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"Reducing UPOPs and Mercury Releases from the Health Sector in Africa" project mid-term evaluation
Commissioning Unit: Madagascar
Evaluation Plan: 2015-2020
Evaluation Type: Project
Completion Date: 12/2018
Unit Responsible for providing Management Response: Madagascar
Documents Related to overall Management Response:
 
1. Recommendation:

The project must 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: 2020/01/23] [Last Updated: 2020/01/23]

The management accepts the recommendation : Periodic follow-up visits and regular meetings with model hospitals, project staff and the technical working group to ensure sustainability of the best environmental practices introduced in HCWM and use of mercury free medical devices.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
Periodic visits of the model hospitals using the autoclaves: meetings with model hospitals
[Added: 2020/01/23]
UPOPs project staff 2019/03 Completed Quarterly visits realized
Quarterly meetings with the technical working group to discuss relevant challenges faced by the model hospitals and provide solutions to sustain the best environmental practices in HCWM in the model health facilities
[Added: 2020/01/24]
UPOPs project staff, technical working group 2019/03 Completed
2. Recommendation:

It is essential that the solar panel system at the CSB2 Manjakandriana provides enough power to compensate for the consumption of the autoclave. A meter shall be installed and the PIU shall regularly check if the electricity produced is sufficient to compensate the electricity consumed by the autoclave

Management Response: [Added: 2020/01/23] [Last Updated: 2020/01/23]

The management accepts the recommendation : Adjustment work of the installation of the solar panel system by the service provider and on-site visit of MOH and MOE technicians at the hospital CHRD Manjakandriana in November 2018

Key Actions:

Key Action Responsible DueDate Status Comments Documents
Request of adjustment work of the installation of the solar panel system by the service provider
[Added: 2020/01/24]
Project staff, service provider 2018/11 Completed
On-site visit of MOH and MOE technicians and project staff at CHRD Manjakandriana
[Added: 2020/01/24]
Project staff, MOH technicians (SEM, SILO, DHRD, DRSP Analamanga), MOE (Stockholm C) 2018/11 Completed The electricity consumption of the hospital is reduced by 60% and it will be largely sufficient for a bi-weekly operation of the autoclave at CHRD Manjakandriana
3. Recommendation:

The instructional posters for hospitals and clinics on how to properly manage HCW should be updated, so that they reflect the existing system.

Management Response: [Added: 2020/01/23] [Last Updated: 2020/01/23]

The management accepts the recommendation : Printing updated job aids on segregation of HCW in the model hospitals is planned in 2019

Key Actions:

Key Action Responsible DueDate Status Comments Documents
Workshop to update and validate the job aids for model hospitals
[Added: 2020/01/24]
Project staff, technical working group 2019/03 Completed
Workshop to update and validate the job aids for model hospitals
[Added: 2020/01/24]
Project staff, technical working group 2019/05 Completed Job aids already updated
Printing the updated job aids for model health facilities
[Added: 2020/01/24] [Last Updated: 2020/03/17]
Project staff 2019/06 Completed Job aids already displayed on the wards of the model hospitals History
4. Recommendation:

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. This leaves little time of 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 be taken 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: 2020/01/23] [Last Updated: 2020/01/23]

The management accepts the recommendation : Only one teaching hospital CHU Morafeno Toamasina will receive an autoclave to treat without incineration its own waste and waste from a second new model hospital CHU Analankininina Toamasina. An on-site preparation of these 2 new model hospitals is planned on February 11 till 15 by the MOH technicians (DGEHU, SSENV and national trainer) in Toamasina to facilitate and accelerate as possible the readiness of these new sites.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
Conduct an on-site visit of the 2 new model hospitals: collect of baseline data, prepare environmental authorization, identify the needs for making available a functioning building for the autoclave…
[Added: 2020/01/24]
Project staff, MOH technicians (national director, DGFS, SSENV) 2019/02 Completed
Close follow-up of the actions identified to accelerate as possible the readiness of these new sites
[Added: 2020/01/24]
Project staff, MOH technicians (national director, DGEHU, SSENV) 2019/12 Completed
5. Recommendation:

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: 2020/01/23]

The management accepts the recommendation : All the 4 model hospitals equipped with the autoclave for non-incineration treatment of HCW received also a vehicle for safely transport of HCW conform to ADR standards. They will be encouraged and supported to treat the waste of neighboring public and private health care facilities.

Key Actions:

Key Action Responsible DueDate Status Comments Documents
Workshop with the model hospitals and technical working group
[Added: 2020/01/24]
Project staff, technical working group 2020/03 Completed
Conduct an advocacy on collaboration between model hospitals and neighboring public and private health care facilities
[Added: 2020/01/24]
MOH persons in charge (DGFS, DHRD, SSENV…), project 2020/03 Overdue-Initiated

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