Programmes to address the safety of how medication is delivered and the prevention of infections have been commonplace in many countries of the world for over a decade. But the Smart Injection Programme is making true inroads at pulling together all the work that has been done, from district to national to regional level, into one cohesive whole. Formerly segregated for convenience into injections for immunisation and injections for everything else (‘therapeutic’), Smart now encourages public health bodies to consider injection safety as a holistic whole, where simply every injection must ‘do no harm’. 

Two regions are at the forefront of the Smart Injection Programme revolution, rolled out in assistance with the World Health Organisation Safe Injection Global Network, the Program for Appropriate Technology in Health, Save the Children, Rotary International, the British Medical Association, United States Agency for International Development and others in partnership with SafePoint. 

The East, Central and Southern African Health Community (ECSA) led the way with a ground-breaking, unique resolution passed by the ten member states in March 2007. This laid out a roadmap to achieving injection safety across the sub-Saharan region, with ambitious but achievable timelines set to reach programme milestones. 

The regional collaboration is co-ordinated by the ECSA Secretariat based in Arusha, Tanzania, and ably directed by Dr. Steven Shongwe and his team. Among them, Dr Helen Lugina has taken personal charge of the Smart Programme and has energetically taken on the lead in maintaining the countries on track. ECSA hosted a follow-up meeting for the resolution where further steps were taken to ensure that all members had the first prerequisite for Smart: a ratified national policy on injection safety. ECSA has committed to all ten member states completing this preliminary stage before the next regional meeting in March 2008, and for proposals for implementation of that policy to be in place. The countries are also seeking assistance from the WHO and others to complete fact-finding national assessments to determine current injection practices - essential for defining best, and worst, practice in a country.

Among these countries lie the leaders and innovators in injection safety. Uganda has the most advanced programme in the world, going as far as banning completely standard (reusable) disposable syringes in mid-2007. Under the leadership of Ministry of Health Clinical Director Jacinto Amandua and Making Medical Injections Safer Director Victoria Masembe, Uganda has boldly forged a path in both policy and implementation, drawing in safer devices, better healthcare worker training, and public awareness programmes - and presenting a true example both to the region and the rest of the world. 

Almost on the other side of the world, a commitment was made for the first country-level Smart Programme pilot. Indonesia, a vast island state, committed to taking steps to develop Smart nationally. Like ECSA, this would first incorporate national policy on injection safety. A pilot programme is being planned in partnership with PATH and a national assessment is being scheduled. Given the size and the decentralised nature of the country, the small scale pilot will be a model for other provinces to take up Smart, and will also provide a template for other countries to follow. The Ministry of Health, under the leadership of Dr Siti, has been instrumental in bringing the need for injection safety to the fore, and actively taking steps to ensure that it is achieved. A follow up meeting including all stakeholders will be held in April 2008. Minister Dr Siti has been in particular strongly in favour of implementing a policy that would ban the use of standard syringes, following the proven track record in Africa. 

SafePoint would like to add their congratulations and long-standing support to the Smart countries and looks forward to active steps in 2008 towards our common goal - safe injections for all.