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

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Evaluation Plan:
2018-2022, Kyrgyzstan
Evaluation Type:
Final Project
Planned End Date:
08/2018
Completion Date:
09/2018
Status:
Completed
Management Response:
Yes
Evaluation Budget(US $):
11,200

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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: 00088593
Evaluation Plan: 2018-2022, Kyrgyzstan
Evaluation Type: Final Project
Status: Completed
Completion Date: 09/2018
Planned End Date: 08/2018
Management Response: Yes
Corporate Outcome and Output (UNDP Strategic Plan 2018-2021)
  • 1. Output 1.4.1 Solutions scaled up for sustainable management of natural resources, including sustainable commodities and green and inclusive value chains
Evaluation Budget(US $): 11,200
Source of Funding: GEF
Evaluation Expenditure(US $): 11,200
Joint Programme: No
Joint Evaluation: No
Evaluation Team members:
Name Title Email Nationality
Dinesh Aggarwal INDIA
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: Terminal Evaluation
Focal Area: Persistent Organic Pollutants
Project Type: MSP
GEF Phase: GEF-5
GEF Project ID: 5068
PIMS Number: 5155
Key Stakeholders: The Ministry of Health of the Kyrgyz Republic, The State Agency on Environment Protection and Forestry of the Kyrgyz Republic
Countries: KYRGYZSTAN
Comments:

Evaluator: Dinesh Aggarwal, India (International Consultant)

Lessons
Findings
Recommendations
1

For future project designs: In the results-framework of the project some of the indicators / targets are in percentage terms, with the figures not specified. Also, the figures of total number / population on which these numbers are to be applied are not available. It is because of this reason that assessment regarding achievement of results against indicators / targets becomes difficult in qualitative terms and one has to go for qualitative aspects while assessing the achievement of results. It is recommended that in case targets are fixed in percentage terms, the method to determine the number on which these % are to be applied also be provided.

2

A periodic inspection of the practices being followed regarding disposal of medical waste at Health care facilities (HCF) and period training of the responsible staff would help to ensure that the serialization is happening as per the requirements.

3

The project has very successfully addressed the issue of handling and disposal of the syringes. However, there is still the problem of disposal of the medical waste made out of PVC (polyvinyl chloride) (transfusion kits, catheters, oxygen masks, IV fluid bags etc.). It is recommended that the government invite private sector partners to establish recycling facility for PVC containing medical waste. As the backbone for sterilization and collection of the medical waste is already there, there won’t be any incremental cost for recycling PVC containing medical waste. On the other hand it is likely to provide some revenue to the Health Care Facilities (HCF).

4

The project has supported replacement of mercury containing thermometers with the electronic thermometers at the healthcare facilities. A proposal to replace the mercury containing thermometers at the household levels may also be considered.

5

The syringes being used presently has a rubber component (in the plunger part of the syringe), at the end of the recycling facility these rubber component is manually removed from the plastic part before the recycling. This requires deployment of human resources (cost). It also exposes the workers to a potential health risk. It is recommended that the government may consider a proposal to allow the use of syringes without the rubber part. This may be made mandatory. This will reduce an additional step at the recycling facility and will also take care of any potential health risk to the workers.

6

The recycling facility currently make articles like flower pots etc. out of the plastic recovered out of the syringes. It is recommended that a proposal to produce the containers (using the recovered plastics) for collecting and sterilizing the syringes at hospitals. The container and the syringes after sterilization can then be taken directly to the recycling machine. Without the need to manually empty and transfer the waste syringes a number of times. This will reduce the efforts and will also take care of any potential exposure to the health risks.

1. Recommendation:

For future project designs: In the results-framework of the project some of the indicators / targets are in percentage terms, with the figures not specified. Also, the figures of total number / population on which these numbers are to be applied are not available. It is because of this reason that assessment regarding achievement of results against indicators / targets becomes difficult in qualitative terms and one has to go for qualitative aspects while assessing the achievement of results. It is recommended that in case targets are fixed in percentage terms, the method to determine the number on which these % are to be applied also be provided.

Management Response: [Added: 2018/09/12] [Last Updated: 2018/09/12]

The recommendation is well noted, and the proposed mechanism of setting indicators will be taken into account when developing a future project to be funded by the GEF.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
The recommendation is well noted for the future project design. No action required.
[Added: 2018/09/12]
UNDP Country Office (CO) 2018/08 Completed The recommendation will be taken into the account for future project design.
2. Recommendation:

A periodic inspection of the practices being followed regarding disposal of medical waste at Health care facilities (HCF) and period training of the responsible staff would help to ensure that the serialization is happening as per the requirements.

Management Response: [Added: 2018/09/12] [Last Updated: 2018/09/12]

After the medical waste treatments have been established/supported at the pilot HCFs, staff of the points were trained according to the established requirements and it is further a responsibility of the HCFs to keep their staff trained in case of turnover and the State Department on Epidemiologic Surveillance is the responsible entity to monitor the quality of work of the autoclaving points. This is the rule issued by the Ministry of Health of the Kyrgyz Republic. These requirements were also shared at the Project final workshop with participation of all project beneficiaries, including the staff of the 100 FAPs (Health Dispensaries, only exist in rural areas). 

Key Actions:

Key Action Responsible DueDate Status Comments Documents
The recommendation is accepted and taken in to the account. No actions required.
[Added: 2018/09/12]
UNDP Country Office 2018/08 Completed
3. Recommendation:

The project has very successfully addressed the issue of handling and disposal of the syringes. However, there is still the problem of disposal of the medical waste made out of PVC (polyvinyl chloride) (transfusion kits, catheters, oxygen masks, IV fluid bags etc.). It is recommended that the government invite private sector partners to establish recycling facility for PVC containing medical waste. As the backbone for sterilization and collection of the medical waste is already there, there won’t be any incremental cost for recycling PVC containing medical waste. On the other hand it is likely to provide some revenue to the Health Care Facilities (HCF).

Management Response: [Added: 2018/09/12] [Last Updated: 2018/09/12]

This recommendation is well noted, and UNDP will monitor the further progress of recycling with regards to the PVC (polyvinyl chloride) containing waste generated from the HCFs. However, it should be noted that during the latest monitoring visit to one of the major and central HCF it came to our attention that the PVC containing medical waste has always been collected by the private sector for recycling and this will be continued with no doubt. This is certainly providing some revenue for the HCF as well.     

Key Actions:

Key Action Responsible DueDate Status Comments Documents
This recommendation is well noted, no actions required.
[Added: 2018/09/12]
UNDP Country Office 2018/08 Completed
4. Recommendation:

The project has supported replacement of mercury containing thermometers with the electronic thermometers at the healthcare facilities. A proposal to replace the mercury containing thermometers at the household levels may also be considered.

Management Response: [Added: 2018/09/12]

The recommendation is well noted, but it should be noted that the household level was not part of the approved project document. However, the project has implemented very innovative and very wide public outreach campaign on how to handle mercury thermometer leakages and pros of mercury free thermometers that has covered the household level. The animated cartoons were posted onto the UNDP web pages and UNDP is keeping up with the public by addressing their questions regarding the issue.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
The recommendation is accepted for future project design, no actions required at this moment.
[Added: 2018/09/12]
UNDP Country Office 2018/08 Completed
5. Recommendation:

The syringes being used presently has a rubber component (in the plunger part of the syringe), at the end of the recycling facility these rubber component is manually removed from the plastic part before the recycling. This requires deployment of human resources (cost). It also exposes the workers to a potential health risk. It is recommended that the government may consider a proposal to allow the use of syringes without the rubber part. This may be made mandatory. This will reduce an additional step at the recycling facility and will also take care of any potential health risk to the workers.

Management Response: [Added: 2018/09/12] [Last Updated: 2018/09/12]

This recommendation is well noted, however it should be noted that according to medical personnel nurse making injections there were many cases when rubber-less syringes brought them problems when making injections at a different speed, while rubber head syringes are quite easy to use and fully removes the above problem. Never-the-less, once the Terminal Evaluation report has been finalized it will be formally circulated to the national partners, including the Ministry of Health (MoH), with a special emphasis on this very recommendation for their further consideration.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
Translate into Russian the final version of the Terminal Evaluation (TE) report and share it with national partners, including Ministry of Health (MoH) for their consideration and further follow-up.
[Added: 2018/09/12] [Last Updated: 2018/12/16]
Project Team 2018/12 Completed To be disseminated to the national partners by the end of the year. History
6. Recommendation:

The recycling facility currently make articles like flower pots etc. out of the plastic recovered out of the syringes. It is recommended that a proposal to produce the containers (using the recovered plastics) for collecting and sterilizing the syringes at hospitals. The container and the syringes after sterilization can then be taken directly to the recycling machine. Without the need to manually empty and transfer the waste syringes a number of times. This will reduce the efforts and will also take care of any potential exposure to the health risks.

Management Response: [Added: 2018/09/12] [Last Updated: 2018/09/12]

This recommendation is well noted. Once the Terminal Evaluation (TE) report has been finalized it will be formally circulated to the private sector partners which cooperated with the project, a special emphasis would be put on this very recommendation for their further consideration.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
Translate into Russian the final version of the TE and share it with private sector recycling companies for their consideration and further follow-up, if the proposed technology is appropriate and financially viable.
[Added: 2018/09/12] [Last Updated: 2018/12/16]
Project Team 2018/12 Completed The recommendation is accepted and will be followed up accordingly by December 2018. History

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