Increasing Access to Injection Equipment in Burkina Faso:
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Increasing Access to Injection Equipment in Burkina Faso: When Essential Drugs Programmes Improve Injection Safety. Sophie Logez Phamaciens Sans Frontières Clermont Ferrand, France. Objectives of the Study (2000 & 2001).

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Increasing Access to Injection Equipment in Burkina Faso: When Essential Drugs Programmes Improve Injection Safety

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Increasing Access to Injection Equipment in Burkina Faso:When Essential Drugs Programmes Improve Injection Safety

Sophie Logez

Phamaciens 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)


*

* 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

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


Findings (2):Origin of Injection Equipment Found in Pharmacies

Trade mark

Number of

Proportion

community

(%) *

pharmacies

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

60%

Prescriptions with an antibiotic

50%

40%

Proportion of prescriptions

30%

20%

Prescriptions with an injection

10%

0%

1992

1995

1997

1998

2000

(n=5)

(n=16)

(n=28)

(n=32)

(n=41)

Year

30 Prescriptions reviewed in each facility


Reported Awareness Regarding Pathogens Transmitted through Unsafe InjectionsBurkina Faso, 2001

Awareness in the population

HCV

Awareness among providers

HBV

HIV

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Proportion (%)


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: (1) Strengths


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

Worsening

No change

Improvement


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