The World Health Organization (WHO) estimates unsafe administration of injections in health care settings is responsible for 8 to 16 million cases of hepatitis B infections, 2.3 to 4.7 million cases of hepatitis C, and 80,000 to 160,000 cases of HIV infections annually. In response to this crisis the WHO, in collaboration with partners from the Safe Injection Global Network (SIGN), developed an intervention strategy aimed at reducing the incidence of unsafe and unnecessary injections. The main areas of focus of the SIGN are:

1. Behavior change of health care workers and patients to ensure safe injection practices and reduce unnecessary injections.
2. Ensuring availability of equipment and supplies.
3. Managing medical waste safely and appropriately.

Zambia was one of 15 priority countries identified in the President’s Emergency Plan for AIDS Relief (PEPFAR) for preventing the spread of HIV infections. In 2004, in accordance with PEPFAR activities aimed at eliminating the preventable medical transmission of HIV, Chemonics International — in partnership with Jhpiego and the Manoff Group — began implementing the Zambia Medical Injection Safety Project (MISP). The project focuses on improving systems and practices related to infection prevention and injection safety (IP/IS). Since 2004 Chemonics has expanded the project to a national scale, with the MISP team providing training, procurement, follow-up and supportive supervision, and behavior change communication (BCC) programs in health care facilities in all 72 districts of the nine provinces of Zambia...