Mid Term Evaluation of Reducing UPOPs and Mercury Releases from the Health Sector in Africa project (Medical Waste Management)

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Evaluation Plan:
2016-2021, Zambia
Evaluation Type:
Mid Term Project
Planned End Date:
12/2018
Completion Date:
03/2019
Status:
Completed
Management Response:
Yes
Evaluation Budget(US $):
40,000

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Title Mid Term Evaluation of Reducing UPOPs and Mercury Releases from the Health Sector in Africa project (Medical Waste Management)
Atlas Project Number: 00087064
Evaluation Plan: 2016-2021, Zambia
Evaluation Type: Mid Term Project
Status: Completed
Completion Date: 03/2019
Planned End Date: 12/2018
Management Response: Yes
UNDP Signature Solution:
  • 1. Poverty
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 13. Take urgent action to combat climate change and its impacts
SDG Target
  • 13.2 Integrate climate change measures into national policies, strategies and planning
Evaluation Budget(US $): 40,000
Source of Funding: Project Budget, Donor
Evaluation Expenditure(US $): 40,000
Joint Programme: No
Joint Evaluation: No
Evaluation Team members:
Name Title Email Nationality
GEF Evaluation: Yes
GEF Project Title: Reducing UPOPs and Mercury Releases from the Health Sector in Africa project (Medical Waste Management)
Evaluation Type: Terminal Evaluation
Focal Area: Climate Change
Project Type: EA
GEF Phase: GEF-1
GEF Project ID:
PIMS Number: 4865
Key Stakeholders: Global Environmental Facility (GEF), Ministry of Health (MoH), Zambia Environmental Management Agency (ZEMA), Ministry of Lands, Natural Resources and Environmental Protection (MLNREP), Civil Society organizations, Private Sector, and Other Cooperating Partners
Countries: ZAMBIA
Lessons
Findings
Recommendations
1

Sustainability of activities implemented prior to the MTR

The project ust ensure that the non-incineration and mercury free technologies introduced under phase 1 of the project become or remain (as applicable) sustainable in the long-term through periodic follow-up visits.

2

Operatinalisation of Autoclave at UTH

The HCWM system at the UTH must be fully implemented and made funcional. It is essential that the country's premier teaching hospital has a well fuctioning HCWM system.

3

Recycling

The recycling company Waste Master (Z) is a perfect opportunity to easily recver recyclable materials from hospitals in Lusaka. Efforts are starting at the UTH, for the Chilenje and Matero Level 1 hospitals matters are still at the discussion stage. The PIU should encourage and facilitate the process, so that plastic, paper and cardboard re recovered t these three hospitals.

4

2nd Phase of project site selection

The project document expects the introduction of non-incineration and mercury- free technologies at more HCFs during the second phase of the project. It is recommended to consider the installation of more autoclaves very carefully, as the project's completion date is in April 2020. The leaves little time for the time consuming and complex issue of establishing structures to house the new autoclaves. So,if the PIU decides to purchase one or more autoclaves, very great care must b etaken in selecting the receiving HCFs, so that it is certain that all necessary resources are available to rapidly establish a building for the new autoclaves.

5

Utilisation of autoclaves to full capacity

When planning the second phase of the project, it is important that measures are taken to ensure that the treatment capacities of the installed (and any future) autoclaves are fully utilised. These autoclaves can complete six treatment cycles in an eight-hour working day. This means that several treatment facilities should not be placed within one city, unless there is sufficient waste to keep all the autoclaves busy. Some of the already installed autoclaves can be expected to operate at well below capacity, i.e. their waste treatment capacity is far greater than the quantity of waste generated by their host facility. To utilise this excess capacity, the PIU should work toward ensuring that all surrounding HCFs send their infectious waste to the hospitals equipped with treatment systems. Here the project can help these new model facilities with training, equipment, workshops and other actions to bring about a collaboration between the HCFs within each project region.

1. Recommendation:

Sustainability of activities implemented prior to the MTR

The project ust ensure that the non-incineration and mercury free technologies introduced under phase 1 of the project become or remain (as applicable) sustainable in the long-term through periodic follow-up visits.

Management Response: [Added: 2019/05/16]

The project accepts accepts the recommendation and will continue to conduct quarterly monitoring visits to all healthcare facilities as set out in the 2019 AWP. PIU are commited to ensuring that the technologies introduced uder phase 1 are being utilised and are sustainable in the long term. Further, PIU will continue to document any concerns rasied on mercury free devices so that feedback can be shared with the SHiPP project. Furthermore, UNDP will enage the leadership at MoH to discuss the project sustainability.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
Weekly and monthly follow ups to sites and collection of monthly data on the utilization of autoclaves and the amount of healthcare waste autoclaved.
[Added: 2019/11/15]
PIU 2020/12 Initiated . All the three HCFs installed with autoclaves were trained in data collection using the Regional Team’s prescribed dataTools. Data collection has proved a very good tool for checking the best practices in Healthcare waste management.
2. Recommendation:

Operatinalisation of Autoclave at UTH

The HCWM system at the UTH must be fully implemented and made funcional. It is essential that the country's premier teaching hospital has a well fuctioning HCWM system.

Management Response: [Added: 2019/05/16]

The project accepts the recommendation and ackowledges that the HCWM system at UTH must be fully implemented.A new focal point person was appointed to oversee the operations and utilizations of th eautoclave. Hoever, if improvements are still not seen meetings will be escalated to directors, senior management at all levels of HCFs and the Permannet Secretary (Technical) at Ministry of Health.

Weekly follow ups on the use of autoclaves and datat collection wil be carried out by PIU both in person and by phone.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
Weekly follow ups on the use of autoclaves and data collection will be carried out by PIU both in person and by phone.
[Added: 2019/11/15]
PIU, UTH environmental health personnel 2020/12 Initiated Data collection Tools shared and UTH environmental Health personnel trained in data collection
3. Recommendation:

Recycling

The recycling company Waste Master (Z) is a perfect opportunity to easily recver recyclable materials from hospitals in Lusaka. Efforts are starting at the UTH, for the Chilenje and Matero Level 1 hospitals matters are still at the discussion stage. The PIU should encourage and facilitate the process, so that plastic, paper and cardboard re recovered t these three hospitals.

Management Response: [Added: 2019/05/16]

The project shall continue engaging Waste Master to continue collecting recyclable materials at the three facilities. PIU will support signing of MOU between Waste Master and UTH ad Matero so that recycling activities can be undertaken and then sime training and capacity building can be provided.

The PIU will continue monitoring of recycling activities.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
Training completed
[Added: 2019/05/16] [Last Updated: 2019/11/14]
PIU, WMZL & HCFs 2019/08 Completed Waste Master Zambia Limited trained health personnel at Chilenje Level 1 hospital. History
Signing of MoU
[Added: 2019/05/16] [Last Updated: 2019/11/14]
PIU, WMZL & HCFs 2019/08 Completed WMZL signed an MoU with Chilenje level 1 hospital & set up waste recycling systems bay for receipt & segregation of waste History
4. Recommendation:

2nd Phase of project site selection

The project document expects the introduction of non-incineration and mercury- free technologies at more HCFs during the second phase of the project. It is recommended to consider the installation of more autoclaves very carefully, as the project's completion date is in April 2020. The leaves little time for the time consuming and complex issue of establishing structures to house the new autoclaves. So,if the PIU decides to purchase one or more autoclaves, very great care must b etaken in selecting the receiving HCFs, so that it is certain that all necessary resources are available to rapidly establish a building for the new autoclaves.

Management Response: [Added: 2019/05/16]

The project is aware of the challenge to put up the autoclave housing. To this effect, only one site, Chilenje level 1 District Hospital has been selected to install an autoclave.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
Autoclave housing to be completed
[Added: 2019/05/16] [Last Updated: 2020/01/08]
PIU, MoH & HCF - Chilenje 2020/01 Completed Autoclave housing at chilenje hospital has been completed History
5. Recommendation:

Utilisation of autoclaves to full capacity

When planning the second phase of the project, it is important that measures are taken to ensure that the treatment capacities of the installed (and any future) autoclaves are fully utilised. These autoclaves can complete six treatment cycles in an eight-hour working day. This means that several treatment facilities should not be placed within one city, unless there is sufficient waste to keep all the autoclaves busy. Some of the already installed autoclaves can be expected to operate at well below capacity, i.e. their waste treatment capacity is far greater than the quantity of waste generated by their host facility. To utilise this excess capacity, the PIU should work toward ensuring that all surrounding HCFs send their infectious waste to the hospitals equipped with treatment systems. Here the project can help these new model facilities with training, equipment, workshops and other actions to bring about a collaboration between the HCFs within each project region.

Management Response: [Added: 2019/05/16]

The PIU accepts that the autoclaves are underutilised at the moment and that this is to do with the outstanding issues of final disposal. As this is in the process of being resolved PIU will encourage HCFs to received additional waste for treatment by autoclave from surrounding HCFs. It should be noted that UTH and NDT currently receive waste for treatment from surrounding HCFs and once final disposal is resolved this waste will be autoclaved. 

 

(all three HCFs are engaging with their local authorities for designated sites within municipal dump sites)

Key Actions:

Key Action Responsible DueDate Status Comments Documents
HCF is expected to have designated site within dump site
[Added: 2019/05/16] [Last Updated: 2019/11/14]
PIU, MoH & HCF, MoLG 2019/08 Completed Ndola Teaching & Kabwe General Hospitals have had sites designated. History
Autoclaves used at capacity
[Added: 2019/05/16] [Last Updated: 2020/01/08]
PIU, MoH & HCF, MoLG 2019/12 Completed Autoclaves used are now being used at capacity History

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