Projects
Zimbabwe Infection Prevention and Control Project
1. Introduction
On April 18, 2011 the Biomedical Research and Training Institute (BRTI) and its partners, the Infection Control Association of Zimbabwe (ICAZ) and Management Science for Health (MSH) submitted a proposal in response to a Request for Application(RFA), (CDC-RFA-GH11-1144) for Strengthening Infection Control and Prevention in Health Care Facilities in Zimbabwe under the President’s Emergency Plan for AIDS Relief (PEPFAR). The proposal described a strategy for theZimbabwe infection Prevention and Control project (ZIPCOP), to work with the Ministry of Health and Child Care (MOHCC) to strengthen the national infection prevention and control program. On the 13th September 2011, BRTI received a Notice of Award letter from (CDC) for a grant of $800.000, the first part of a $5million grant over a 5year budget period, with a one year no cost extension, to initiate ZIPCOP. This was the beginning of a program that has developed a National Infection Prevention and Control(IPC) policy, guidelines, training modules, established a National team of IPC trainers, developed management structures in IPC, as well as transforming attitudes and practices that contribute to a safer health care environment for patients and staff in Zimbabwe’s healthcare facilities. This is a report of the activities, achievements, challenges and lessons learnt over the 6 years of implementation with an emphasis on the reduction of HIV and TB transmission during healthcare that contributed to a sustainable IPC program in Zimbabwe.
2. Background
At the time of the response to the RFA, although the HIV prevalence in Zimbabwe had declined from 24.6% in 2003 to 13.7% in 2009 the prevalence rate was still high with 1.2 million adults and children infected with HIV.This contributed to the high burden of communicable disease with acute respiratory infections, intestinal infections, pulmonary tuberculosis (TB). The incidence rate of TB in 2007 was 782/100,000 with an estimated low case detection rate of 42% in 2006. Tuberculosis was among top five leading causes of hospital admission and out-patient consultation and patients with HIV and TB related conditions occupying up to 70% of all hospital beds. Since that time the incidence of TB has been revised downwards following a National TB prevalence survey (2013-2015) with an estimated TB incidence rate in 2015 of 242/100 000 population. Of the 1.2 million HIV infected individuals 944,614 were accessing ART by the end of September 2016 which could be a contributing factor to the reduction. Nevertheless Zimbabwe remains one of eight countries in Africa that appear in all three World Health Organization (WHO) lists with high absolute numbers and or per capita incidence of TB, TB/HIV and MDR TB.
In 2009 WHO had prioritized infection control as one of the essential components of HIV prevention, care and treatment services. An effective infection prevention and control program (IPCP) would reduce the transmission of TB and other infections in a Health Care environment. A survey (2010) conducted by the Ministry of Health and Child Care (MOHCC) investigated the status of infection control policies particularly in relation to TB infection control in 33 facilities in 2010. The report indicated that although 96% had an infection control focal person in place and over half (58%) had an infection control committee only 12% had and infection control plan, 21% had an IPC training program but the infection control focal person in only one facility had formal training in IPC.
The high level of infection has also led to considerable pressure on an inadequately staffed and underfunded health services. Erratic power and water supplies added to the problem of providing a safe health care environment for patients and health workers particularly with a high risk of exposure to non-resistant and resistant strains of Mycobacterium tuberculosis. It was difficult to maintain an effective IPC program due to lack of funding, loss of experienced staff, multi-tasking of staff, lack of training in IPC and deterioration of infrastructure. ZIPCOP working through the Nursing Directorate, the focal department within the MOHCC for IPC, set out to address these challenges
Section B: NARRATIVE
3. Project Goals and Objectives
The overall goal of ZIPCOP was to reduce morbidity and mortality from infectious diseases in Zimbabwe. The purpose of the project was to support the MOHCC in improving infection prevention and control practices in health care facilities nationwide to prevent the transmission of infectious diseases, including TB, among patients and staff.
The specific objectives of ZIPCOP were:
Objective 1: To support the MOHCCin the development and dissemination of a national IPC policy, strategic plan and monitoring and evaluation (M&E) tools for infection control by the end of year 1
Objective 2: To support the implementation of a national training program on IPC at the in-service and pre-service level to strengthen the implementation of IPC activities at the facility level.
Objective 3:Toprovide technical support to health care facilities in the development and implementation of IPC plans.
Objective 4To: Support renovations of selected central, provincial, or district hospitals to ensure appropriate environmental conditions for improved infection prevention and control.
Objective 5: To provide post exposure prophylaxis (PEP) to 100% of health care workers exposed to HIV in the 100 facilities that are supported in the development of IPC plans by the end of the project period
Objective 6: To support the procurement and appropriate use ofPersonal Protective Equipment (PPE) for the 100 targeted facilities
In the response to the RFA the proposal stated “ZIPCOP will implement specific activities whose objective is to build the capacity of the various structures and organs of the organizations associated with IPC in Zimbabwe like (ICAZ”. ZIPCOP focussed on building the capacity of ICAZ.
Outputs (2011 – 2017)
- National Infection Prevention and Control (IPC) Guidelines (2013) and National IPC Policy, strategic plan, and M&E plan and tools (2015)
- A National IPC Committee established by the MoHCC – multi-sectorial committee – representatives from MoHCC Departments, Ministry of Construction, EMA, Private Health Sector, and NGOs to support and coordinate IPC activities with 3 TWGs for Training, Surveillance and M&E and Infrastructure
- A National MoHCC in-service training program (with curriculum and facilitator’s guide) developed and delivered for IPC Trainers; training in Basic IPC (including TBIC) for HCWs and Health Managers
- IPC Curriculum strengthening pre-service training programs for Nurses, Medical and Dental students, Environmental Health Officers
- Provincial Health Teams and Management of Central Hospitals briefed
on IPC Standards and the requirements of the National IPC Policy
- A provincial IPC coordinator in each province
- A Core MoHCC Certified Team of IPC trainers in each Province
- Monitoring and Evaluation tools with a scoring and grading system for IPC programmes
- A National Infection Control Association with increased outreach and capacity for training participating in IPC training programmes in Zimbabwe
- TBIC Video for community outreach (Title: Engaging the Community to reduce spread of TB – A team Approach)
Healthcare Associated TB Infection Prevention Project
Focus 1: Strengthening management structures for rolling out TBIC
- Provided technical & logistical support to operations of the established NIPCC & its TWGs (Infrastructure, Surveillance and M&E and Training) and provided a forum for inter-action across MoHCC departments, funding agencies and NGOs .
- The project advocated for IPC to be an essential part of the provincial and district reporting system at the PHTs and DHTs
- Reporting of TB amongst HCWs into the National Health Information
System (DHIS2)
Focus 2: Screening of HCWs for TB linking with NCDs as part of wellness programme
Development & implementation of a National Policy for TB screening of HCWs
Target: Establishing free TB screening services for HCWs at Provincial, District & Mission Hospitals as per National Policy (draft approved by the PS)
- Training of HCW TB screening & wellness teams at Provincial and Central Hospital levels
- Procurement and distribution of equipment to facilitate establishment of TB screening services including registers (purchased and distributed)
Focus 3 : Strengthen pre-service awareness of risks of TB transmission among HCWs students during their training
- 2017 Training and consultation with Nurse Tutors from Nursing Schools in Northern and Southern regions completed to:
- Strengthen TBIC teaching in the curriculum
- Extend TB-HCW screening beyond initial screening on intake to regular annual screening
- Introduction of TB- risk assessment into the nursing and medical student curriculum:
- TB-risk assessment tool and reporting format developed
- TB risk assessment activity with report back introduced into third year medical student district hospital attachment in October-November 2017.
HATIPP ZIM – DIPSA Project (2018 – 2019????
Implementation of a Postgraduate IPC Diploma at the University of Bindura and IPC Systems Strengthening for TBIC and HCW screening in Southern Africa (the HATIPP-ZIM DIPSA project)
Goal: To strengthen the quality of IPC programmes both in Zimbabwe and in the Southern African Region through the training of advanced infection prevention and control (IPC) practitioners who will be a resource for the management of IPC programmes at National Level, at Provincial, District level and in the Southern Africa regions
IPC Post Graduate Diploma
Modular, Part-time programme based on University of Stellenbosch Model
Collaboration: between BRTI, ICAZ and Bindura University with support from the Infection Control Africa Network (ICAN) and CDC expertise
IPC Technical Documents developed