Medical Waste Management Pilot Project in the Southern West Bank Governorates (HEB SW 010 09) PROJECT KICK-OFF WORKSHOP Hebron, 6 August 2012 Mario Paolini - NEXUS Consultant
Partners Applicant Italian Partners Local Partners
Donor 2004: agreement between the Italian Ministry of Foreign Affairs and the Palestinian National Authority Program promoted by Directorate of the Mediterranean and Middle East (DGMM) in collaboration with Italian Local Authorities Total funds: 25 million Euro 2006: program started in partnership with Directorate for Joint Service Councils for Services, Planning and Development
PMSP Methodology and Sectors Partnership between Italian Local Authorities (Regions, Provinces and Municipalities) and Palestinian Local Authorities (Palestinian Municipalities and Joint Service Councils) 5 Priority Sectors: 1. Water and Sanitation; 2. Solid Waste Management; 3. Cultural Heritage and Tourism; 4. Social Development, 5. Institutional and Capacity Building
Medical waste in West Bank Reliable and updated information on medical waste not available No systematic collection of data on generation rate and quantities of medical waste in HCFs Estimated average generation rate of around 1.3 Kg/bed/day and 100 g / outpatient visit Around 13% of medical waste produced consists of infectious waste (MoH sources)
Current practices in MWM - 1 95% of the infectious sharp waste and 50% of other infectious waste (operating theatres and labs) segregated (MoH sources) Internal regulations and guidelines introduced in many HCFs and medical and support staff received relevant training Some hospitals using autoclaving to treat infectious MW
Current practices in MWM - 2 Procedures are not always followed accurately due to lack of supervision and monitoring Medical waste mixed with the general waste in open baskets Lacking of colour coding, labelling of containers and onsite storage containers Bags not strong enough, easily punctured allowing leakage and spillage No special carts or special routes for MW
Current practices in MWM - 3 MW disposed with municipal solid waste: 69% in open containers, very often in public areas outside the HCFs About 65% of infectious MW disposed of untreated in open dumping site and 15% disposed of by open burning Few exceptions. E.g., Ramallah Governmental Hospital: separation, segregation and treatment of infectious MW by autoclave sterilisation introduced by a pilot project implemented with UNDP support.
Causes of current situation 1. Lack of a legal framework, setting policies, procedures, roles and responsibility, monitoring and enforcing mechanisms 2. Lack of capacities and resources by actors involved in the different phases of medical waste management 3. Lack of resources to establish and run treatment facilities with sufficient capacity to serve all medical waste producers.
Concerns about MW Lack of a comprehensive medical waste management system recognised a serious problem with major implication for the public health and the environment National Strategy for Solid Waste Management in the Palestinian Territory 2010-2014: the treatment of medical waste before its final disposal according to the polluter pays principle to limit its negative health and environmental impacts among strategic objectives. Palestinian National Health Strategy 2011-2013: commitment towards improving the medical waste management in all HCFs.
MWM legal framework to be approved By-law developed, but not yet approved MoH and other concerned ministries committed to define the legal framework and approve binding regulations
Indicative roles of different institutions MEnA JSC/MoLG
Main responsibilities of HCFs Segregate medical waste Control quantity and types of medical waste Create temporary storage facility Treat MW or prepare untreated MW to be transferred and treated outside HCF Keep records of different types of MW Train employees and officials in charge of waste and medical waste management
Origin of the project Medical waste management as common concern of JSC-H&B, MoLG and MoH JSC approached PMSP in order to get support for a project in this sector. The Italian NGO NEXUS Emilia Romagna and the Emilia Romagna Region interested in participating in the project by mobilising the necessary expertise and contributing additional resources. Assessment carried out in July 2011 by a team of Italian experts, with the participation of representatives of JSC- H&B, MoLG, MoH, EQA, public and private hospitals in workshops, meetings and field visits.
Intervention approach Pilot Project involving about 18 hospitals (public and private) in Hebron and Bethlehem governorates, generating around 1,000 Kg of infectious medical waste per day. Develop and implement a MWM system and test it over the project duration. Lessons learned to improve the medical waste management system and provide indications to further develop the legal framework of the sector. If successful, the model could be extended to other areas of Palestine and/or other types of MW.
MWM Pilot Project Approved on 20 April 2012 Officially started on 9 July 2012 Duration: 14 months Budget: 795,357.50 Euro Contributions: PMSP: 85% Italian Partners: 11% Applicant: 4%
Overall objectives To contribute to the reduction of public health and environmental hazards due to unsafe handling and disposal of medical waste in the opt; To contribute to the capacity building of concerned institutions (MoLG/JSC, MoH and MEnA) in the sector of medical waste management. Need for substantial interventions at different levels and large investments to build the capacity of actors involved and to provide sufficient waste treatment plants The Pilot Project has a limited scope: dealing only with infectious medical waste in hospitals, as major medical waste producers Some reduction of MW quantity disposed unsafely Some improvement in capacity of institutions
Specific objective To establish a pilot management system for safe handling and disposal of medical waste produced by public and private hospitals, in Hebron and Bethlehem governorates Responding effectively to the needs Testing the effectiveness, efficiency and sustainability of the proposed MWM model Learning lessons towards the definition of standards for dealing with MW in all stages of the cycle
Expected result - 1 1. Institutional cooperation mechanisms among relevant stakeholders (JSC, MoLG, MoH, MEnA) established Operational framework for developing procedures and guidelines for HCFs, technical arrangements and a tariff system for collection, treatment and disposal, and monitoring and enforcing mechanisms Activities MWM Survey MWM Plan Agreements on MWM service provision
Expected result - 2 2. Training sessions on MWM issues for relevant staff of the concerned institutions delivered Carry out training needs assessment and organise training on MWM for different target groups Activities Training of Trainers Training of HCF staff Training of JSC-H&B staff Training of staff of Environmental Health Dept., MEnA and Municipalities
Expected result - 3 3. Separation, segregation, collection, transportation, treatment and disposal of MW implemented MWM system to be implemented according to the approved MWM Plan and the agreements Activities Procure vehicle and MW containers and other equipment for HCFs Establish a medical waste treatment plant Carry out collection, transportation, treatment and disposal
Expected result - 4 4. Public awareness campaign on the hazards of random medical waste disposal carried out Increase awareness at different levels in the society about the importance of developing a system for safe handling, treatment and disposal of medical waste. Activities: Prepare and disseminate information materials Organise public information events Organise awareness events for waste pickers at landfill
Target groups and final beneficiaries 20 trainers responsible for MWM training activities; 510 HCFs medical, administrative and cleaning staff involved in MWM; 9 JSC operational staff involved in collection and treatment of MW; 50 inspectors of Environmental Health Department / MoH, MEnA and Municipalities responsible for monitoring and quality control of MWM operations; 80 waste pickers working at landfill. The final beneficiaries are communities living in the governorates of Bethlehem and Hebron (820,000 people)
Implementation strategy - 1 Flexibility and adaptation to meet the challenges of an innovative approach ("pilot project ) Adopt and develop existing good practices: procedures and guidelines for HCFs staff, training programmes and related manuals and learning materials. Build on the lessons learned from previous experiences
Implementation strategy - 2 Bring in know-how and experiences in developing and managing a comprehensive MWM system from the Emilia Romagna Region Create synergy with other development agency working in the MWM sector in order to get additional support to or strengthen certain project components (e.g.: training)
Approach to MW treatment Centralised treatment plant in Hebron Transfer Station Different treatment technologies under consideration Advantages of centralised approach: economy of scale; lower running and maintenance costs; more effective monitoring possibility to expand treatment capacity in the future include additional HCFs possibility to switch to different treatment technology in the future (i.e. waste-to-power incinerators), while expanding the management system already in operation.
Sustainability Need to cover the cost of the collection, treatment and disposal service Polluter pays principle Cost-recovering mechanisms developed Tariff system introduced
Activities in the initial phase MWM survey on MW generation, current practices and level of staff training, and final selection of HCFs to be involved Equipment procurement (treatment plant, MW containers, vehicle, etc.) MWM Plan defining: procedures and guidelines for HCFs, operational mechanisms for collection, treatment and disposal, tariff system for service cost recovery monitoring and enforcement mechanisms Training programmes for: Trainers - HCF staff - JSC staff - MoH (EH Dept.), MEnA, Municipalities staff with monitoring and inspection responsibilities Project s official launching event
THANK YOU!