Making injections safe in China : how much will it cost and who will pay?

Injection safety is a major concern in China and a high priority for the Ministry of Health (MOH). The unsafe use and inappropriate disposal of injection materials place patients, health care workers, and entire communities at increased risk for infection and injury. In 1996, the year that the Chinese government launched its National Expanded Program of Immunization (EPI) Safe Injection Plan for 1997-2000, only 30 percent of all injections were provided according to the national injection standard of one sterile syringe and one sterile needle for each injection. The Government of China, with assistance from its development partners, has made great strides in improving injection safety. The MOH has issued regulations regarding the safe disposal of medical waste, including injection materials for both immunization and other health (therapeutic) services. However, even today, use of non-sterile syringes, re-use of syringes, and unsafe disposal of syringes is not uncommon. Current financial incentives lead public health facilities to neglect less profitable preventive health care services, in general and injection safety in particular. In order to address this problem, the government should consider: (i) separate accounting systems for free immunization services and for-profit preventive care to assure appropriate use of public monies. The Government needs to clearly define the responsibility of public health care providers and regulate the allocation of public funds. Most importantly, EPI funds should not be used for the provision of for-profit health care; and (ii) establishing a specific fund for the purchase, distribution, and safe disposal of injection material for immunization services. If carefully regulated, such a fund would motivate health care providers to properly use and dispose of injection materials.