Role of advocacy in implementing and sustaining infection prevention and injection safety programs in Zambia

Background: In Zambia medical transmission of HIV via unsafe and unnecessary injections is preventable through implementation of sustainable infection prevention and injection safety (IP/IS) programs. Limited resources within the health sector for IP/IS programs make it difficult to significantly reduce the medical transmission of HIV. To boost resources for IP/IS programs, the Zambia Medical Injection Safety Project (MISP) has implemented an advocacy strategy targeting district, provincial, and national levels.

Methodology: MISP's advocacy strategy was created in collaboration with the MOH and other stakeholders and activities have been implemented in 36 districts. Advocacy orientation workshops with provincial, district, and facility healthcare managers were held where National IP guidelines and other guidelines related to safe IP/IS were distributed. During the workshops MISP lobbied healthcare managers to promote IP/IS activities such as training healthcare workers in IP/IS best practices and conducting IP/IS commodity management and procurement assessments. Additionally, the National Infection Prevention Working Group was strengthened through increased membership and it is now a leader in IP/IS advocacy efforts. To assess the IP/IS advocacy activities MISP conducted a process evaluation and analyzed inputs and outputs at the district, provincial, and national levels using records, checklists, and observations.

Major Results: • Establishment of a memorandum of understanding with the MOH stating their commitment for stronger IP/IS programs. As such, the MOH now covers the cost of storing and distributing IP/IS commodities to district healthcare facilities. • Zambia's health minister launched the National IP/IS Strategic Plan, which has been incorporated into the National Health Strategic Plan, 2006-2010. • MOH policy makers have begun to articulate the importance of IP/IS programs in national and international forums. • Ninety percent of the 36 districts have established IP/IS committees and appointed a focal person to lead IP/IS activities in the district. • Over half of the districts followed-up to date have included IP/IS activities in their annual action plans and budgets.

Recommendations: Ensuring a purposeful advocacy strategy within the context of a service delivery technical assistance project can deliver significant benefits at national and local level. This is especially critical and relevant in respect to the project's long-term impact, adoption, and ultimate sustainability of technical and material investments.