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. 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 Key Issues for India

4. 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 Main Gaps

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

6. 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 Objectives

7. Progress thus far… - 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… Formation of a Core Group at national level

8. 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 Activities

9. A solution exists in AD syringes. Assist / encourage GoI to transition to ADs for all immunization in a phased manner Focus on public sector health facilities In areas with greater private sector involvement – encourage move to ADs 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. Sub Group – Immunization: Agenda

10. 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 Sub Group – Curative : Agenda

11. 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 Sub Group – Curative: Activities under way

12. 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 Sub-Group Waste Disposal - Agenda:

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. Formation of coordinating groups for: oCommunication / Advocacy oImplementation – Model projects, curricula development and inclusion, workshops oToolkit Development oEvaluation Activities, contd.

15. 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 Results So Far

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. 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…… Roadmap of next steps