Detailed Mechanism Funding and Narrative

Details for Mechanism ID: 4966
Country/Region: Zambia
Year: 2007
Main Partner: Chemonics International
Main Partner Program: NA
Organizational Type: Private Contractor
Funding Agency: USAID
Total Funding: $1,000,000

Funding for Biomedical Prevention: Injection Safety (HMIN): $1,000,000

This program aims to reduce the preventable medical transmission of HIV due to poor Injection Safety (IS) and Infection Prevention (IP) practices. The transmission of HIV through unsafe medical practices, while accounting for a small percentage of overall transmission, is largely preventable. The major issues are blood safety, injection safety practices, handling and processing of sharp instruments, and handling and disposal of medical waste. Infection prevention (IP) practices in Zambia are generally weak due to severe human resource constraints in the health sector, restricted budgets and limited availability of necessary equipment and commodities, weak quality support and supervision systems, and provider and consumer preferences for injections.

The Medical Injection Safety Program (MISP) works with other Emergency Plan partners in implementation of activities and technical collaboration, including formative research results, technical information on making injections safer, and evidence of performance improvement of staff trained in injection safety. The Emergency plan partners include: JHPIEGO (Zambia Defense Forces (ZDF) (9091); Zambia Prevention, Care and Treatment (ZPCT) (8885); Centre for Infectious Disease Research in Zambia (CIDRZ) (9000); Catholic Relief Services (CRS)/AIDS Relief (8827); Health Services and Systems Project (HSSP) (8794); Project TBD (9520); and a wide range of VCT partners.

19 out of the 72 districts in Zambia have already started implementing IS/IP activities. The specific activities have included training of healthcare workers and managers, supplementation of injection safety supplies and equipment, and advocacy for policies on proper management and disposal of clinical waste. In FY 2007, the MISP will expand its coverage by adding two new districts in each of the nine provinces—a total of 18 new districts. This expansion will increase the number of districts providing IS/IP services to 38, representing a 53% coverage of all districts. The activity will be implemented in collaboration with the provincial and district health offices, and will seek to increase the number of trained healthcare workers through utilization of the district staff already trained in IS/IP under the National Infection Prevention Working Group.

The MISP is designed to impact on IS and IP issues at the district, provincial, and national levels. At the district level, the program will support training of health workers, strengthening of performance improvement systems, and support for commodities and logistics management. Through participation in the formulation of district and provincial action plans, the project will have the potential to influence government's budget allocation for essential commodities (e.g., needles, sharps boxes, disinfectants, and Personal Protective Equipment (PPE)). At the national level, the project will support advocacy and policy efforts.

Furthermore, MISP will also provide supplementary support through the procurement of additional commodities needed for the implementation of the initiative.

Specifically, and in collaboration with Ministry of Health (MOH) procurement and distribution specialists, and the Medical Stores Ltd (MSL), and in conjunction with other cooperating partners (e.g. Project TBD, ZPCT, HSSP, Churches Health Association of Zambia (CHAZ), CRS, and JHPIEGO/PCI/ZDF), the Injection Safety project will carry out the following four activities:

(1) Logistics: Strengthening the logistics process, including forecasting, procurement, inventory management, and distribution of essential commodities (e.g. disposable syringes, sharps disposal boxes) through the following strategies:

(a) Orientation of managers and provision of technical support to the infection prevention committees and to the focal persons in order to promote symmetry of information on forecasting and procurement among the line managers and the frontline service providers (which will ensure that the right types and quantities of commodities are ordered and delivered in time to the consumption point).

(b) Strengthening of communication between key stakeholders through regular meetings, correct data flow, reports, and feedback in order to bring coherence in the commodity procurement and delivery system among the facilities, the district, and the central MSL.

(c) Monitoring and assessment of the commodity situation in the 18 target districts,

including the procurement and provision of essential equipment and supplies to fill gaps.

(2) Training: MISP will train 15 service providers in each of the 18 target districts, leading to a total of 270 health care workers trained in IP/IS. MISP also expects train an additional 200 or more health care workers, furthering the expansion and sustainability of the program.

(3) Support and Supervision: The program will continue to render support to partners and to districts trained in previous years in order to improve IS/IP practices and to promote in-house training. The support will be facilitated through visits to the site, where standards-based improvements will be advocated.

(4) Advocacy: The program will sponsor one advocacy meeting for 30 participants in each of the nine provinces. The participants will include managers, frontline service providers, and community leaders. The development of information, education, communication (IEC) and other activities required for sound IS/IP practices will be informed by findings from formative research on behavior, attitudes, practices, knowledge levels, and motives towards IS/IP. The focus of the activities and the IEC material will be on generating demand for improved IP practices and reducing demand for unnecessary injections. Discussions with community leaders will address issues concerning the need to decrease the demand for injectable medicines and to protect people, especially children, from being exposed to needles and injection by-products that are not properly disposed.

(5) Collaboration with other stakeholders: The program will work with the National Infection Prevention Working Group (NIPWG), within the conceptual framework of the National Health Strategic Plan in the implementation of the National Infection Prevention Strategy (2005-2007) and, in the review of guidelines on standard IP/IS practices. The program will also work closely with the Environmental Council of Zambia, on the development of policies and guidelines for management of clinical waste and with the National Drug Formulary committee to reduce injection seeking behaviors and advocate for changes in policy that could result in reduction of unnecessary injections by replacing injectable medications with oral medications wherever possible. The program will also work with the MOH to develop and implement protocols and guidelines for post exposure prophylaxis and hepatitis B vaccination. Other collaborators include: the United Nations Children's Emergency Fund, the World Health Organization, the World Bank/ZANARA project, and the Department for International Development.

(6) HMIS: The program will support the MOH and collaborate with other partners to work towards incorporating IP/IS indicators in the national Health Management Information System (HMIS), and support the NIPWG to implement its performance monitoring plan.

By working with and supporting the GRZ health structures (MOH, Provincial Health Office, District Health Management Team (DHMT)), MISP is building local capacity and establishing frameworks to promote sustainability of the program investments. At the local level, the program works with the facility and DHMT to help them include IP/IS activities and commodities in their own action plans and budgets. At the national level, MISP helps to establish and disseminate guidelines and standards and to integrate IP/IS concepts into other programs, an approach which also promotes long-term sustainability.

Subpartners Total: $455,574
Johns Hopkins University: $354,179
Manoff Group, Inc: $101,395