Vaccine and Pharmaceutical Delivery Technologies

Health care waste management

Strengthening systems to ensure health impact

A safe injection is one that does not harm the patient, the health care worker, or the community. However, new and better tools for safer injections are only part of the puzzle. Behind each injection are complex systems involving procurement, logistics, and personnel.

When these systems are firmly established and well resourced, injections are given by trained health workers who use new, sterile syringes readily obtained from a nearby and reliably stocked supply room. Used syringes are also discarded in tamper-proof containers, preventing people from accessing them. By comparison, in countries where resources are stretched thin, health workers may not be trained in injection safety or have adequate supplies or a proper disposal system for contaminated injection equipment and infectious medical waste. As a result, the very injections meant to prevent or treat disease can end up causing it.

Tackling the issue from all sides

PATH addresses the complex issues of health care waste management in low-resource settings from a variety of angles. Our efforts align with a three-part strategy developed by the World Health Organization for promoting safe injections.

1. Changing the behavior of health workers and patients
To ensure a safe injection each time, health workers and medical waste handlers must understand and implement best practices for injection safety. These include safely disposing of needles and syringes. Because injection devices, waste disposal methods, and access to appropriate tools can vary, health workers may not be up to date on best practices for injection safety and programs may lack the resources necessary to conduct regular trainings. To meet these training needs, PATH developed the Giving Safe Injections and Training Health Workers in the Management of Sharps Waste manuals, which are intended for use and adaptation by programs, health workers, and waste handlers in low-resource settings.

2. Ensuring the availability of equipment and supplies
With numerous partners, PATH continues to advance the development of safe injection technologies that are appropriate for use in low-resource settings. To stoke demand, we have also assisted individual countries in setting up or building on their own procurement and waste disposal systems. We have designed curricula and hosted workshops to support the procurement capacity development of health officials and to strengthen the waste management practices of health care programs.

More recent work has focused on ensuring that the right supplies reach the right places at affordable prices. Through the Making Medical Injections Safer project, PATH helped ministries of health in ten African countries as well as Haiti and Guyana to identify and procure more than 250 million safety syringes, 175,000 sharps disposal containers, and 2,300 needle remover devices.

Once a country’s needs for safe injection supplies in the therapeutic sector were identified, we helped country officials to liaise with suppliers, initiate competitive bidding, and arrange for rapid product shipments. Ultimately, by pooling countries’ needs and purchase orders, our efforts also helped to reduce the price of goods—better enabling country program access to safer and more reliable equipment and supplies.

3. Managing waste safely and appropriately
Injection safety includes the safe management of health care waste. Both require appropriate equipment and training at the health facility level and the capacity to manage systems at the regional and national levels. Without appropriate policies and adequate resource allocation, health workers are unable to access the supplies, training, and infrastructure they need to ensure injections do no harm.

PATH has a long history of working with countries on policy and planning at the national level to identify, assess, and address relevant gaps and opportunities. A number of ministries of health have since developed national policies on the financing and purchase of appropriate health care commodities. They have also strengthened system weaknesses in the management of medical waste. Botswana, Ethiopia, Kenya, Mozambique, Nigeria, Rwanda, and Uganda now use guidelines that PATH developed to train health workers in safer waste management practices, including the proper segregation, handling, and destruction of contaminated sharps. Additional activities in Kenya are described below.

Ongoing work in Kenya

With support from the US President’s Emergency Plan for AIDS Relief (PEPFAR), PATH continues to build on the strong foundation created through previous activities, including the Making Medical Injections Safer project, by working closely with the Kenya Ministry of Health and other PEPFAR-funded programs in partnership with ETLog Health to strengthen Kenya’s national health care waste management plan. In collaboration with these and other partners, we are working to:

  • Create appropriate systems for monitoring and evaluating the plan in action.
  • Refine training guidelines to ensure the sustainable implementation of best practices.
  • Develop policies, standards, and tools for accessing health care waste management commodities.
  • Bolster health system infrastructure as well as environmentally friendly approaches to treatment at a variety of district hospital locations.

Additional information