SIGN meeting report 2003. - World Health Organization

Indonesia, the interactional group discussions consisted in moderated discussion
between prescribers and patient, so that the provider could be confronted to the absence
of preference for injections among users. Preliminary results of the discussions suggest
that in Karachi as in Indonesia, patients trusted providers to choose a mode of
administration and did not necessarily prefer injections. A final evaluation of the
intervention and control groups is scheduled for late 2003 and will determine whether
the intervention was successful in reducing the proportion of outpatient visits followed
by an injection.
Advocating to achieve standards in Malawi
12
Ann Maureen PHOYA,
Ministry of Health, Lilongwe, Malawi
In Malawi, a country highly endemic for HIV infection, an infection control project was
initiated with the support of WHO/AFRO and CRHCS. As a first step, policies were
adapted for the country. Second, an assessment identified the gaps in infection
prevention and control activities. Third, an implementation plan formulated to train
staff and provide equipment and supplies. Monitoring and evaluation was included in
the accreditation process and included a reward system. Stakeholder involvement and a
participatory methodology for standard development were important for acceptance
and compliance with standards. Organization of the standards in an operational way,
following the steps of service delivery processes, eased their adoption by facility staff,
thus minimizing the need for external support. The utilization of a change management
strategy that included aspects such as leadership development, resource mobilization,
incentives, feedback and team work from the beginning was essential. The use of
standards led to provider empowerment and sense of control. Policy level support was
important at every step of the process. Issues to consider include the continued
motivation of staff that is a challenge, involving clients and community in an effective
and interactive way to ensure relevance of national standards to community needs and
the use of standards as a self-administered tool to ensure continued application of the
national standards on the job. Next steps will address a complete ongoing process
evaluation to learn lessons for expansion, as well as the expansion of this model to all
other hospitals within Malawi and as pilot projects at the health centre level and the
development of a public dissemination campaign to promote quality services in the
community. JHPIEGO supported the development of operational standards as well as
the monitoring of implementation of the standards in selected hospitals of the country.
The national infection control programme in Egypt
Maha TALAAT,
NAMRU 3, Cairo, Egypt
Initial assessment of infection control and injection practices conducted in 2000 in Egypt
indicated that the basic infection control concept was not well recognized in health care
in Egypt. Injections were overused – particularly in the private sector – and were
sometimes given with injection equipment reused in the absence of sterilization. As a
follow up, a programme was initiated for (1) the promotion of infection control in health
care facilities, (2) the promotion of injection safety and infection control in primary care
settings and (3) the promotion of injection safety at the community level. Interventions
were based upon standard development in association with a communication/
behaviour change strategy that included a cascade training scheme. An infection control
training curriculum targeting infection control teams was developed. The training
course is a series of one week courses over a six-month period. It covers standard
precautions and infection control in high risk settings. The course was piloted for 80
trainees using international faculty members. The development of Information,
Education and Communication material was the focus of special efforts that included
substantial pilot testing with target audiences. TV and radio spots were produced and
aired free of charge by the public television. Interactive theatre was also used. An
incentive programme awarded special recognition during a ceremony with the