John Snow International - Nairobi, Kenya



Dr. Songa Jackson, Country Advisor;
Catherine Lengewa, Behavior Change & Training Advisor

Faculty Supervisor:

Mbithe Anzaya


MDI-Kenya Class of September 2007

History of the Agency:

John Snow International is a non-profit organization dedicated to promoting and protecting the health of individuals and communities throughout the world. JSI provides expertise on a wide ranch of public health issues to governments and donors. In Kenya, JSI seeks to establish an environment free of medical transmission of HIV/AIDS and other blood-borne infections through promotion of safe injection practices and efficient
management of healthcare waste.

CHIP Project:

“JSI Making Medical Injections Safer”

JSI identified a critical problem in the health care sector in Kenya: weak healthcare waste management (HCWM) systems in Ministry of Health (MOH) facilities. In response, JSI seeks to support the MOH to strengthen healthcare waste management systems in its health facilities.

Jackson and Lengewa developed two objectives: 1) to support the MOH in the establishment of waste disposal units in 40 districts by October 2008, and 2) to increase knowledge of 350 healthcare waste handlers through training on safe healthcare waste management in 40 districts by October 2008. To achieve these objectives, JSI created a program to rehabilitate existing deMontfort incinerators, install sharps waste disposal pits, construct placenta pits, and build capacity through hands-on training for waste handlers and incinerator operators.

Changes Made:

  • Rehabilitated incinerators and constructed ash pits and placenta pits in 17 health facilities in Eastern, Central,
  • Coast, and Nairobi provinces
  • Initiated waste disposal unit rehabilitation in 20 health facilities in Nyanza, Western, and Rift Valley provinces
  • Developed a draft of a training manual for incinerator operators
  • Procured 85 sets of Personal Protective Equipment (PPE) for incinerator operators
  • Developed training plans—targeted 350 incinerator operators to be trained
  • Supported district hospitals to mobilize internal resources to construct and rehabilitate incinerators
  • Obtained provincial support and commitment to improve disposal facilities in Central Province
  • Trained several Public Health Officers in constructing deMontfort incinerators in Central Province

Lessons Learned:

Challenges have included lack of technical capacity at the district level to supervise the rehabilitation process, unavailability of materials in local markets, and delays due to Kenya’s postelection violence. Despite these obstacles, JSI is increasing the depth and breadth of this project. Its plans include completing the remaining incinerators, training incinerator operators, advocating for prioritization of medical waste and budgetary allocation for HCWM, mobilizing resources from partners, and encouraging public-private partnerships. The JSI team has had great success in collaborating with the Ministry of Health and building upon momentum to scale up this important program. Ultimately, this project ensures the safe and effective disposal of healthcare waste to protect the health of the community.

According to Jackson, “The MDI program helped me to refocus our activities by formulating a clear mission statement for the organization. We can now clearly state our goals, objectives and strategic options for every assignment we commit to undertake for the Ministry of Health. We are now better equipped to engage the Ministry of Health in activities that are qualitatively sound and have great impact in mitigating the needs of our community. JSI is forever grateful for the opportunity to have had two of our staff attend the MDI training.”