PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Subdivisions of Program Areas, these track general higher level sub-classifications of expenditure.
Subdivisions of Major categories, these are the most detailed expenditure data.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008
This narrative is for both Track 1.0 and Track 2.0 John Snow Injection Safety activities.
By the end of COP07, Making Medical Injection Safer (MMIS) will have implemented injection Safety (IS)
programs in five states (Anambra, Edo, Cross River, Lagos, Kano) and the Federal Capital Territory (FCT)
and individual USG and GON health facilities across another seven states (Bauchi, Benue, Nassarawa,
Niger, Plateau, Kwara and Ogun). During this period, MMIS will have conducted training of trainers for
PEPFAR implementing partners (IPs) in additional states. In COP 08, MMIS will expand to 60 new sites in
a total of 5 additional States.
The significant change in MMIS activity from COP07 to COP08 is the expansion strategy within selected
sites as directed by USG and GON to include covering activities in the rest of the hospital in addition to HIV
related service departments. JSI/MMIS will continue to be the key support in Government of Nigeria (GON),
faith based and private health facilities where other IPs are not present. MMIS will continue to lead IS
training for the GON and USG supported sites. MMIS will coordinate the supply of safe injection
commodities for COP08 after completion of facility training. MMIS will also support the setting up of
supervision systems at site level in all sites where injection safety activities are being implemented.
MMIS will continue to build capacity in the four technical areas: capacity building, behavioral change of
healthcare personnel to promote safe injection practices and communities to promote oral medication where
possible, ensuring availability of equipment and supplies, and appropriate healthcare waste management at
the 789 previously supported health facilities. In addition MMIS will extend its activities to approximately 60
supported public and private health facilities through ad hoc partnership with corresponding IPs and GON.
As of June 2007 MMIS provided training to 6,334 individuals, slightly above their COP07 targets at the time
by 334. In COP08 MMIS will provide IS training to a total of 8,000 individuals using FMOH adapted
WHOAFRO/JSI training curriculum. MMIS will institutionalize supportive supervision systems and
strengthening infection prevention committees at tertiary and secondary health facility levels.
MMIS will also promote safe injection practices, and oral medication to reduce unnecessary demand for
injections at community level through Community Based Organization (CBO) interventions and the mass
media in collaboration with INTERNEWS/ENHANSE. Advocacy and behavior change communication (BCC)
efforts include periodic advocacy meetings with policy makers at all levels of healthcare management and
dissemination of BCC materials, tools, job aids, posters and pamphlets to healthcare providers and
community based strategy. Collaborative BCC work will continue with national and local
institutions/organizations such as NAFDAC, and local/community and religious organizations. Community
outreach activities which will commence immediately after training is expected to foster community
engagement on issues of health with emphasis on injection safety issues as it affects communities in
Nigeria. MMIS will work to develop and maintain grassroots coalitions and encourage those coalitions to
advocate for injection safety with focus on the reduction of the demand for unnecessary injections,
promoting available and necessary oral medication and proper healthcare waste management to the
relevant health authorities and government. MMIS has subcontracted BCC activities to AED (Academic for
MMIS will continue to work towards commodity security. MMIS is procuring IS commodities such as safe
injection devices and safety boxes through its sub-contractor; PATH (Program for Appropriate Technology).
Commodities are stored at the Government Central Medical Store in Oshodi (Lagos) and distributed by UPS
to the focal States' Stores. MMIS has a tracking system to collect data on consumption and stock levels
along the supply chain. This system will be expanded in COP08 to ensure all implementing sites are
empowered to accurately forecast injection commodities and track consumption data.
MMIS will work through the Federal Ministry of Environment and the National Prevention Technical Working
Group with other partners to map out the HCWM microplan for selected HF sites, and adapt the National
adopted HCWM Plan and policy at the lowest service delivery points. MMIS will procure IS commodities
through SCMS for the USG partners in FY08 and will continue full support to her focal sites and provide
support to USG sites.
MMIS will support healthcare waste management through provision of seed waste segregation commodities
and through building infectious waste pits and encouraging the building of incinerators for proper disposal in
accordance with WHO standards such as encapsulation in rural areas. We will also support the repairs,
maintenance and running cost of incinerator whenever possible where applicable.
MMIS will continue to work with the Federal Ministry of Health (FMOH) and other major stakeholders (such
as the Nursing Council of Nigeria and Medical and Dental Council of Nigeria) and training health institutions
(such as Medical, Dental, Pharmacy, Nursing and Midwifery schools and Schools of health technology) to
review, include and update safe injections issues in their various curricula. In addition, on the job training
will continue to take place at supported sites mentioned above (old or new) and a new training package for
new entrance health workers into the healthcare system will be developed and distributed for
implementation to capture new health care workers intakes after completion of site trainings.
The new National Policy on Injection safety and Health care Waste Management will be disseminated
widely through USG supported sites and professional stakeholders. The adoption of safe syringes action
plan development will be supported toward the August 2009 ban of disposable syringes by NAFDAC.
CONTRIBUTION TO OVERALL PROGRAM AREA:
This activity will maximize the impact of integrated HIV/AIDS programming and will contribute to the
prevention of 1,145,545 new HIV infections by 2010 and contribute towards the PEPFAR global
achievement of the 2,7,10 goals. This will also improve the equity in access to HIV prevention services to
the communities most in need; both rural and urban by reducing the risk of transmission to the community
as well as to health care workers. These activities would contribute substantively to NACA's 5-year Strategy
Framework implementation; develop strong links between MMIS services and other service provides such
as PEPFAR IPs, National Primary Health care Development Agency (NPHCDA), UNICEF, the World Bank
and WHO, working on HIV/AIDS issues, IS and healthcare waste management.
LINKS TO OTHER ACTIVITIES:
Activity Narrative: This activity also relates to activities in HIV Counseling and Testing, Laboratory, Palliative Care, TB/HIV,
ART Services, Blood Safety and OVC. Health care workers involved in these programs will benefit from the
training program in injection safety and the adoption of utilization of single syringe and needle, needle stick
policy and PEP protocol, all which will improve the safety for workers safety involved in these other
POPULATIONS BEING TARGETED:
Targeted population includes healthcare workers at focal health facilities; which include doctors, nurses,
pharmacists, laboratory scientists, phlebotomists, store keepers and waste handlers. Religious and
community leaders, community-based organizations are also targeted within the community. In addition,
heads of service and administrators need to be aware of the policies put in place to limit medical
transmission of HIV. Government policy makers, line ministries and National AIDS Control program staff are
also targeted for advocacy to leverage policy decisions, national guidelines and sustainability issues.
Furthermore, these activities will target the general population through the community outreach program, as
they will be provided with safer injection practices.
Through these activities, emphasis is placed on training of staff and capacity development of 850 supported
sites. This program will provide the basis for a workplace program through professional medical
associations that will ensure that the all treatment and laboratory specimens are handled safely, with
minimal risk to healthcare providers.
Stigma and discrimination also occur in healthcare settings, and this has been reported in Nigeria. As
HIV/AIDS treatment and care programs have been initiated, the training of all levels of healthcare providers
in universal precautions and the risks of medical transmission have helped reduce the stigma and
discrimination that can occur in these settings due to fear of occupational hazard.
ACTIVITY DESCRIPTION :
This activity relates to the injection safety (3.3.04) program area. In COP08 the MMIS project will continue
advocacy and policy dissemination efforts with the Federal Ministry of Environment concerning health care
The national baseline injection safety assessment completed in 2004 by the Federal Ministry of Health and
the Making Medical Injections Safer (MMIS) project identified gaps in facility level health care waste
management (HCWM). For example, only 2.5% of health facilities had general injection safety policies and
none had health care waste management policies in place. The assessment also revealed that sharps
were present around 65% of the surveyed facilities and that 96.2% of the secondary and tertiary level
facilities had improper waste disposal. Less than 4% of the facilities had high temperature incinerators, and
so most sharps and clinical waste were disposed via open dumping in municipal sites or via unsupervised
MMIS has been addressing these issues through support for the formation of a National Technical HCWM
working group, under the leadership of the Federal Ministry of Environment in partnership with the Ministry
of Health. Plans are underway for the creation of a national level HCWM Steering Committee that will be
tasked with the implementation of HCWM policies, guidelines and plans for action developed by the working
MMIS will continue to work with the Federal Ministry of Environment and state health waste management
agencies at the health facility level to improve health care waste management throughout Nigeria. During
COP08, efforts at the national level will include the continued support for the HCWM working group, which
will expand to include state level and UN stakeholders as well as interested NGOs. MMIS will facilitate the
development and adoption of policies, guidelines and action plans through national workshops, for eventual
legislative consideration by the GON. At the state level, the Lagos State Waste Management Authority
(LAWMA) will continue to receive technical support from MMIS to serve as a role model for other states
looking to effectively address sharps waste management issues through state and facility level waste
management policy development.
MMIS will also work to disseminate and implement the WHO standards of practice for waste segregation,
storage, transport and environmentally appropriate final disposal as well as the dissemination of any new
legislative actions resulting from the HCWM working group's efforts. These dissemination efforts will be
accomplished via statewide HCWM summits and trainings for all levels of policy makers and waste
CONTRIBUTIONS TO OVERALL PROGRAM AREA:
MMIS assistance to the Ministry of Environment will support the development and implementation of health
care waste policies and practices, leading to the appropriate handling of health care waste and the related
reduction in risk of infection due to exposure to sharps and other hazardous waste by health care
professionals, waste handlers, and the general community.
LINKS TO OTHER ACTIVITIES:
These policy level efforts are linked directly to the full range of activities occurring under safe injection
program area. The wider impact on health care waste management will also be seen at the facility level
implementation of activities in the areas of blood safety, HCT, lab and others where health care waste is
POPULATIONS BEING TARGETED:
This activity targets leaders within national ministries and government parastatals.
This activity includes an emphasis on institutional capacity development and on building human resources
and quality services as detailed in the activity description above.