Protect human health and the environment from unintentional releases of POPs and mercury from the unsound disposal of healthcare waste in Kyrgyzstan

Report Cover Image
Evaluation Plan:
2012-2017, Kyrgyzstan
Evaluation Type:
Mid Term Project
Planned End Date:
11/2016
Completion Date:
12/2016
Status:
Completed
Management Response:
Yes
Evaluation Budget(US $):
15,900

Share

Document Type Language Size Status Downloads
Download document Draft MTR Report - Submitted 2016-12-15.pdf report English 2437.30 KB Posted 279
Download document Pops mercury tracking tool v02.xlsx related-document English 62.98 KB Posted 283
Title Protect human health and the environment from unintentional releases of POPs and mercury from the unsound disposal of healthcare waste in Kyrgyzstan
Atlas Project Number: 00062205
Evaluation Plan: 2012-2017, Kyrgyzstan
Evaluation Type: Mid Term Project
Status: Completed
Completion Date: 12/2016
Planned End Date: 11/2016
Management Response: Yes
Focus Area:
  • 1. Environment & Sustainable Development
  • 2. Others
Corporate Outcome and Output (UNDP Strategic Plan 2014-2017)
  • 1. Output 1.3. Solutions developed at national and sub-national levels for sustainable management of natural resources, ecosystem services, chemicals and waste
Evaluation Budget(US $): 15,900
Source of Funding: GEF
Evaluation Expenditure(US $): 15,900
Joint Programme: No
Joint Evaluation: No
Evaluation Team members:
Name Title Email Nationality
GEF Evaluation: Yes
GEF Project Title: Protect human health and the environment from unintentional releases of POPs and mercury from the unsound disposal of healthcare waste in Kyrgyzstan
Evaluation Type: Mid-term Review
Focal Area: Biodiversity
Project Type: MSP
GEF Phase: GEF-5
GEF Project ID: 5068
PIMS Number: 5155
Key Stakeholders: Ministry of Health of the Kyrgyz Republic; State Agency for Environmental Protection and Forestry
Countries: KYRGYZSTAN
Comments:

The evaluation was done by Mr. Peder Bisbjerg, International Consultant (pedergregersbisbjerg@hotmail.com).

Lessons
Findings
Recommendations
1

It is recommended that very close attention be paid to the 100 First Aid Points (FAPs) where autoclaves are being installed in 2017. This will not be an easy task, due to the sheer number of FAPs covered by the project and the transportation times required to reach each FAP. Therefore, substantial human resources and several vehicles will probably be required to provide good technical support to all FAPs. Other than training and capacity building, it is likely that there will be other issues to address to ensure that the HCWM and treatment system is fully functional in every FAP:

  • The location of the autoclave may have to be reconsidered within certain FAPs;
  • Measures may be needed to ensure good operations with an unreliable power supply;
  • Steps may be necessary to safeguard hygiene in facilities without running water;
  • Finding a harmless disposal route for the sterilised waste;
  • Some autoclave operators may be fearful of such a valuable machine and require additional training or support; and
  • Provision of spare parts and/ or maintenance as required.

If it has not already been done, it is suggested that the project estimate the number of FAPs that can on average be visited by a national expert in a day; both when installation and training takes place, as well as for follow-up visits. Then estimate the number of follow-up visits required (e.g. one visit for installation and three follow-up visits for each FAP over a six-month period). This will give an estimate of the number of national experts and vehicles required - obviously taking into account that a national expert cannot both conduct training at a HCF in Bishkek and in a FAP at the same time! It can be expected that considerable resources will be required for the implementation of the autoclave systems in the FAPs and that this may be difficult to complete by July 2017.

2

If possible, the project should be extended for an additional nine months, i.e. till April 2018. As the project has been prudent in its financial management, this can be done as a no cost extension. Such an extension would address the risk that all project activities may not be completed in a satisfactory manner by July 2017, where the areas of concern are the operation of autoclaves in FAPs and the approval of all policy and regulatory documents covering HCWM and mercury management. The key activities during a possible project extension would be nos. 1 and 2 below:

  1. Ensure that ample support is provided to all 100 FAPs that have received autoclaves to address any problems that may arise. This could range from additional training, through technical support to assistance with maintenance.
  2. Provide support and push for the approval of the policy and regulatory documents developed by the project pertaining to both HCWM and mercury management.
  3. It is expected that all collection, transport, storage and disposal of mercury containing thermometers will be completed by July 2017. An extension would mean that any delays in execution of this portion of the project would have no impact. It could be envisaged that the treatment at the Khaidarkan Mercury Mine and Plant is delayed due to technical, politic or financial disagreements - so an extension would allow the project to resolve any issues that could develop.
  4. With an extension, it would be logical to follow up with the 11 HCFs in Bishkek to ensure that both the HCWM system and the mercury phase out is operating fully as planned. Such visits could be to all eleven facilities on a quarterly basis; where after training, technical advice or other support could be provided to resolve any identified issues.

The project extension would operate under the same organizational framework as at present.

3

Upon completion of this project, all hospitals in Kyrgyzstan with 25 and more beds will have a fully functional HCWM system. The logical next step for MoH and funding agencies would be to closely analyse the sustainability and benefits obtained from the installation of autoclaves to the 100 FAPs. Should the outcome be positive and the conclusion that it is advantageous to equip FAPs with integrated HCWM systems, the next step would be to also equip the country’s other 800 FAPs with autoclaves. In parallel with such an intervention, the possibilities and opportunities of targeting even smaller sources, such as small clinics, doctor’s offices, dentists and veterinary practices should also be examined. Such a project could be a phase II of this project or a new project for the MoH.

If the pilot project to phase out mercury in HCFs is successful, it should be evaluated whether this is a solution that could be duplicated throughout the country. Ideally, a much broader approach should be considered to addressing “one of the top ten chemicals or groups of chemicals of major public health concern.” This project has developed a National Action Plan on terminal phasing out mercury and prohibiting mercury containing equipment usage in the healthcare sector 2017-2020, so the next step is to implement the plan. Presumably, funding would be easier to obtain if Kyrgyzstan was a signatory of the Minamata Convention on Mercury. Any such project would need to consider which government institution would be the focal point if “all” mercury is to be addressed. Another consideration is to assess whether mercury use can be phased out in a country with mercury and gold mines. There could be some significant conflicts between mining interests and those wishing to phase out the use of mercury.

1. Recommendation:

It is recommended that very close attention be paid to the 100 First Aid Points (FAPs) where autoclaves are being installed in 2017. This will not be an easy task, due to the sheer number of FAPs covered by the project and the transportation times required to reach each FAP. Therefore, substantial human resources and several vehicles will probably be required to provide good technical support to all FAPs. Other than training and capacity building, it is likely that there will be other issues to address to ensure that the HCWM and treatment system is fully functional in every FAP:

  • The location of the autoclave may have to be reconsidered within certain FAPs;
  • Measures may be needed to ensure good operations with an unreliable power supply;
  • Steps may be necessary to safeguard hygiene in facilities without running water;
  • Finding a harmless disposal route for the sterilised waste;
  • Some autoclave operators may be fearful of such a valuable machine and require additional training or support; and
  • Provision of spare parts and/ or maintenance as required.

If it has not already been done, it is suggested that the project estimate the number of FAPs that can on average be visited by a national expert in a day; both when installation and training takes place, as well as for follow-up visits. Then estimate the number of follow-up visits required (e.g. one visit for installation and three follow-up visits for each FAP over a six-month period). This will give an estimate of the number of national experts and vehicles required - obviously taking into account that a national expert cannot both conduct training at a HCF in Bishkek and in a FAP at the same time! It can be expected that considerable resources will be required for the implementation of the autoclave systems in the FAPs and that this may be difficult to complete by July 2017.

Management Response: [Added: 2016/12/25] [Last Updated: 2017/12/20]

The recommendation is accepted and there are some actions already initiated in order to respond to the recommendation.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
In addition to #285 Order of Ministry of Health KR from 28 April 2016, develop and approve the Standard Operating Procedures for operating the autoclaves provided by the project
[Added: 2017/01/05] [Last Updated: 2017/12/20]
Project team, CO 2017/04 Completed History
With aim to build capacity, knowledge and develop skills of specialists of 100 FAPs on medical waste management, project will provide a technical support with development and conducting of 4-day training module, using interactive educational methods and will also develop training materials and handouts. Specialists of 100 FAPs at the end of training will obtain appropriate skills to operate autoclaves.
[Added: 2017/01/05] [Last Updated: 2017/12/20]
Project team, CO 2017/12 Completed Trainings are conducted successfully History
Regular monitoring and evaluation visits will be organized with participation of representatives from Ministry of Health (MoH) to assess the sustainability of newly established HCWM system on primary level (installation of equipment and autoclaves, trainings for FAP’s staff, afterwards follow-up visits with certain recommendations).
[Added: 2017/01/05] [Last Updated: 2017/12/20]
Project team, CO, Ministry of Health 2017/12 Completed Following the Annual Work Plan for 2017, monitoring visits have been conducted with participation of representatives of Ministry of Health of the Kyrgyz Republic. History
2. Recommendation:

If possible, the project should be extended for an additional nine months, i.e. till April 2018. As the project has been prudent in its financial management, this can be done as a no cost extension. Such an extension would address the risk that all project activities may not be completed in a satisfactory manner by July 2017, where the areas of concern are the operation of autoclaves in FAPs and the approval of all policy and regulatory documents covering HCWM and mercury management. The key activities during a possible project extension would be nos. 1 and 2 below:

  1. Ensure that ample support is provided to all 100 FAPs that have received autoclaves to address any problems that may arise. This could range from additional training, through technical support to assistance with maintenance.
  2. Provide support and push for the approval of the policy and regulatory documents developed by the project pertaining to both HCWM and mercury management.
  3. It is expected that all collection, transport, storage and disposal of mercury containing thermometers will be completed by July 2017. An extension would mean that any delays in execution of this portion of the project would have no impact. It could be envisaged that the treatment at the Khaidarkan Mercury Mine and Plant is delayed due to technical, politic or financial disagreements - so an extension would allow the project to resolve any issues that could develop.
  4. With an extension, it would be logical to follow up with the 11 HCFs in Bishkek to ensure that both the HCWM system and the mercury phase out is operating fully as planned. Such visits could be to all eleven facilities on a quarterly basis; where after training, technical advice or other support could be provided to resolve any identified issues.

The project extension would operate under the same organizational framework as at present.

Management Response: [Added: 2017/01/05]

UNDP Kyrgyzstan will submit a request for nine months no cost extension to UNDP-GEF, justifying the reasons and providing detailed information of the activities planned within the extended period.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
No-cost extension request is submitted to UNDP-GEF.
[Added: 2017/01/05] [Last Updated: 2017/12/20]
Project team, CO 2017/01 Completed Sent to RTA in IRH. The Project is extended till mid 2018. History
Provide necessary technical support for the approval of the policy and regulatory documents developed by the project pertaining to both HCWM and mercury management at the national level
[Added: 2017/01/05] [Last Updated: 2017/12/20]
Project ream, CO 2017/12 Completed History
The Hg mercury containing thermometers are safely disposed per the Agreement between the Khaidarkan mercury plant and Ministry of Health (MoH).
[Added: 2017/01/05] [Last Updated: 2017/12/20]
Project team, CO, Ministry of Health 2017/08 Completed History
Quarterly visits to 11 pilot HCFs will be organized jointly with the representatives of MoH for technical and other support that might be required to resolve any potential issues.
[Added: 2017/01/05] [Last Updated: 2017/12/20]
Project team, CO, Ministry of Health 2017/12 Completed History
3. Recommendation:

Upon completion of this project, all hospitals in Kyrgyzstan with 25 and more beds will have a fully functional HCWM system. The logical next step for MoH and funding agencies would be to closely analyse the sustainability and benefits obtained from the installation of autoclaves to the 100 FAPs. Should the outcome be positive and the conclusion that it is advantageous to equip FAPs with integrated HCWM systems, the next step would be to also equip the country’s other 800 FAPs with autoclaves. In parallel with such an intervention, the possibilities and opportunities of targeting even smaller sources, such as small clinics, doctor’s offices, dentists and veterinary practices should also be examined. Such a project could be a phase II of this project or a new project for the MoH.

If the pilot project to phase out mercury in HCFs is successful, it should be evaluated whether this is a solution that could be duplicated throughout the country. Ideally, a much broader approach should be considered to addressing “one of the top ten chemicals or groups of chemicals of major public health concern.” This project has developed a National Action Plan on terminal phasing out mercury and prohibiting mercury containing equipment usage in the healthcare sector 2017-2020, so the next step is to implement the plan. Presumably, funding would be easier to obtain if Kyrgyzstan was a signatory of the Minamata Convention on Mercury. Any such project would need to consider which government institution would be the focal point if “all” mercury is to be addressed. Another consideration is to assess whether mercury use can be phased out in a country with mercury and gold mines. There could be some significant conflicts between mining interests and those wishing to phase out the use of mercury.

Management Response: [Added: 2017/01/05]

The Recommendation is taken into the account and some actions are already initiated to respond to the recommendation

Key Actions:

Key Action Responsible DueDate Status Comments Documents
In case the newly integrated HCWM system at the FAPs level will positively result, UNDP CO in partnership with the MoH will consider opoortunities for developing a project proposal on replication of the experience across the country and negotiate with potential donors
[Added: 2017/01/05] [Last Updated: 2017/12/20]
Project team, CO 2017/05 Completed History
If the pilot project on phasing out the mercury in HCFs is successful, UNDP project will consult with the Government and advise of the soultion’s results that could have been replicated across the country. Afterwards, UNDP CO will discuss with national partners on mobilization of additional external resources for minimization of mercury releases in the health sector.
[Added: 2017/01/05] [Last Updated: 2017/12/20]
Project team, CO 2017/12 Completed History

Latest Evaluations

Contact us

1 UN Plaza
DC1-20th Floor
New York, NY 10017
Tel. +1 646 781 4200
Fax. +1 646 781 4213
erc.support@undp.org