The aim of the Medical Injection Safety Project (MISP) is to reduce and/or prevent medical transmission of

HIV due to poor injection safety (IS) and infection prevention (IP) practices, which can account for up to five

percent of all HIV transmissions. MISP promotes blood safety, safe handling and processing of sharp

instruments, and correct handling and disposal of medical waste. The major factors contributing to poor IS

and IP practices in Zambia include: human resource constraints within the health sector; restrictive budgets;

limited availability of necessary equipment and commodities; weak support and supervision systems (weak

management controls); and provider and consumer bias for injections.

MISP works with and/or has provided technical updates to a variety of other in-country PEPFAR partners,

including: JHPIEGO working with the Zambia Defense Forces ( ZDF); Zambian Prevention, Care, and

Treatment Partnerships (ZPCT); the Centre for Infectious Diseases Research in Zambia (CIDRZ); Catholic

Relief Services (CRS); Health Services and System Program (HSSP); and with a wide range of other

counseling and testing partners to support the Ministry of Health (MOH) in mitigating the spread of HIV.

From FY 2005 through FY 2007, MISP has trained 572 healthcare workers in IS/IP in 38 of the 72 districts

of Zambia. Follow-up supervisory visits to sites reached with IS/IP training have demonstrated improved

IS/IP behavior, including the implementation of the standard Post-HIV Exposure Prophylaxis protocol. In FY

2008, MISP will implement IS/IP activities in 18 new districts, translating into a national coverage of 56

districts from FY 2005 through FY 2008. The project will also train 15 health care providers from each of the

18 districts (totaling 270 providers), translating into a total of 842 providers trained in IS/IP. In FY 2008,

MISP will follow up and make supervisory visits at the 18 districts to provide technical assistance. Greater

emphasis will be placed on the transfer of IP/IS knowledge and skills to health care workers with the highest

threat of predisposition to medical transmission of HIV (phlebotomists, injection dispensers, and clinical

waste handlers). To enhance sustainability, MISP will continue to interface with other partners and the

private sector to leverage each other's resources into IS/IP activities, through joint planning, training,

development of guidelines, etc. Further, MISP will train five trainers of trainers in each of the nine provinces

(totaling 45 trainers), who will in turn continue to oversee the IP/IS training program with support from the

MOH, the provincial health offices (PHO), and other stakeholders. The Project will work closely with

managers and supervisors, facility-based infection prevention committees, and focal point persons to foster

ownership and sustainability of the activities.

In FY 2007, MISP will collaborate with USG partners and non-USG partners, such as: the World Health

Organization (WHO), the United Nations Children's Fund (UNICEF), the National HIV/AIDS/STI/TB Council

(NAC), the Environmental Council of Zambia (ECZ), and the Medical Council of Zambia (MCZ), the MOH,

the Medical Stores Ltd (MSL) and the district health management teams (DHMT) to strengthen the IS/IP

commodity security system. In FY 2008, MISP will focus on strengthening linkages between front-line

service providers and the managers responsible for forecasting and procurement to ensure the right types

and quantities of IS/IP commodities are promptly procured and delivered. MISP will also strengthen

communications and follow-up between facilities and the districts, and between the districts and MSL. To

enhance ownership and sustainability of the IP/IS commodity security system by the MOH, MISP will

continue to collaborate with the procurement and distribution units of the MOH and MSL. The project will

also procure and distribute essential equipment and supplies to the 18 districts that will receive training in

FY 2008.

In FY 2007, MISP held one advocacy meeting attracting 30 participants (mainly managers and community

leaders) from the nine provinces. In addition, the project conducted a series of formative research activities

to inform the development of appropriate behavior change and communication (BCC) materials. In FY

2008, MISP will continue to hold advocacy meetings with facility managers and community leaders to

facilitate the prioritization and inclusion of IP/IS activities in the work plans of health facilities. MISP will also

utilize the BCC materials developed in FY 2007 to increase IS/IP awareness and reduce demand for

unnecessary injections. In addition, results from the formative research conducted in FY 2007 and the mid-

term evaluation (to be conducted in FY 2008) on IS/IP practices will continue to be disseminated to key

stakeholders, including the MOH.

In FY 2007, MISP provided leadership to the National Infection Prevention Working Group (NIPWG) in

advocating for, and drafting the national infection prevention policy. The project also worked closely with

the ECZ in finalizing guidelines on the management of health care waste. In FY 2008, the project will

support the implementation of the national infection prevention policy. The policy will compel institutions to

build capacity to anticipate, recognize, evaluate, and control factors that may impair health and well-being at

the workplace, including IS/IP-related factors. The policy will also define stake-holder role as it relates to:

institutionalization of controls protocols hierarchy, recording and reporting exposure to risk, disposal of

clinical waste at the clinic level, involvement of labor movements, and compensation. In addition, MISP will

continue to assess waste management systems in the 18 target districts and provide technical assistance,

as needed. As part of the sustainability strategy, the project will continue to collaborate with the ECZ and

the MOH in the implementation of policies and guidelines on the management of clinical waste. MISP will

also strengthen collaboration with other USG partners involved in counseling and testing to ensure proper

handling and disposal of medical waste.

MISP, through its leadership role on the NIPWG, will also continue to support the MOH to work towards

incorporating the IP/IS indicators into the National Health Management Information System (HMIS). At the

same time, the project will support the NIPWG to implement its own performance monitoring plan.

By working with and supporting the MOH, the PHO, and the DHMT, MISP is building local capacity and

establishing frameworks to promote sustainability of program investments. At the local level, the program

works with health facilities and DHMT to include IP/IS activities in their own action plans and budgets. At

the national level, the project will help to develop and disseminate guidelines and standards, and integrate

IP/IS concepts into other programs areas.

All FY 2008 targets will be reached by September 30, 2009.