The partnership project with Gates foundation grant in 2001 was rolled out in a phased manner to strengthen routine immunization with introduction of Hepatitis B and AD syringes into immunization program. Initial success lead to reworking of plans for fast expansion, in three years with consolidation and strengthening in last two years. With introduction of AD Syringes the issue of safe disposal became prominent. Operational research on the safety box led to modifications in the prototype, introduced new challenges to find local manufacturers to make the product for wider introduction. This improved scope to coordinate with other projects to integrate safe injection pits into the disposal system, try out new solutions for sharps waste management in light of new pollution control guidelines. Study at Mehboobnagar district point towards feasibility of introducing small puncture proof containers and needle cutters as a solution for sharps waste management at the rural settings. Injection safety has been introduced in immunization sector and the challenge still remains to extend this to the curative sector, which contributes to more than 90% of the problem.