1. Increasing Access to Injection Equipment in Burkina Faso: When Essential Drugs Programmes Improve Injection Safety Sophie Logez Phamaciens Sans Frontières Clermont Ferrand, France

2. Objectives of the Study (2000 & 2001) Evaluate the impact of national drug policy on injection safety between 1992 and 2001, including: –Describing the features of the national drug policy that may have influenced injection practices –Quantifying the changes in access to injection equipment –Quantifying the changes in injection practices –Identifying the potential adverse effects of National Drug Policy on: Injection overuse Sharps waste management

3. Methodology Cross-sectional study : –Phase 1: Injection practices, Aguilera and Fitzner(2000) –Phase 2: National drug policy evaluation, Logez (2001) Two-stage cluster sampling –8 districts, probability of selection proportional to population size –10 health centres in each districts, simple random sampling Data Collection Procedure (Phase 2) –Interviews with key stakeholders (Centre level) –Interviews with district wholesalers (District level) –Review of registers, Interviews with healthcare workers, pharmacy staff, and the population ( Healthcare centre level)

4. * * Re-use of equipment exceeded 50% in 1995

5. Key Elements of the National Drug Policy Central level –National drug policy formulation with regulatory framework –Central bulk procurement by public-private consortium –Injection equipment in National Essential Drug List, with set price District level –Wholesalers and supervisory team Healthcare centre level –Community pharmacies in each healthcare centre –Cost recovery according to the Bamako initiative, including for routine EPI injection equipment

6. Increased Access to Injection Equipment 5 ml Syringes sale in Burkina Faso –1996: 884 000 –2000: 1 840 000 Price of new 5 ml disposable syringes and needle sets –10 US cents Price of equipment judged affordable by: –88% of pharmacy managers –50% of healthcare workers –55% of buyers Proportion of Healthcare Facilities with Community Pharmacy, Burkina Faso, 1990 -2000

7. Findings (1): Patient Demand for Safe Injections between 1992 and 2001, According to Healthcare Workers

8. Findings (2): Origin of Injection Equipment Found in Pharmacies Trade markNumber of community pharmacies Proportion (%) * PentaFerte (Italy, official)4284% Others (Spain)510% Others (Germany)36% Data missing510% * Total exceeding 100% as some pharmacies carried more than one type

9. Rational Drug Use Indicators during the Months of June, Burkina Faso, 1992-2001 0% 10% 20% 30% 40% 50% 60% 1992 (n=5) 1995 (n=16) 1997 (n=28) 1998 (n=32) 2000 (n=41) Year Proportion of prescriptions Prescriptions with an antibiotic Prescriptions with an injection 30 Prescriptions reviewed in each facility

10. Reported Awareness Regarding Pathogens Transmitted through Unsafe Injections Burkina Faso, 2001 0%10%20%30%40%50%60%70%80%90%100% HIV HBV HCV Proportion (%) Awareness in the population Awareness among providers

11. Impact of the National Drug Policy on Injection Practices in Burkina Faso: (1) Strengths Increased access to safe injection equipment No major adverse effects in terms of: Injection overuse Worsening of sharps waste management situation, as perceived by healthcare workers National drug policy may have contributed to: Decrease in the re-use of equipment in the absence of sterilization Consumer demand for safe equipment

12. Impact of the National Drug Policy on Injection Practices in Burkina Faso: (2) Weaknesses Unsafe practices in the area of: –Sharps waste collection –Sharps waste management Limited implementation of recommended prices Cost recovery as per Bamako initiative is the keystone of the whole system

13. Recommendations Address price control and profit margin issue Implement policies and plans for safe healthcare waste management Bundle auto-disable injection equipment and sharps boxes with vaccines Combine curative injection equipment orders to sharps boxes Include sharps boxes in the list of essential drugs Finance sharps boxes with cost recovery using syringes and needles sales

15. Healthcare Workers Perception Regarding Sharps Waste Management between 1992 and 2001 Improvement No change Worsening