Midterm Review - Reducing UPOPs and Mercury Releases from the Health Sector in Africa

Report Cover Image
Evaluation Plan:
2018-2021, RBEC
Evaluation Type:
Mid Term Project
Planned End Date:
05/2019
Completion Date:
03/2019
Status:
Completed
Management Response:
Yes
Evaluation Budget(US $):
40,000

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Title Midterm Review - Reducing UPOPs and Mercury Releases from the Health Sector in Africa
Atlas Project Number: 00090700
Evaluation Plan: 2018-2021, RBEC
Evaluation Type: Mid Term Project
Status: Completed
Completion Date: 03/2019
Planned End Date: 05/2019
Management Response: Yes
UNDP Signature Solution:
  • 1. Sustainable
Corporate Outcome and Output (UNDP Strategic Plan 2018-2021)
  • 1. Output 2.1.1 Low emission and climate resilient objectives addressed in national, sub-national and sectoral development plans and policies to promote economic diversification and green growth
SDG Goal
  • Goal 12. Ensure sustainable consumption and production patterns
  • Goal 3. Ensure healthy lives and promote well-being for all at all ages
  • Goal 6. Ensure availability and sustainable management of water and sanitation for all
SDG Target
  • 12.4 By 2020, achieve the environmentally sound management of chemicals and all wastes throughout their life cycle, in accordance with agreed international frameworks, and significantly reduce their release to air, water and soil in order to minimize their adverse impacts on human health and the environment
  • 3.3 By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases
  • 6.3 By 2030, improve water quality by reducing pollution, eliminating dumping and minimizing release of hazardous chemicals and materials, halving the proportion of untreated wastewater and substantially increasing recycling and safe reuse globally
Evaluation Budget(US $): 40,000
Source of Funding: GEF Project Resources
Evaluation Expenditure(US $): 37,500
Joint Programme: No
Joint Evaluation: No
Evaluation Team members:
Name Title Email Nationality
Peder Bisbjerg International Expert pedergregersbisbjerg@hotmail.com
GEF Evaluation: Yes
GEF Project Title: Reducing UPOPs and Mercury Releases from the Health Sector in Africa
Evaluation Type: Mid-term Review
Focal Area: Ozone Depleting Substances
Project Type: FSP
GEF Phase: GEF-6
GEF Project ID: 4611
PIMS Number: 4865
Key Stakeholders: Respective Ministries in Ghana, Madagascar, Tanzania and Zambia and project partners, WHO and NGO Health Care Without Harm (HCWH)
Comments:

The project is managed by RBEC Istanbul Regional Hub and the actual implementation is in Africa covering Ghana, Madagascar, Tanzania and Zambia.

Lessons
Findings
Recommendations
1

The placement of sterilised waste on a dumpsite or landfill, without any change of physical form is clearly a concern to all project countries. To fully utilise the autoclaves, it is clear that the sterilised waste must be shredded or otherwise altered prior to landfilling. The Regional Project Team is already aware of this and shredders are included in the new Catalogue of HCWM Equipment, so that the countries will receive shredder during the second project phase.

For areas where there are several autoclaving facilities within one city, it should be examined whether one shredder could be installed at either the landfill or a central location and handle all the sterilized waste.

2

There are clearly issues with the availability of a local service technicians from TTM to provide maintenance and repair services for the autoclaves. During the MTR visits, this was an issue in Ghana, Madagascar and Tanzania. It is essential that this issue is resolved with the TTM main office.

3

The Project Document states that “an additional 12 rural health posts are to be supported during the second phase of the project.” It is strongly recommended that the project focusses on larger hospitals in the second phase. Rural health posts may be able to properly segregate and handle their infectious waste, but the quantities of waste they generate is small and the costs of bringing this waste to an autoclave facility are prohibitive.

4

The Project Document recommends to “Increase composting activities, which will significantly reduce the volume of the waste that needs to be transported to the landfill/dump site. Organic waste makes up the majority of HCF waste. By developing composting activities on the premises, HCFs could reduce waste collection rates charged by the municipal service providers, while generating some additional income through the sale of compost.” This advice should be disregarded. While it is environmentally sound guidance to collect and treat organic waste, this activity, like other forms of waste treatment, costs money and it is very unlikely that the compost can be sold. Therefore, the Regional Project Team should only encourage the on-site composting of garden waste (not food waste) for use within the hospitals’ green areas.

1. Recommendation:

The placement of sterilised waste on a dumpsite or landfill, without any change of physical form is clearly a concern to all project countries. To fully utilise the autoclaves, it is clear that the sterilised waste must be shredded or otherwise altered prior to landfilling. The Regional Project Team is already aware of this and shredders are included in the new Catalogue of HCWM Equipment, so that the countries will receive shredder during the second project phase.

For areas where there are several autoclaving facilities within one city, it should be examined whether one shredder could be installed at either the landfill or a central location and handle all the sterilized waste.

Management Response: [Added: 2019/05/03]

Recommendation is relevant based on project’s findings therefore the regional project team has already included shredders in the updated catalogue of HCWM equipment. BoQ of 2nd round of central procurement of HCWM equipment was prepared to include 7 shredders for three project countries (Ghana, Madagascar and Zambia). Tanzania opted for local procurement of compacters/balers on same purpose to alter the physical appearance of the treated waste.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
Finalization of procurement and installations of shredders (in Ghana, Madagascar and Zambia) and compacters/balers (in Tanzania)
[Added: 2019/05/03] [Last Updated: 2019/10/02]
Regional Project Management Unit 2020/01 Initiated The procurement/installation of compacter/balers in Tanzania has already completed. Procurement of shredders (in Ghana, Madagascar and Zambia) is still ongoing as part of the centralized procurement case for the non-incineration HCWM technologies, with a delay due to prolonged procurement process. The delivery/installations of shredding systems is currently expected to be completed latest before the end of January 2020. History
2. Recommendation:

There are clearly issues with the availability of a local service technicians from TTM to provide maintenance and repair services for the autoclaves. During the MTR visits, this was an issue in Ghana, Madagascar and Tanzania. It is essential that this issue is resolved with the TTM main office.

Management Response: [Added: 2019/05/03]

Recommendation is accepted. The regional project team has already communicated with the contractor, TTM on this issue and also organized three separate calls (virtual meetings) together with representatives of TTM and national teams of four countries to discuss on issues related to operationalization and maintenance of the autoclave equipment. Specifically, on this recommendation, there has been an agreed plan of communication and action (with TTM and national teams) in cases of non-responsiveness of the local agent to any service request. Project’s additional response to the MTR recommendation, would be that regional project team can also prepare a SOP document 1) to clarify roles and responsibilities of contractor, local agent and requestors for the provision of maintenance service; and 2) to clarify communication line among different stakeholders – TTM, its local agents and national stakeholders - in cases of non-responsiveness to maintenance requests in the countries.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
Preparation and dissemination of Standard Operating Procedures for maintenance service requests and related communication/action plan in case of non-responsiveness by the local service providers.
[Added: 2019/05/03] [Last Updated: 2019/07/02]
Regional Project Management Unit 2019/05 Completed The SOP for maintenance communication (attached) was prepared with the supplier, TTM and shared with national project teams for them to ensure that all participants -technical partners, administrators and users- become aware about these SOPs. History
3. Recommendation:

The Project Document states that “an additional 12 rural health posts are to be supported during the second phase of the project.” It is strongly recommended that the project focusses on larger hospitals in the second phase. Rural health posts may be able to properly segregate and handle their infectious waste, but the quantities of waste they generate is small and the costs of bringing this waste to an autoclave facility are prohibitive.

Management Response: [Added: 2019/05/03]

Recommendation is well accepted and in line with the decisions taken in the last regional project meeting (Dec-18 in Ghana). Therefore, as agreed with national partners, the project has only included only 6 large hospitals as pilot hospitals of second phase; 3 hospitals in Ghana, 2 hospitals in Madagascar and 1 hospital in Tanzania.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
Selection of larger and central hospitals during in the second phase
[Added: 2019/05/03]
Regional Project Management Unit 2019/04 Completed The action has been completed during the discussion phase with all key stakeholders. Agreed with national partners, in the second phase of the project, only 6 large hospitals were selected as pilot facilities; 3 hospitals in Ghana, 2 hospitals in Madagascar and 1 hospital in Tanzania.
4. Recommendation:

The Project Document recommends to “Increase composting activities, which will significantly reduce the volume of the waste that needs to be transported to the landfill/dump site. Organic waste makes up the majority of HCF waste. By developing composting activities on the premises, HCFs could reduce waste collection rates charged by the municipal service providers, while generating some additional income through the sale of compost.” This advice should be disregarded. While it is environmentally sound guidance to collect and treat organic waste, this activity, like other forms of waste treatment, costs money and it is very unlikely that the compost can be sold. Therefore, the Regional Project Team should only encourage the on-site composting of garden waste (not food waste) for use within the hospitals’ green areas.

Management Response: [Added: 2019/05/03]

Recommendation is discussed and agreed by all project stakeholders during the last regional project meeting (Dec-18 in Ghana) and in line with the recommendations of regional expert team. Therefore, composting activities indicated in the Project Document will not be implemented in the second phase of the project. Instead, the project will continue to encourage bio-digestion activities and possibly expand the bio-digestion activities both in Tanzania and Madagascar.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
Removal of composting activities and inclusion of bio-digestion activities in the annual workplan.
[Added: 2019/05/03]
Regional Project Management Unit 2019/04 Completed The action has been completed during the discussion phase by all project stakeholders and noted by the management response. Support to compost activities are removed and bio-digestion activities are already included in the annual work plan.

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