Injection practice and safety and healthcare waste management in India

Context
Following the 55th World Health Assembly (2002), and subsequent initiatives taken by the WHO, quality of health care in general and patient safety in particular have emerged as critical areas of health policy concern. Safe injection practices are of special relevance for developing countries like India which are in the process of expanding universal health coverage, addressing vaccine-preventable diseases, preventing transmission of blood-borne pathogens (for e.g. HIV/AIDS, Hepatitis B & C), detection and monitoring of chronic diseases through blood and other tests, warranting extensive use of invasive techniques. While India accounted for 25 to 30 percent of 16 billion injections administered worldwide, a national population-based cluster survey revealed that nearly 63 percent of them were unsafe (IPEN study group 2012).[i] Recognizing their implications for population health and economic development, the Government of India’s National Centre for Disease Control brought out a “Handbook on Safe Injection Practices” in 2014, with guidelines covering the life cycle of injections. In 2015, the WHO provided guidelines on rational and safe use and disposal of syringes for the safety of both patients as well as health service providers.

Objectives
To support WHO Country Office in providing evidence and a sound baseline for informed and evidence-based technical support to Indian policymakers in planning way forward, the proposed paper will conduct a situation analysis on current status and initiatives for injection safety and health care waste management (HCWM) in India, together with an identification of challenges and potential policy recommendations towards the same.

Approach / methodology
Within the given time-frame of 6 months (1 March to 31 August 2016), the study will largely employ qualitative research methods to achieve the above-mentioned objectives:

1) Systematic literature review: The first objective here will be to develop a methodology for detailed and systematic policy and literature review of:

  • Major international, national, selected state[ii] policies and initiatives (identified on the basis of online search as well as preliminary interactions with relevant officials) as well as documents collected during field research in India;
  • Published literature (online and offline resources from public and private sector, cross-referencing to get literature and estimates on frequency and innovations regarding safe use and disposal of injections, prevention of re-use, data on the burden of morbidity and mortality linked to blood-borne infections, injectables included in the essential medicines list, HCWM practices, etc.).

2) Field research: The objective of this exercise will be to elicit views on existing practices; implementation status, impact and challenges to government policies and initiatives; challenges and potential policy recommendations for the rational and safe use and disposal of injections; by means of:

  • Indepth interviews with identified stakeholders in New Delhi and selected states (policymakers, international organizations, health care providers, HCWM staff, industry, civil society, academia, etc.);*
  • Focus group discussions with patients;*
  • Collection of locally available literature for review.

* Interactions with health care providers, HCWM staff and patients would be conducted in selected district hospitals / community health centres within selected states. With other stakeholders, interviews will largely happen in New Delhi, and a few in the state capitals.

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