1. Development of Injection Safety Assessment Toolbox Rebecca Fields The CHANGE Project/USAID

2. Rationale for Assessments and Toolbox Assessments identify local issues so as to design effective, efficient interventions Data provide baseline information, suggest indicators for monitoring Data open the door to dialogue among players potentially involved in IS

3. Toolbox Addresses Conceptual Framework Injection Adverse Event Injection Overuse Unsafe Injection Practices Providers System

4. Toolbox Takes into Account: Logistics Management Sharps/ waste Management Behavior Change Strategies Safe Practices

5. Components of Toolbox Qualitative research on determinants of behavior Frequency and source of injections Health facility survey of injection practices Cross-sectional study of association between infections and injections

6. Toolbox Development Process Kit components drafted early 2000 3-day workshop at BASICS in March 2000 to review/re-think toolbox New tool on “contextual assessment” prepared Tool on injection/infection association deemed “optional”

7. Pilot Use of Tools Burkina Faso - health facility assessment Niger - health facility assessment Albania - contextual assessment Pakistan - qualitative research Uganda (planned) - frequency/source of injections

8. Conclusions (1) Choices Must be Made Scope: specific program (EPI) vs. PHC vs. all percutaneous procedures Feasibility vs. quality of data Local adaptation vs. comparability Turnkey instructions vs. broad guidelines

9. Conclusions (2) Toolbox and Tools Will Change Adaptation to local circumstances is essential New tools may be added

10. Conclusions (3) Gold Standards are Not Created... …they evolve Pilot testing, feedback, revision are essential to make the toolbox useful