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Social Norms
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Research into Perceptions of Providers & Consumers on Immunisation Injection Safety - Nepal

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General Welfare Pratisthan is an NGO that addresses social issues such as education to girl child in Nepal, healthy environment and social health; and specifically STD/HIV/AIDS. This organisation is active in Central, Mid & Far West regions of Nepal for STD/HIV/AIDS prevention and control programmes through outreach to the risk behaving target populations with support from Family Health International, Save the children (US), University of Heidelberg and Free a Child/USA.

At the request of the Ministry of Health, UNICEF Nepal office, and the USAID Nepal mission, General Welfare Pratisthan used qualitative research methods to gain insight into immunisation providers and consumers' perceptions and knowledge about immunisation injection safety and actual field practices.
Communication Strategies
During March-May 2001, the following activities were carried out:
  • Altogether, 42 immunisation venues were visited and observed the practices.
  • Key informant in-depth interviews and direct observations were conducted with 78 immunisation providers & managers.
  • 12 Focus Group Discussions (FGDs) also were conducted with 122 mother having three years old babies.
  • Respondents came from 16 districts across the country and represent Nepal's ethnic and geographic diversity. Of which, 16 venues were in Terai districts, 25 in Hill and 01 in mountain district.


The study carried out from March - August, 2000 had the following activities:
  • At least 105 In-depth interviews with the providers and the injection consumer
  • At least 16 Focus Group Discussions with injection consumers
  • At least 30 Secret Shopping at private injection practitioners' shops

Development Issues
Immunisation and Vaccines
Key Points
Recommendations from these studies include:
  • There is a serious gap between knowledge about injection safety and provider behavior in terms of promoting injections and handling and disposal of injection equipment. Behavior change strategies should be considered, including:
    • Create legislation and policies related to safe handling of medical waste and enforce them.
    • Increase provider access to safe, simple needle removal tools and incinerator boxes, perhaps using social marketing strategies.
    • Improve hospital and municipal handling of medical waste, including availability of incinerators. Conduct research into current practices, if necessary.
    • Implement public education, through the mass media and other channels, emphasizing the toll of HIV and hepatitis B, tetanus, and abscesses related to contaminated sharps. Reinforce existing perceptions about injection risks while taking innovative measures to promote behavior change.
    • This study did not look closely at provision of drips and minor surgical procedures. A rapid assessment related to the safety and incidence of these practices might be useful.
  • It might be useful to assess the quality of disposable syringes in the market. Also, to learn whether anyone is recycling injection equipment and if so, how to stop the practice or how to help consumers and providers to recognize low quality products.
  • Introduction of AD syringes in Nepal should be accompanied by public education as mentioned above.
  • Conduct research among providers to better understand whether they support TT vaccination of pregnant women or not. If not, educate them to the benefits of immunisation.

Providers and consumers seem to agree that reuse of a needle and syringe by same person is a good way to save money. Consumers feel that it is a good way to protect themselves against infection with HIV and hepatitis B. Promotion of auto-disable syringes will be challenging in Nepal since they may seem expensive and unnecessary to some consumers. However, the AD syringes may also provide new profit opportunities for injection providers and may become popular with them. At the same time, providers may lose income from sale of used injection equipment (if the buyers want to recycle the syringes).
Partners

Financial and technical support was provided by the Gates Children's Vaccine Program at PATH, Seattle, USA.

Sources

Executive Summary of Recent Qualitative Research on Immunisation Injections in Nepal from the General Welfare Pratisthan.

Click here for the full text of the Executive Summary.