Increasing Access to Injection Equipment in Burkina Faso:

When Essential Drugs Programmes Improve Injection Safety

Sophie LogezPhamaciens Sans Frontières

Clermont Ferrand, France

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

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)

Injection Practices in 52 Health Centres,Burkina Faso, 2000

Reuse of equipment 4%

Sharps in open containers 83%

Sharps around health centres 57%

Aguilera et al. WHO unpublished study

Observed practice Proportion of

facilities

*

* Re-use of equipment exceeded 50% in 1995

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

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

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Prop

ortio

n of

cen

tres

with

pha

mac

ies

Proportion of Healthcare Facilities with Community Pharmacy,

Burkina Faso, 1990 -2000

Findings (1):Patient Demand for Safe Injections between

1992 and 2001, According to Healthcare Workers

0%5%

10%

15%20%25%30%35%

40%45%50%

Less No change More Much more

Findings (2):Origin of Injection Equipment

Found in PharmaciesTrade mark Number of

communitypharmacies

Proportion(%) *

PentaFerte (Italy, official) 42 84%

Others (Spain) 5 10%

Others (Germany) 3 6%

Data missing 5 10%

* Total exceeding 100% as some pharmacies carried more than one type

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

Pro

port

ion o

f p

resc

ripti

on

s

Prescriptions with an antibiotic

Prescriptions with an injection

30 Prescriptions reviewed in each facility

Reported Awareness Regarding Pathogens Transmitted through Unsafe

InjectionsBurkina Faso, 2001

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

HIV

HBV

HCV

Proportion (%)

Awareness in the population

Awareness among providers

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

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

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

Healthcare Workers Perception Regarding Sharps Waste Management

between 1992 and 2001

Improvement

No change Worsening