Reducing UPOPs and Mercury Releases from the Health Sector in Africa

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Evaluation Plan:
2016-2021, Tanzania
Evaluation Type:
Mid Term Project
Planned End Date:
03/2019
Completion Date:
03/2019
Status:
Completed
Management Response:
No
Evaluation Budget(US $):
7,500

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Download document Terms of Reference International Consultant Midterm Review of UNDP-GEF Project .pdf tor English 134.82 KB Posted 55
Download document Final MTR Report 190319.pdf report English 4153.01 KB Posted 155
Title Reducing UPOPs and Mercury Releases from the Health Sector in Africa
Atlas Project Number: 00087082
Evaluation Plan: 2016-2021, Tanzania
Evaluation Type: Mid Term Project
Status: Completed
Completion Date: 03/2019
Planned End Date: 03/2019
Management Response: Yes
UNDP Signature Solution:
  • 1. Sustainable
Corporate Outcome and Output (UNDP Strategic Plan 2018-2021)
  • 1. Output 1.2.2 Enabling environment strengthened to expand public and private financing for the achievement of the SDGs
SDG Goal
  • Goal 15. Protect, restore and promote sustainable use of terrestrial ecosystems, sustainably manage forests, combat desertification, and halt and reverse land degradation and halt biodiversity loss
SDG Target
  • 15.2 By 2020, promote the implementation of sustainable management of all types of forests, halt deforestation, restore degraded forests and substantially increase afforestation and reforestation globally
Evaluation Budget(US $): 7,500
Source of Funding: GEF
Evaluation Expenditure(US $): 7,500
Joint Programme: Yes
Joint Evaluation: Yes
  • Joint with UNDP
Evaluation Team members:
Name Title Email Nationality
GEF Evaluation: Yes
GEF Project Title: Reducing UPOPs and Mercury Releases from the Health Sector in Africa
Evaluation Type: Mid-term Review
Focal Area: Persistent Organic Pollutants
Project Type: EA
GEF Phase: GEF-1
GEF Project ID: 4611
PIMS Number: 0
Key Stakeholders: Ministry of Health, Community Development, Gender, Elderly and Children, WHO, Health Care Without Harm (HCWH)
Countries: TANZANIA (UNITED REPUBLIC OF )
Lessons
1.

The project strategy is clearly well suited to the needs and goals of all stakeholders. The project’s objectives are well aligned with the donors’ objectives. In country, the Ministries of Environment wish to meet their obligations under the Stockholm and Minamata Conventions, this project serves to meet this goal, building skills within the Ministries in the process. In all four countries, the Ministries of Health’s aspiration to improve HCWM within their hospitals have been accelerated by this project. Hence, the constellation of REDUCING UPOPS AND MERCURY RELEASES FROM THE HEALTH SECTOR IN AFRICA MTR – FINAL REPORT 81 stakeholders and the project’s objectives are well matched and could be replicated elsewhere with equal success. There are obvious economies of scale through the regional implementation.

Procurement becomes more efficient, as equipment can be purchased in bulk. the resources required to develop training materials and to conduct training are similar, no matter if one or five countries are involved. Furthermore, the exchange of experiences between the recipient countries has a positive impact.

Sterilised waste cannot be directly landfilled in some countries, when this is the case, the physical form of the waste can be changed through shredding. This is not a recommended step (see section 4.2), as it increases the overall HCW management costs. Other solutions, such as a fenced off area for HCW at the landfill or burying the waste at the landfill are alternatives. It is clear from the experience of this project that the disposal of the sterilised waste must be carefully considered during such a project’s inception phase. For small remote HCFs, the is no easy solution to ensure that collected infectious waste is sterilised, due to the high costs of transportation. Therefore, the priority of implementing non-incineration HCWM systems should be as follows:

1. Teaching hospitals are the best place to start. Firstly, they have the most skilled professionals and hence these are the facilities where it is easiest to implement a successful system. Secondly, these are the locations where medical professionals are trained. So, if the future doctors, nurses and EHOs are trained in hospitals with a well-functioning HCWM system, they will have a better understanding of the importance of good hygiene and be able to bring this knowledge to their future work places.

2. Large hospitals. 3. Smaller facilities where it is generally a greater challenge to implement HCWM systems, as these facilities have less skilled staff, frequently lack resources and often have a hectic environment, as the number of patients greatly exceeds the handling capacity. So future projects should focus on teaching hospitals and other larger hospitals to the extent possible. This is where there is the greatest return on the investment in the form of a well-functioning HCWM system. Finally, when planning the installation of autoclaves (or other non-incineration treatment technology), it is paramount to consider the treatment capacity of the equipment. It is essential that the autoclave capacity is used to the extent possible. This means that a hospital with an autoclave should also treat waste from other health facilities (cluster treatment). This also means that facilities located close to one another should not all be equipped with autoclaves. Hence, cluster or central treatment is to be prioritised, as this offers an economy of scale (obviously taking into account transport costs).


Findings
1.

The project is perfectly aligned with the GEF’s strategy, where two focal areas are persistent organic pollutants and the phase-out of mercury.

The four participating project countries have all have ratified the Stockholm Convention. which calls for “priority consideration” of alternative technologies that avoid the formation of dioxins and furans, such as non-incineration technologies identified in the BAT/BEP guidelines. Hence the countries’ respective National Implementation Plans (NIP) identify medical waste incineration as a source of dioxins/ furans and recommend the application of the BAT/BEP guidelines to help meet with the Stockholm Convention obligations.

 The project has helped the four countries with their (future) obligations under the Minamata Convention in two ways: Firstly, by conducting an inventory of mercury containing medical devices found in HCFs. Seconding, by directly contributing to the phasing-out of these instruments.

Other than reducing UPOPs and mercury releases from the health sector, the health authorities also see a substantial benefit from the project in the form of a decrease in nosocomial infections.

 The project predominantly benefits the vulnerable, in that improved hygiene and HCWM within healthcare facility betters the working conditions of the hospital staff (mostly female), the patients (frequently poor women and their children) and the visitors. So, although gender issues were not specifically addressed during the design phase, the project does comprehensively improve the conditions for these groups of people. 


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