Injection safety work in countries
In 2015, WHO initiated an ongoing pilot intervention campaign on injection safety in three countries including India, Egypt and Uganda, to provide successful examples and lessons learned, to other countries. The purpose of the pilot is:
- to demonstrate feasibility of the campaign and policy at national/local level;
- to provide impact data on key indicators, for example the number of injections per person per year, the percentage of unsafe injections etc.; and
- to evaluate some of the success factors and barriers to technology and behavioural change.
The key components of the intervention are:
- rapid review of available information
- political commitment and stakeholder engagement-leading to a local policy
- baseline assessment of injection practices
- procurement and continuous availability of products
- device introduction, industry engagement
- health care waste management
- awareness campaign for patients and communities
- monitoring and evaluation.
The injection safety project in Egypt has gained significance since its launch in 2015. Injection safety is also a key component of Government’s initiative of addressing treatment and preventive measures related to hepatitis C transmission. The new injection safety policy was finalized after a national concurrence workshop in June 2017. Reuse prevention syringes (RUPs) will be introduced in the country after finalization of the national policy on injection safety in 2018. Key injection safety milestones achieved by Egypt in 2017 include:
- completion of the study to assess the cost-effectiveness of investing in injection safety and RUPs;
- the decision that in the course of 2018, the WHO patient safety curriculum guide will be offered to health care workers via an online module as part of capacity-building for national health care workers;
- that an Egyptian syringe manufacturer has acquired WHO pre-qualification to locally produce 3, 5 and 10 ml RUPs in the country; and
- a communication campaign in Arabic to kick off in 2018, to educate the population on injection safety.
WHO, along with the Ministry of Health and Population is in discussion with the Supreme Council of universities to develop a continuous medical education (CME) programme on injection safety for all medical and para medical undergraduate students.
In 2017, with technical assistance from WHO, Uganda established a national Injection Safety Technical Working Group (TWG) which was tasked with reviewing existing procurement and health care and sharps waste management policies in light of the 2015 WHO guidelines on injection safety. The TWG has recommended addressing the fluctuating prices of reuse prevention syringes (RUPs), to increase the number of syringe suppliers, to enhance capacity of the national regulatory agency to ensure the quality of injection devices coming into the country. Issues related to the capacity of the health managers and improving skills of health care workers on use of RUPs have also been highlighted. The Quantification Procurement Planning Committee (QPPC) has not been able to aggregate commodity requirements from the private sector and this issue still needs to be addressed. The TWG recommendations addressing some of the gaps will be formulated into a revised policy in 2018 and will be tabled to wider stakeholders and the Ministry of Health. In 2017, 600 health workers were trained on IPC and injection safety following the October-November Marburg virus outbreak in the Sebei Region.
India has been progressing steadily since the launch of the WHO led injection safety project in July 2016. By the start of 2018, the pilot state, Punjab, had already achieved four important milestones.
- In line with the WHO 2015 injection safety guidelines, the Health Department of Punjab, in December 2017, procured a sizeable number of reuse prevention syringes (RUPs) which will be used in health facilities of Maler Kotla block of Sangrur districts, which has an approximate population of half a million people.
- The community-based knowledge, attitude and perceptions study on injections has been completed and findings have been shared with the Government of Punjab, and will soon be further disseminated, which will help the intervention team to develop targeted messages.
- The study to assess the cost-effectiveness of investing in injection safety and RUPs in Punjab and India as a whole has been completed. This study will be a useful advocacy tool for the country, as well as globally to promote RUPs.
- The injection safety training materials for health care workers, and particularly nurses and paramedics, has been developed and translated into the local Punjabi language and will be used in trainings across the State in the coming weeks.
The injection safety-related work has been integrated within the National Action Plan for Hepatitis Prevention and Control in India, which will be announced soon. The injection safety-related activities in this draft plan have been costed at around US$ 2.3 million, for a period of three years. The amount excludes the cost of syringe procurement, the funding for which will come from state government budgets.