Summary

JHPIEGO will assist the Ministry of Health (MoH) to complete the roll out of the performance and quality

improvement initiative in infection prevention to all districts in an effort to reduce HIV and possible Hepatitis

B transmission among health providers in health facilities. This will be achieved through facilitating

sensitization meetings, training quality improvement and assurance support teams in infection prevention

(IP), conducting baseline assessments at the facilities, conducting monitoring and supervision at facilities,

addressing identified IP gaps with available resources, and working with District Health Management Teams

(DHMT's) to ensure they budget sufficient funds to guarantee the availability of adequate and consistent

supply of IP commodities. Target population for the program is the general population. These activities wrap

around performance and quality improvement work to be undertaken by JHPIEGO with family planning and

maternal and child health funding.

Background

Since 2002, JHPIEGO Malawi has worked with MoH Nursing Division and the National Quality Assurance

Steering Committee (NQASC) to improve IP practices in hospitals throughout Malawi. As the JHPIEGO

bilateral agreement comes to an end in September 2007, the follow-on activities in this area will be

undertaken through a central agreement with JHPIEGO. Among the critical activities to be completed is the

roll out of the national IP guidelines and standards to all health facilities.

To date, the PQI/IP process has been introduced in 35 hospitals. Improvements have been documented in

all hospitals and nine have achieved recognition by MoH. JHPIEGO will continue to roll out this initiative to

other facilities and support the existing facilities to achieve recognition status.

Activity 1: Development of National Guidelines

JHPIEGO will build on the assistance provided through the previous JHPIEGO bilateral project to help the

MoH in developing national guidelines and standards for IP. The infection prevention standards cover 14

departments of the hospital that includes the operating theater, labor/maternity wards, medical wards,

surgical wards, casualty department, laboratory, dental, and family planning clinics; and these are being

implemented in 35 health facilities covering all central and district hospitals. Two thousand and twelve

health workers in Malawi have been trained in injection safety with technical support from JHPIEGO and

other USG partners MSH and Save the Children. With FY 2008 funding, JHPIEGO will provide support in

increasing the capacity of health care institution workers to prevent occupational exposure to HIV, Hepatitis

B and other infections including hospital-based nosocomial infections. The first activity is to provide

supportive supervision to the existing 35 hospitals throughout Malawi that have already been introduced to

the national IP standards so that a maximum number of sites receive certification as meeting MoH infection

prevention standards and guidelines. These activities will be coordinated with activities carried out by USG

partner Pact Malawi (ID#17396)

Activity 2: Technical Assistance

JHPIEGO will expand the provision of technical assistance to the MoH to adapt the standards to be

applicable at the Health Center levels so that correct IP practices can be extended. As part of this process,

JHPIEGO will also assist the Reproductive Health Unit (RHU) and the Nursing Directorate to create a

method of recognition and certification for Health Centers which achieve IP standards.

Activity 3: IP Standards

JHPIEGO will work with stakeholders at the district level to roll out IP standards to the Health Center level.

JHPIEGO will demonstrate this process in 15 Health Centers and encourage MoH, DHMTs, and other

partners to take up this initiative.

Activity 4: Training in Injection Safety

JHPIEGO will train 180 health care workers in safe injection practices and universal precautions as well as

introduce health care workers to procedures for using post exposure prophylaxis (PEP). Four training

sessions will be held at these 15 sites, and three members at each facility will be trained. JHPIEGO will

continue to work with the existing 35 hospitals to address multiple underlying factors affecting facilities'

ability to meet their IP goals. Pact Malawi will extend this training and disseminate PEP information to

greater numbers of health care workers (see Pact Injection safety narrative).

This funding will go specifically to support hospital staff training in providing injection safety and hospital

supervisory staff training in ensuring a minimum quality standard for services.