Under the President's Emergency Plan for AIDS Relief (PEPFAR), University Research Co., LLC (URC) assisted the Namibian Ministry of Health and Social Services (MOHSS) to improve the medical injection safety as well as safe disposal of medical waste in the country. The program was implemented nationwide. URC used a collaborative approach for testing various interventions to reduce transmission of blood borne pathogens through medical injections and sharps. Before developing the interventions in 2004, a rapid assessment was conducted to look at the existing injection and waste management practices to identify opportunities for improvement. Based on the assessment results, the URC/Namibia team worked with MOHSS and other partners to develop National and Regional improvement plans. A National Injection Safety Group (NISG) was also established to lead, support and monitor injection and waste management practices.

Over the life of the project, URC supported MOHSS to develop policy guidelines on infection control including medical injection safety and safe disposal of medical waste. URC also supported MOHSS with the distribution of post exposure prophylaxis (PEP) guidelines and the National Standard Treatment (STG) guidelines. The project trained over 7,000 public and private health care workers. In addition, the project procured over 350,000 safety boxes, personal protective equipment for waste handlers, and color coded disposal bin liners. As part of the procurement support, URC assisted the Central Medical Stores (CMS) in developing a procurement plan including the development of a tender for the safety boxes.

To influence provider prescription and injection administration practices, the project conducted regular chart audits as well as observed provider practices in a sample of facilities. The results from audits and observations were presented during the quarterly Plan-Do-Study-Act (PDSA) cycle meetings. Over the life of the project, significant improvements in provider practices were noticed. There were also significant reductions in sharps related injuries as well as increase in the use of post-exposure prophylaxis (PEP) among healthcare workers experiencing needle-stick injuries. URC worked closely with MOHSS and its Information, Education and Communications (IEC) Office to develop a communication strategy and materials to change behavior of clients regarding the demand for injections and of providers on safe injection practices and prescription practices according to National standards. The project increased awareness regarding rational use of injectable drugs among both community member and healthcare workers. There were significant reductions in the use of medical injectable drugs over the life of the project.

A system for monitoring and evaluation of injection and waste management practices has been established through quarterly facility assessments followed by PDSA (plan, do, study, act) meetings at regional level. The regional and national MOHSS staff were actively involved in the PDSA cycles for ensuring long term sustainability of key project interventions. The project also worked with other USG implementing partners including MSH, TCE to further expand and improve the strategic interventions. The projects impacts and outcomes have been documents by en external evaluation with has been attached as Appendix A with the report.