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Sophie Logez Phamaciens Sans Frontières Clermont Ferrand, France

Increasing Access to Injection Equipment in Burkina Faso: When Essential Drugs Programmes Improve Injection Safety. Sophie Logez Phamaciens Sans Frontières Clermont Ferrand, France. Objectives of the Study (2000 & 2001).

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Sophie Logez Phamaciens Sans Frontières Clermont Ferrand, France

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  1. Increasing Access to Injection Equipment in Burkina Faso:When Essential Drugs Programmes Improve Injection Safety Sophie Logez Phamaciens Sans Frontières Clermont Ferrand, France

  2. Objectives of the Study (2000 & 2001) • Evaluate the impact of national drug policy on injection safety between 1992 and 2001, including: • Describing the features of the national drug policy that may have influenced injection practices • Quantifying the changes in access to injection equipment • Quantifying the changes in injection practices • Identifying the potential adverse effects of National Drug Policy on: • Injection overuse • Sharps waste management

  3. Methodology • Cross-sectional study : • Phase 1: Injection practices , Aguilera and Fitzner(2000) • Phase 2: National drug policy evaluation, Logez (2001) • Two-stage cluster sampling • 8 districts, probability of selection proportional to population size • 10 health centres in each districts, simple random sampling • Data Collection Procedure (Phase 2) • Interviews with key stakeholders (Centre level) • Interviews with district wholesalers (District level) • Review of registers, Interviews with healthcare workers, pharmacy staff, and the population (Healthcare centre level)

  4. * * Re-use of equipment exceeded 50% in 1995

  5. Key Elements of the National Drug Policy • Central level • National drug policy formulation with regulatory framework • Central bulk procurement by public-private consortium • Injection equipment in National Essential Drug List, with set price • District level • Wholesalers and supervisory team • Healthcare centre level • Community pharmacies in each healthcare centre • Cost recovery according to the Bamako initiative, including for routine EPI injection equipment

  6. Increased Access to Injection Equipment • 5 ml Syringes sale in Burkina Faso • 1996: 884 000 • 2000: 1 840 000 • Price of new 5 ml disposable syringes and needle sets • 10 US cents • Price of equipment judged affordable by: • 88% of pharmacy managers • 50% of healthcare workers • 55% of buyers Proportion of Healthcare Facilities with Community Pharmacy, Burkina Faso, 1990 -2000

  7. Findings (1):Patient Demand for Safe Injections between 1992 and 2001, According to Healthcare Workers

  8. Findings (2):Origin of Injection Equipment Found in Pharmacies Trade mark Number of Proportion community (%) * pharmacies PentaFerte (Italy, official) 42 84% Others (Spain) 5 10% Others (Germany) 3 6% Data missing 5 10% * Total exceeding 100% as some pharmacies carried more than one type

  9. Rational Drug Use Indicators during the Months of June, Burkina Faso, 1992-2001 60% Prescriptions with an antibiotic 50% 40% Proportion of prescriptions 30% 20% Prescriptions with an injection 10% 0% 1992 1995 1997 1998 2000 (n=5) (n=16) (n=28) (n=32) (n=41) Year 30 Prescriptions reviewed in each facility

  10. Reported Awareness Regarding Pathogens Transmitted through Unsafe InjectionsBurkina Faso, 2001 Awareness in the population HCV Awareness among providers HBV HIV 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Proportion (%)

  11. Increased access to safe injection equipment No major adverse effects in terms of: Injection overuse Worsening of sharps waste management situation, as perceived by healthcare workers National drug policy may have contributed to: Decrease in the re-use of equipment in the absence of sterilization Consumer demand for safe equipment Impact of the National Drug Policy on Injection Practices in Burkina Faso: (1) Strengths

  12. Impact of the National Drug Policy on Injection Practices in Burkina Faso: (2) Weaknesses • Unsafe practices in the area of: • Sharps waste collection • Sharps waste management • Limited implementation of recommended prices • Cost recovery as per Bamako initiative is the keystone of the whole system

  13. Recommendations • Address price control and profit margin issue • Implement policies and plans for safe healthcare waste management • Bundle auto-disable injection equipment and sharps boxes with vaccines • Combine curative injection equipment orders to sharps boxes • Include sharps boxes in the list of essential drugs • Finance sharps boxes with cost recovery using syringes and needles sales

  14. Healthcare Workers Perception Regarding Sharps Waste Management between 1992 and 2001 Worsening No change Improvement

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