NIP Update, Integration of POPs into National Planning and Promoting Sound Healthcare Waste Management in Kazakhstan

Report Cover Image
Evaluation Plan:
2016-2020, Kazakhstan
Evaluation Type:
Mid Term Project
Planned End Date:
12/2016
Completion Date:
12/2016
Status:
Completed
Management Response:
No
Evaluation Budget(US $):
25,000

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Title NIP Update, Integration of POPs into National Planning and Promoting Sound Healthcare Waste Management in Kazakhstan
Atlas Project Number: 00071893
Evaluation Plan: 2016-2020, Kazakhstan
Evaluation Type: Mid Term Project
Status: Completed
Completion Date: 12/2016
Planned End Date: 12/2016
Management Response: No
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 $): 25,000
Source of Funding: Project
Evaluation Expenditure(US $): 25,000
Joint Programme: No
Joint Evaluation: No
Evaluation Team members:
Name Title Email Nationality
GEF Evaluation: Yes
GEF Project Title: NIP Update, Integration of POPs into National Planning
Evaluation Type: Mid-term Review
Focal Area: Persistent Organic Pollutants
Project Type: FSP
GEF Phase: GEF-5
GEF Project ID: 4442
PIMS Number: 4612
Key Stakeholders: Ministry of Energy
Countries: KAZAKHSTAN
Lessons
Findings
1.

4.1 Project Strategy(S)

4.1.1 Project design

The evaluators consider that the project conceptualization and design are satisfactory. The main objective of the project is to reduce the releases of unintentionally produced POPs and other globally harmful pollutants into the environment by promoting sound healthcare waste management in Kazakhstan, and to assist the country in implementing its relevant obligations under the Stockholm convention. The procedures sought by the project for a substantial reduction of POPs release (segregation, waste treatment by alternative treatment technologies) are the very same procedures that will prevent the spreading of waste borne disease in the hospitals. Therefore, in addition to its global environmental objectives, the project produces a direct benefit on the health of patients and hospitals personnel, by improving the hygienic conditions of the facilities where it is implemented. The phasing out of mercury containing thermometer will reduce the chemical risks of contamination by broken thermometers in future and provides a new route for the safe storage. The evaluators consider that the holistic approach sought by the project, aimed at establishing an entire chain of healthcare waste management (from production to disposal) and at the same time supporting non-combustion technologies, is the correct approach for minimizing the release of U-POPs from the sector. In order to prevent the generation of waste the idea of “green procurement” is initiated but not followed up in a consequent manner by the project design. In order to follow a sustainable approach of the project activities one component is mainly aiming to assess and update the legal regulations or to provide recommendations


Tag: Climate Change Adaptation Resilience building Environmental impact assessment Waste management Challenges Health Crises Health Sector Programme/Project Design

2.

4.1.2 Results Framework/Logframe

The Project’s Logical Framework (PLF) as developed for the project and incorporated in the signed project document and has been reviewed and assessed as part of this MTR. The PLF outlines the project’s overall objective, the project’s components and outcomes, provides pre-project baseline information, presents the project’s Indicatorsas well as Mid Term and End of Project Targets. One of the main objectives of the project is to create a national system for regulating POPs and mercury management, as well as sound management of healthcare waste. Nursing staff is mostly responsible for handling waste in healthcare organization. These are mostly women. Component 3 of the project is aimed at improving professional work standards for all employees of hospitals, in this case, the majority of them are women. The project is also aimed at building capacity and awareness on managing persistent organic pollutants and mercury. Due to the fact that women have the potential to deliver accumulated in their body chemicals to children these issues were given special attention during training sessions and seminars. Recommendations were provided on reducing risk of chemicals impacting women health during the seminars. Throughout its duration the project conducted a significant amount of capacity building. For the details on these training events (number of participants per training event, type of participants, etc.) kindly refer to the Annex. Based on this summary table the project involved 65 % females in their capacity building and awareness raising events and enhanced herewith women’s empowerment.


Tag: Disaster Risk Reduction Resilience building Environment Policy Waste management Challenges Health Sector Capacity Building Women and gilrs Youth

3.

4.1.3 Stakeholders engagement

The project document contained a section on “Stakeholder Analysis” which listed the roles and responsibilities of various stakeholders having a role in the management ofhealthcare waste, Pesticides and POPs. The project document listed particular stakeholders (e.g. entities) with whom the project had engaged during the PIF/PPG phase, as well as larger groups of project stakeholders, which the project anticipated to engage with during project activities (e.g. Health facilities, NGOs, regional and local government authorities, general public and international development agencies, etc.). In the section “Stakeholder Involvement Plan”, the project document elaborated upon the ways in which it would engage various project stakeholders, including among else, project board meetings, technical consultations, trainings and outreach activities and awareness raising events.


Tag: Environmental impact assessment Challenges Health Sector Risk Management Bilateral partners Capacity Building Civil Societies and NGOs National Institutions

4.

4.2 Progress Towards Results(S)

4.2.1 Analyze of the status of project objectives and outcomes

The status of the project objective and outcomes is described and rated in detail in the“Progress towards Results Matrix” of Annex 6.10. This table rates the progress towards the end-of-project targets for the project objective and each outcome is analyzed. The columns “Midterm Target”, and “End-ofproject Target” were populated with information from the results framework, scorecards, PIRs and the Project Document. The results of the status of the project towards the end of project targets are visualized by a color system:


Tag: Disaster Risk Reduction Environment Policy Waste management Effectiveness Health Crises Capacity Building Civil Societies and NGOs National Institutions

5.

Justification of the ratings

The objective is expected to achieve most of its end-of-project targets, with only minor shortcomings. This rating has been provided as the project is considering all indicators of the objective on track or is likely to achieve the targets in 2017. Nevertheless, minor deviations can be assumed on the reduction of POPs resulted by the implementation of the pilot projects as not 10 but 8 pilots will be established and therefore the POP reduction rate might not be reachable. Furthermore, there is a low but realistic risk that the piloted central waste treatment center will not win the public tender for the treatment of the waste from the public hospitals. The coordination of the MEAs is difficult as this is an intersectoral approach which need to be supported by different Ministries – responsibilities are not fully clarified and there is a certain lack of intersectoral communication.


Tag: Disaster Risk assessments Waste management Challenges Health Sector

6.

Capacity building activities

Until the MTR s duration the project conducted a significant amount of capacity building. As in Component 1-3 capacity building elements are included, the project implemented an efficient approach to organized trainings and workshops.POPs training and workshops have been integrated into the general (1-3 days) training, that includes also mercury and HCW issues. In the table below an overview provided of the workshops and trainings facilitated and organized by the project is summarized and not further outlined in the justification of the outcomes below. For the details on these training events (venue, number of participants per training event, type of participants, etc.) kindly refer to the Annex.


Tag: Environment Policy Environmental impact assessment Waste management Efficiency Health Sector Capacity Building

7.

Outcome 1.1 POPs inventories improved for informed decision making and priority setting

Training module on POPs risks and their sound management with testing section has been developed by the Centre for Sustainable Development. The module is used as part of conventional training for professional educational institutions and for staff of related state institutions and businesses. The project implements a complex approach to organized trainings and workshops to make the activities logistically more efficient. POPs training and workshops have been integrated into the general (1-3 days) training, that includes also mercury and HCW issues like summarized in the Capacity building table. Furthermore 10 workshops were conducted at which 538 persons participated. The POPs inventory have been completed, reported and distributed among stakeholders. Data on new POPs have been captured in the NIP update document which was submitted to the Stockholm Convention Secretariat. The inventory of PCB has been updated.

Justification of the ratings

The outcome is expected to achieve most of its end-of-project targets, with only minor shortcomings.Overall POPs regular inventory mechanism is not yet completely developed due to insufficient laboratory capacity, standards for reporting, and deficient sampling data. But interviewed organizations and the Government expressed clear intentions to include POPs into national monitoring system of hazardous chemicals. This will naturally take longer than a project lifetime, due to reasons that are beyond the project’s mandate and capacity. It is anticipated that ZhasylDamu Information Center will serve as a central data base for statistics, technical reports, and EIA related documents.


Tag: Disaster Risk Reduction Environment Policy Waste management Efficiency Health Sector Capacity Building

8.

Outcome 1.2 National capacities on POPs monitoring, analytical capabilities are assessed

A number of sites were selected for sampling POPs in soil and air. Soil samples were collected from meteorological stations of these cities and sampling equipment was installed for 9 months to allow for passive air sampling. Every three months, filters in the sampling equipment are replaced and the used filters are sent to the RECETOX laboratory (nominated focal point laboratory of the Stockholm Convention in the region), located in Brno, the Czech Republic. Tests will help to identify the following POPs content in soil and air: PCDD/F, HCB, PCB, pesticides. As of now, results from soil analysis from the abovementioned regions were received. Data show increased POPs concentration in the following regions: HCH in Atyrau, DDT in Atyrau and Ust-Kamenogorsk, and PCDD in Atyrau. Statistical database for the calculation of uPOPs inventory built and validated are envisaged to be finalized in December 2016.10 employees of the territorial bodies, responsible for monitoring and control of quality of the environment, were trained by the Stockholm Convention focal point for monitoring of POPs (Brno, Czech Republic).

The completed capacity assessment reports on nine (9) laboratories having the potential to determine uPOPs in the various environmental media, if methodologies are provided and accreditation is supported to enable full commercial activity. Maximum allowable emissions for dioxins and furans have been set by Decree of Ministry of Energy # 26 of January 21, 2015. The project supported travel of 16 laboratory staff to participate in training tour in RECETOX laboratory in Brno, Czech Republic.

 


Tag: Environmental impact assessment Waste management Health Sector Project and Programme management Capacity Building

9.

Outcome 1.3 Policy, institutional frameworks and enabling regulatory environment are in place to ensure better control on POPs accumulation and emissions

A project has prepared a solid assessment on institutional gaps and recommended approaches to address them to comply with the requirements of three chemicals related conventions (Basel, Rotterdam and Stockholm) and improve national communication and data management capacity. The report was submitted to the Ministry of Energy RK.


Tag: Environment Policy Efficiency Impact Health Sector Project and Programme management Capacity Building Civil Societies and NGOs

10.

Justification of the ratings

The outcome is expected to achieve most of its end-of-project targets, with only minor shortcomings. A specific intersectoral Commission for POPs will not be established as an intersectoral Commission is already operational which took over the management of POPs. The NIP has been updated on new POPs – over and above that the NIP update on u-POPs has been initiated – the submission is planned for 2017.


Tag: Effectiveness Efficiency Relevance Project and Programme management

11.

Outcome 1.4 Improved institutional coordination on chemical MEAs

A project has prepared a solid assessment on institutional gaps and recommended approaches to address them to comply with the requirements of three chemicals related conventions (Basel, Rotterdam and Stockholm) and improve national communication and data management capacity. The report was submitted to the Ministry of Energy RK.


Tag: Policies & Procedures Programme Synergy Project and Programme management Strategic Positioning Country Government Capacity Building Coordination

12.

Justification of the ratings

The outcome is expected to achieve most of its end-of-project targets, with only minor shortcomings.As the approval of new strategies are currently not supported by the government, the project team changed this mid-term target towards a“long-term plan for the submission of national reports.”


Tag: Coherence Relevance Project and Programme management Indigenous people National Institutions

13.

Outcome 2.1 Mercury assessment implemented, national consultations held to identify priorities for actions and capacity building on mercury risks carried

A training course „Requirements to sound healthcare waste management in the medical institutions" was developed and presented to "ZhasylDamu" JSC and RSE "Informational and Analytical Center" for use in training courses of employees of the environmental services industry.

Quantitative assessment of mercury releases to environment was conducted – containing data sources, major sources and national capacities in which recommendations were included. "The report on the inventory of mercury in the Republic of Kazakhstan" was provided to the Ministry of Energy.

Project team participated in a regional IPEN meeting in Central Asia on public participation in chemical safety issues in Eastern Europe, Caucasus and Central Asia (EECCA) countries. Following that meeting,and local consultations, a justification concept on Minamata convention ratification drafted and is prepared for submission to the Ministry of Foreign Affairs for review. Furthermore, a stakeholder workshop on Minamata Convention was held in Astana with 35 participants, representing ministries, industries, NGOs.

Awareness raising: Project news and campaigns are applied on the ZhasylDamu web site, leaflets published and disseminated and media reports available. In collaboration with the UNDP/ GEF Project on Energy Efficiency two seminars were held to raise awareness of energy-resource saving in healthcare facilities, including the handling of chemicals and waste" (Aktau and Kyzylorda cities) attended by 85 people.


Tag: Environmental impact assessment Waste management Coherence Relevance Project and Programme management Capacity Building

14.

Justification of the ratings

It can be assumed that the end of project mosttargets will be completely fulfilled.Future plan’s outline and proposed legislative improvements (inclusive release standards) to control mercury management have not been drafted yet but in accordance to the project team this is planned.


Tag: Relevance Project and Programme management

15.

Outcome 3.1 Sound health-care waste management through uPOPs and mercury reduction approaches are demonstrated in 2-3 regions of the country

An overview report of healthcare wastes management in the Republic of Kazakhstan – baseline assessment was completed. Recommendations were prepared to make amendments and changes to the Sanitary-epidemiological requirements for healthcare facilities. Adoption is scheduled for December 2016.Proposed changes to the legislation on public procurement were reflected in the Law of RK of 04.12.2015, #434-V «On public procurement» paragraph 4, article 37, which strengthened requirements on bidding procedures for provision of services, including healthcare waste management.

The developed training module on sound HCW management is used by regional institutions for professional upgrade of the staff. Data collection on HCW sources, types, quantities, and classification in Kazakhstan is completed and systemized in summary tables and were used for selection of the pilot regions and development of HCW Management Plans on facility and on regional level. This assessment covers 16 regions of the country, with a focus on all state-funded hospitals and medical facilities. 154 medical facilities (2,761 beds) in the pilot regions.


Tag: Coherence Relevance Health Sector Project and Programme management Capacity Building Policy Advisory

16.

Justification of the ratings

The outcome is expected to achieve most of its end-of-project targets, with only minor shortcomings. Shortcomings have been identified in the setup of pilot HCWM projects in selected hospitals. Here the mid-term targets have not been reached, as the non-burn technology is not operational, vehicles not purchased, the infrastructure not finalized and therefore the pilot not started yet. All activities have been initiated and it is planned to start the operation of the pilot projects in February 2017. The operation of the pilots is depending on the approval that the companies / hospitals are winning the public tenders for the treatment of the waste from the hospitals. The tender will be published in January 2017. Pricing methodologies have been elaborated by an international consultant but have not been followed up.Currently there are no mercury thermometers remaining in state budget-funded healthcare facilities in the three (3) pilot regions. Nevertheless, in 2017 additional 3000 mercury containing thermometers will be collected which would be in accordance to the end-of the project target.

Furthermore, additional training is needed for the pilot facilities on hcwm before the operation starts.


Tag: Coherence Relevance Health Sector Policies & Procedures Project and Programme management

17.

Outcome 3.2 Linkages between sound HCWM practices and minimization of uPOPs and mercury demonstrated through training and awareness raising programmes

During this reporting period, the project supported adoption of changes to the list of best available technologies (BAT) for managing healthcare waste, by the Law of RK of 25.04.2016, 505- V on Amendments and changes to certain legal acts of RK on the matters of environment and subsoil use.

The environmental code now includes a norm, which recommends the use of any recommended technologies taken up in the HCWM BAT list of the European Integrated Pollution Prevention and Control Bureau.The development of a training module on managing healthcare waste has been completed. Work has started on approving and integrating it into the training curriculum for medical colleges, universities and professional development courses. Progress in this area will be conducted in the next reporting cycles.As part of South-South cooperation and experience exchange, project team participated in the GIZ-funded international conference for Central Asia, Afghanistan and other countries on biological hazard safety and protection in the neighboring, Kyrgyzstan in October 2014.


Tag: Environment Policy Coherence Relevance Health Sector Project and Programme management

18.

Justification of the ratings

The outcome is expected to achieve most of its end-of-project targets, with only minor shortcomings.To obtain the end-of the target the institutionalization of training on hcwm is needed by including the already developed concept into the curricula of the medical colleges etc..


Tag: Coherence Relevance Health Sector Project and Programme management

19.

4.2.2 Results GEF Tracking Tool

As the GEF tracking tool used during development of the ProDoc has been updated in June 2015 the current GEF-6 Waste and Chemical tracking tool is used. In the Tables below a number of project results are presented and summarized, which are relevant for the indicators set in this GEF tracking tool.


Tag: Effectiveness Relevance Monitoring and Evaluation

20.

4.2.3 Identify remaining barriers to achieving the project objective

The main barriers outlined in the project document have been reviewed. All barriers namely a) Limited regulatory framework b) Insufficient systemic and institutional capacity c) Inadequate economic incentives and technical tools d) Information and awareness barriers, have been lowered by the project activities and results. Currently the regulative framework has been improved but is still under revision and improvement; training on healthcare waste management has been conducted but needs still to beincluded into the national training system for responsible person on healthcare waste in healthcare facilities as well as in the medical colleges and universities; the ecological friendly alternative treatment technologies are ordered but not operational – nevertheless the business plan of the centralized waste treatment center is including a complete financial reflux and will be financial effective; already more than 900 persons participated at awareness raising and training / workshop events - more training will be conducted in 2017. It can be assumed that the main barriers of the project will be further lowered by the project activities in 2017


Tag: Environment Policy Challenges Relevance Health Sector

21.

4.3 Project Implementation and Adaptive Management (S)

4.3 Project Implementation and Adaptive Management (S) In the following the implementation and adoptive management of the project is evaluated. The reviewed objectives “management, work planning, financing and project monitoring and evaluation” are analyzed and rated. A summary of the rating results is applied in the table below.


Tag: Efficiency Relevance Monitoring and Evaluation Project and Programme management Results-Based Management

22.

4.3.1 Management arrangement

The management arrangements as presented in the Project Document had been clearly described and were based on common project management arrangement for UNDP National Execution modality. The project had fully followed the management arrangements as described. At the start of the project, the Executing Agency/Implementing Partner role was initially assigned to the Ministry of Environmental Protection (MEP), which later on was assumed by the Ministry of Energy. Changes in Executing Agency/Implementation Partner, were the direct result of Government changes.As stated by the Project Document the National Director position was assigned to a senior level representative of the Ministry of Environment while after the Ministry of Energy became the Executing Agency, the Deputy Director of the Waste Management Department of the Ministry of Energy became the new project director.


Tag: Challenges Relevance Human and Financial resources Implementation Modality Project and Programme management UNDP Independent Offices

23.

4.3.2 Work planning

The project actual start date was delayed from September 2013 to April 2014, when the project staff was hired. The main reason for the delay was time-consuming procedures for endorsement and signing of the Project Document by the National Executing Agency. The project prepared Annual Work Plans based on the Project Document strategy description, log frame targets and indicators. Although during the inception workshop no major changes were reported, the project transferred the significant part of the pilot activities from the second (as planned in the Project Document) to the third year of the project implementation due to need for extra time for additional data collection, selection of the pilot sites, and coordination of the preliminary agreements between the participants of the pilot activities together with associated budget for equipment. This change was not formally approved by the Steering Committee during the 2015 planning process.


Tag: Relevance Human and Financial resources Project and Programme management

24.

4.3.3 Finance and co finance

As can be deducted from Table, project expenditures in 2016 (CDRs) are delivered for only 9% of the AWP with 4 months remained until the end of the year. The low delivery rate for 2016 is the result of procurement procedures that had been re-scheduled because of the pre-longed efforts to identify feasible partners for decontamination centers and agreeing specifications for the equipment. The project informed evaluators that the equipment will be delivered and installed by December 2016, which will affect the delivery rate accordingly.


Tag: Efficiency Resource mobilization Project and Programme management Civil Societies and NGOs National Institutions

25.

4.3.4 Project-level Monitoring and Evaluation Systems

The MTR team felt that the “Monitoring and Evaluation Plan” as described and included in the Project Document was comprehensive and in line with the UNDP rules and procedures for Monitoring and Evaluation of (GEF) projects.

The Table below summarizes the M&E activities as planned for in the project document and conducted throughout the project’s implementation. The column “Comments & Observations” summarizes the views of the TE team for each of these M & E activities. In summary the TE team is of the opinion that the M & E of the project, both at project design phase and during implementation, can be rated as Satisfactory (S).


Tag: Relevance Monitoring and Evaluation Project and Programme management

26.

4.3.5 Reporting

The project fully complies with reporting cycle and tools as required by UNDP-GEF guidance and reflected in the project document (see table above). Apart from progress reporting to NDP/GEF, the project used the mandate of the Steering Committee to communicate its results within key governmental institutions and other stakeholders and to adapt to unexpected change in selected pilot hospitals and centers over the project course.

The evaluators reviewed 2 PIRs for 2015 and 2016 and found that they provide concise information on project progress, management, and achievements and prove success in reaching multiple stakeholders and beneficiaries over the project implementation. Both PIRs were rated as satisfactory with risk rating changed down from “high” in 2015 to “low” in 2016 mainly due to efficient risk monitoring and adaptive actions of the project team.


Tag: Effectiveness Relevance Global Environment Facility fund Project and Programme management Civil Societies and NGOs National Institutions

27.

4.3.6 Communications

The project does not have formulated communication strategy, but it undertakes targeted activities to communicate its objectives and results to various groups through media coverage, visual materials,workshops and trainings, public events. Key project target groups and beneficiaries included:

National Government entities: Ministry of Energy (ME); Ministry of National Economy; Ministry of Ministry of Health (MH); Agriculture (MA); Ministry of Justice (MJ); Ministry of Defense (MD); Ministry of Industry and New Technologies.

Regional Ecological Departments of 3 regions: Regional Environmental Departments under the Ministry of Energy, Public Healthcare Departments.

Hospitals in 14 regions of Kazakhstan for HCW assessment and hospitals in 3 pilot regions for project activities.


Tag: Coherence Relevance Health Sector Communication Capacity Building Civil Societies and NGOs

28.

4.4 Sustainability

(S) In the table below, four aspects of sustainability (Financial Sustainability; Socio-Political; Institutional Framework and Governance; and Environmental Sustainability) are analyzed as well as the rated. The ratings used for sustainability aspects of the project are the following: Highly Likely (HL); Likely (L); Moderately Likely (ML) Moderately Unlikely (MU); Unlikely (U); Highly Unlikely (HU). More details on the rating system can be found in the annex.

Overall, the evaluation team feels that the sustainability of the project is Likely (L) which indicates negligible risks to sustainability, with key outcomes on track to be achieved by the project’s closure and expected to continue into the foreseeable future. Thus the project sustainability deemed Satisfactory.


Tag: Environment Policy Sustainability

Recommendations
1

5.2.1 Activities to achieve mid-term targets

 Complete activities towards midterm targets on POPs management (Component 1):

  •  Following up of inserting uPOPs into the NIP, 
  • Finalization of pesticides inventory,
  •  Finalization of uPoP inventory methodology,
  •  Finalization of national POPs monitoring plan

 Complete activities towards midterm targets on mercury management (Component 2):

  •  Finalization of the future mercury reduction plan

 Complete activities towards midterm targets on demonstration projects (Component 3):

  •  Ensuring that the infrastructure for the centralized waste treatment centers is adequate and timely available
  •  Installation and commissioning of autoclaves
  •  Training of workers at the central waste treatment facilities on healthcare waste management and usage of the equipment.
2

5.2.2 Project Recommendations

  •  Exit Strategy: A clear exit strategy needs to be developed so that the mechanisms and structures are created during the project implementation to guarantee the end of funding sustainability.
  •  Accelerate Project Implementation: In order to meet a 100% execution mark by the end of the project in September of 2017, the measures should be taken to accelerate the project activities, as for now about 36% of budget has been utilized.
  •  Project extension: Based on the remaining budget commitments for 2016 - 2017, it is recommended that the project would be extended until December 2017 to have sufficient time frame for substantive testing of pilot centers and for communication of the results and lessons.
  •  Prepare a project video:The establishment of centralized treatment facilities using non-burn technology including the complete segregation, storage, transport, treatment and disposal system should be shown and marketed. It would embed confidence in project partners and healthcare waste managers and handlers, to visually showcase the entire healthcare waste logistic from cradle to grave. A project video would also allow for a good project keepsake that could easily be used share experiences with other countries.
3
  •  Lessons learnt: Capture lessons-learned and project results in a more systemic manner. The project has achieved many results that would be highly beneficial not only for the replication of this project’s results within the country, but also for other countries in the Central Asia Region.
  •  Project proposals: Develop at least one new project proposal which is based on the results of the project and further requests and needs identified during the project implementation.
  •  Support Laboratory Accreditation: The project should further support the process of laboratory accreditation and ensure that the necessary equipment for accreditation is available.
  •  Capacity building: Initiate training for medical staff and logistic staff from pilots after installation and operation of the autoclaves, Insert training concept into the institutional training of medical staff.
  •  Asset Management: Develop a systematic process for the central treatment centers of deploying, operating, maintaining and upgrading their assets like waste equipment, infrastructure and transport vehicles.
  •  Improve access to project documents:The evaluators recommend to reorganize the webpage in order to provide an easier access to project information and to upload useful project materials, such as training materials, specifications of equipment and infrastructure and regional and facility based healthcare waste management plans.
  •  Financial monitoring.The reported contribution from NGOs is based on co-financing letters. An evident based monitoring system need to be established. It is recommended that UNDP and Steering Committee should take notice of this issue. Also the project team should update and monitor the project disbursement in accordance to the AWP and ProDoc in order to react timely and adequate on discrepancies and to initiate mitigation measures.
Management response not available

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