India Injection Safety Coalition

1. India Injection Safety Coalition

2. ”If you have an apple and I have an apple and we exchange these apples then you and I will still each have one apple. But if you have an idea and I have an idea and we exchange these ideas, then each of us will have two ideas.” George Bernard Shaw

3. Key Issues for India • Injections one of the most common • health care procedures • Heavy burden of disease caused by unsafe injections • More than 40 % injections given in India estimated to be unsafe • Growing cause for spread of HBV, HCV, HIV/AIDS

4. Main Gaps • Evidence of uneven quality of sterilization & injection equipment compromising injection safety • Reuse of disposable syringes /needles caused by breaks in supply of adequate volume of equipment • Low awareness of risks from sharps / needle-stick • injuries - health workers / waste handlers / community • Need for appropriate equipment / strategy for • safe disposal of sharps and infected waste

5. Mission To work as a national network of concerned organizations / stakeholders and bring injection safety issues on the national health agenda Started in March 2002

6. Objectives • Work with policy makers to formulate safe injection policies • Assist implementation of safe injection practices and waste disposal • Provide tool kits and resource material to organizations / institutions to improve injection safety in their establishments • Advocate and disseminate information on injection safety issues in the Indian context • Take injection safety to the states, districts where it is most needed

7. Progress thus far… Formation of a Core Group at national level • - All India Syringe & Needle Manufacturers’ Association (AISNMA) • - MoH, Govt. of India • Indian Medical Association • INCLEN • Indian Academy of Pediatrics • Nursing Council of India • PATH Program for Appropriate Technology in Health (Secretariat) • Srishti • UNICEF • WHO India & SEARO • World Bank • Others…

8. Activities • Formation of 3 Sub-Groups for defining specific agendas • - Immunization • - Curative • - Waste Disposal • Core Group meetings • Sub-group meetings / interaction on agenda • Drafting of sub-group agendas

9. Sub Group – Immunization: Agenda • A solution exists in AD syringes. Assist / encourage GoI to transition to AD’s for all immunization in a phased manner • Focus on public sector health facilities • In areas with greater private sector involvement – encourage move to AD’s through IAP, IMA, etc. • Work with government / industry to augment domestic production and supply of quality AD syringes in standard / non-standard sizes • Advocate to highlight risks to providers from unsafe injections to motivate health workers / providers in safe injection practices.

10. Sub Group – Curative : Agenda • Advocacy efforts to focus on rational use of injections • Work closely with IAP/IMA on safe injection practices among providers in the private sector • Policy statement on rational and appropriate use of injections from IMA to all members • Work to include injection safety in medical curriculum at various levels • Involve HIV prevention stakeholders

11. Sub Group – Curative: Activities under way • Evolve safe injection guidelines for implementation by hospitals / nursing homes/ clinics & public health infrastructure for curative injections • Organize lectures / presentations to medical colleges especially SPM departments on injection safety • Bring out special issues on injection safety through medical journals at national and state levels • Include RMPs in advocacy on rational & safe injections

12. Sub-Group Waste Disposal - Agenda: • “First do no harm” principle to be widely advocated • Disposal must take into account both health and environmental concerns • Disposal strategies need to address challenges in various settings – urban vs. rural; fixed vs. outreach, immunization vs. curative, etc. • Look for viable non-incineration solutions

13. Sub-Group Waste Disposal - Activities • Develop model projects in existing interventions of partners • Develop/adapt self assessment tool kit for health facilities, with a resource guide • Include members from Ministry of Environment & Forests, Central Pollution Control Board • Work with MOH & MOEF on policy for safe sharps disposal relevant to different settings • Work with state governments in policy dissemination and implementation

14. Activities, contd. • Formation of coordinating groups for: • Communication / Advocacy • Implementation – Model projects, curricula development and inclusion, workshops • Toolkit Development • Evaluation

15. Results So Far • Expanding network at implementation level through partners networks at state and district levels (e.g. UNICEF & EC, IAP, IMA, “individual champions”) • Fostered collaboration and coordination among partners and brought together on a single platform to speak with a common voice

16. Challenges • Partners remain committed and resource base is expanded to fund regular and planned activities • All partners continue ownership for Coalition agendas and activities • Build inter-departmental coordination within the government – all departments of health, pollution control, and environment must come together to develop an effective policy and agree upon regulatory changes for injection safety – both centrally and at state levels

17. Roadmap of next steps • Regional Workshops • Model projects in selected health facilities / districts • Medical facility self-assessment tool kit and resource guide • Rating of medical facilities • Sponsored publications in professional journals • Advocacy with news media to raise issue – especially vernacular / regional • Media spots for general population [cinema halls, TV (?), ] • Website • Others……