1. Importance of management leadership in affecting change: Experiences from the Medical Injection Safety Project in Zambia
Martha Ndhlovu,
Christopher Mazimba, Answell Chipukuma, Matildah Zyambo, Steve Chanda, Rick Hughes, Kuhu Maitra
APHA -November 2006

2. Background
Zambia is a landlocked country with a population of about 12 million people
High burden of disease
High prevalence of blood- borne diseases (HIV, Hepatitis B)
Tremendous poverty
$380 GNI per capita
Weak health infrastructure and supporting systems
Human resource crisis
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3. By the end of this session you should be able to:
OBJECTIVES
By the end of this session you should be able to:
Illustrate approaches used by the MISP to engage management in playing a leadership role
Describe specific cases in which management leadership resulted in positive changes in medical practices
Share lessons learned
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4. Medical Injection Safety Project Background
5.5 year program funded through PEPFAR
Objective: To prevent the medical transmission of HIV through improved infection prevention and injection safety practices and behaviors.
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5. Introduction
Good IP practices are simple and routine, but they require diligence and attention to detail and until they become habitual, they require behavioral reinforcement and supportive supervision to implement initially.
Because available resources are invariably limited, careful planning, implementing and monitoring activities on a regular basis, whether in a small clinic or busy district hospital, are all essential.
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6. Activities carried out
MOH and MISP launched the national IP/IS strategic plan
Held monthly meetings with the national IP working group
Held advocacy and orientation meetings with 289 managers and supervisors in 9 provinces and 69 districts
Trained 431 HCP providers in 29 districts
Conducted commodity assessment in 36 districts.
Procured IP/IS commodities worth $876,284
Conducted supportive supervision and follow-up in 17 districts
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7. BCC
24 drama groups in 18 districts (16 scale – up and 2 pilot districts) have been assessed and contracted to disseminate IP/IS messages in their respective districts.
Supportive supervision to monitor behavior change was conducted in 18 districts
Conducted a baseline survey covering 3 districts.
Private sector:
- Carried out a literature search,
- Conducted a situational assessment with key informants
- Developed and pre-tested a focus group (FGD) guide and developed a BCC plan
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8. 24 drama groups contracted 265 performance done 203 areas/HCs reached
Impact and results
24 drama groups contracted 265 performance done
203 areas/HCs reached
28,405 community members reached
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9. Orientation of managers
The main objective is to orient the top health care management on the injection safety project, help them identify their roles and gain their support for sustainability.
The managers are urged to incorporate IP/IS issues in their action plans and budgets
Success stories of other hospitals are shared.
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10. Developing successful programs
If behavior change is going to be sustained management reinforcement is required. Together with clinic managers and IP committees, the administrators have a responsibility to:
Set standards for performance, mentor staff and regularly monitor staff performance
Help staff at all levels to do the right things and use correct PPEs
Identified deficiencies and correct them, dangerous practices eliminated and encourage staff to seek inexpensive, doable solutions.
Provide regular feedback and be role models.
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11. Efforts at Kitwe central hospital
Appointed IP/IS focal person
Revitalized IP committee
IP/IS guidelines produced
Conducted sensitization workshop for HCPs Zk 2,600,000 (us $ 660)
Continued purchase IP/IS commodities and so far spent ZK171,430,000($43,503).
Acquired a new incinerator
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12. Efforts at Livingstone General Hospital
Appointed IP/IS focal person and sent her to MISP for orientation on her responsibilities.
Formed IP/IS committee.
Started orientation maids and so far 35 at K300,000 ($ 76).
Continued procurement of IP/IS commodities so far spent ZK 12,472,952 ($3,160).
Carry out on spots checks in hospital wards.
Started demonstrations of IP/IS practices to staff and student nurses.
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13. Efforts at the University Teaching Hospital
Have revitalized the IP/IS committee and appointed a focal point person. Lobbied for construction of new incinerator with funding from ZANARA project
Incorporated IP/IS commodities in their budget, have spent ZK8,300,000 ($2,101)
Use of accountability books for record keeping have been strengthened
IP/IS trained staff have been carrying out demonstrations in the wards.
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14. Ndola Central Hospital (Pilot site)
From January to date have spent ZK35,724,090 ($8,931) on procurement of additional supplies and PPEs
Have continued with staff trainings and orientation (>300 HCPs and support staff)
Management have put a monthly budget allocation of K3,500,000 ($833) for IP/IS
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15. Ndola central hospital (pilot site)
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16. Sustained behavior after one year in 17 districts
yes no % 1
HCP create rapport with the patient 34 17
66.7 2
Use of new syringe and needle from sterile 51
100 3
Two hand re capping of a used needles 6 45
11.8 4
Bend/break needles prior to disposal 50
1.9 5
Disposal all sharps in puncture proof safety box 88
Preparation injection on a clean designated table or tray 43 8 84 7
Hand hygiene with hand rub or washing hands with soap 26 25
50.9
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17. Results
Provincial and District Health Management Teams (DHMT) have incorporated IP/IS into their routine supportive supervision and follow-up
DHMTs and hospital management have developed and produced IP/IS guidelines (PEP, waste management)
Appointment of IP/IS focal persons at district and health facility level
Procurement of additional IP/IS commodities, leading to continuous availability
Immediate supervisors have continued guiding HCPs in IP/IS best practices, reinforcing positive behavior change
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18. National IP working group strengthened and very active.
Results contd
National IP working group strengthened and very active.
MISP signed a memorandum of understanding.
MOH and MISP developed a follow-up and supervisory tool.
MOH wrote circular requesting all DHMTs to incorporate IP/IS activities in their yearly action plans and budgets.
Formation of IP/IS committees at district and facility levels which actively participate in health planning. 36% of IP/IS committees were functioning actively.
Produced a standardized procurement list
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19. Importance of orientation of managers
Lessons Learned
Importance of orientation of managers
The role of follow-up and supportive supervisory visits.
Provision of adequate supplies, information and skills, supervision and motivation is essential
Training of front line health care providers
Follow up and supportive visits
Support of managers from central level is crucial
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20. Taonga chomene!
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