such activities will include, promotion

of health worker safety related policies like immunization of health workers, establishing exposure

management systems and provision of waste management commodities. Behavior change campaigns will

be launched targeting communities and prescribers with the major aim of reducing unnecessary injections.

All activities will be implemented in a manner that will offer men and women equal opportunity to access

information and services.

Provision of technical assistance to PEPFAR implementing partners in the area of health care waste

management funded through the country budget will complement these activities.