National Healthcare Waste Management Strategic Plan

National Healthcare Waste Management Strategic Plan National Healthcare Waste Management Strategic Plan 2016-2021 Ministry of Health The Republic of Maldives National Healthcare Waste Management Strategic Plan c All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any means, electronic, mechanical, photocopying, recording or otherwise without written permission of Ministry of Health, Maldives. Short excerpts from the publication may be reproduced in respect to any fair dealings for the purpose of research or review, pro vided due acknowledgement is made. Published by Health Protection Agency, Ministry of Health Male’, Republic of Maldives Numbered and Verified by: Planning Section Date: 23.2.2017 Policy Planning and International Health Division Endorsement Number: Plan/23/-MoH/2017/08 National Healthcare Waste Management Strategic Plan Table of Contents Abbreviations ......................................................................................................................... 3 Foreword ................................................................................................................................ 4 Lead Authors .......................................................................................................................... 5 Working Group Members ...................................................................................................... 5 Introduction and Justification ............................................................................................... 6 Strategic Approaches ............................................................................................................ 7 Strategic Priorities ................................................................................................................. 8 1.1 Strategic Priority 1: Improving the legal framework for healthcare waste management ....................................................................................................................... 8 1.2 Strategic Priority 2: Improving knowledge management and capacity building 8 1.3 Strategic Priority 3: Implementing of an integrated healthcare waste management system .......................................................................................................... 8 1.4 Strategic Priority 4: Improving and adapting of national and local monitoring and evaluation process ..................................................................................................... 8 1.5 Strategic Priority 5: Resource Mobilization .......................................................... 8 Objectives to implement the strategic priorities .................................................................. 8 1.6 Strategic Priority 1 Objectives: .............................................................................. 9 1.7 Strategic Priority 2 Objectives: .............................................................................. 9 1.8 Strategic Priority 3 Objectives: .............................................................................. 9 1.9 Strategic Priority 4 Objectives: .............................................................................. 9 1.10 Strategic Priority 5 Objectives: .............................................................................. 9 Strategic Plan Implementation and Monitoring.................................................................... 9 Implementation Plan 2016 – 2021 ....................................................................................... 10 1.11 Strategic Priority 1: Improving of the legal framework on healthcare waste management ..................................................................................................................... 10 1.12 Strategic Priority 2: Improving of knowledge management and capacity building ............................................................................................................................. 12 1.13 Strategic Priority 3: Implementing of an integrated healthcare waste management system ........................................................................................................ 17 1.14 Strategic Priority 4: Improving and adopting of national and local monitoring and evaluation process ................................................................................................... 21 1.15 Strategic Priority 5: Resource Mobilization ........................................................ 23 National Healthcare Waste Management Strategic Plan Abbreviations EPA HCF Environment Protection Agency Health Care Facility HCWM Healthcare Waste Management HPA Health Protection Agency RAHSD Regional and Atoll Health Service Division MFDA Maldives Food and Drug Authority MoH Ministry of Health MoEE Ministry of Environment and Energy QAD SOP Quality Assurance Division Standard Operating Procedure WAMCO Waste Management Cooperation WHO World Health Organisation National Healthcare Waste Management Strategic Plan Foreword Developing an integrated and sustainable health care waste management system is of ut most importance to ensure that all wastes generated within the health sector are man aged without adverse effects on human health and environment, as the Republic of Mal dives is moving towards the development of an environmentally sound waste manage ment system in the country. The development of this strategic plan under the “National Healthcare Waste Manage ment Policy (2016)” is a key achievement to improve the present situation of health care waste management in Maldives. This strategic plan will, therefore, guide in enforcing the “National Healthcare Waste Management Policy 2016” and achieving its objectives through the establishment of an integrated countrywide system that is economical, social ly and environmentally sustainable. Implementation of this plan in the future will protect the patients, the health of the workers, the health of the public and the environment from hazards associated with health care wastes generated in the country. I acknowledge that the “Health Care Waste Management Strategic Plan (2016 – 2021)” was developed through extensive consultations with the relevant government institu tions, health care facilities in the Male city, and relevant non- governmental organizations. I guarantee that the plan is practical and achievable. Likewise, effective implementation of this plan requires multi-sectorial effort, cooperation, and engagement at all levels. It requires the involvement of the institutions that generates health care waste, relevant stakeholders of the government, public partner agencies and other institutions, to protect the health of our people and environment. I would like to extend my gratitude to all the members who worked hard in making this plan a success and call upon all the relevant stakeholders to join hands with Ministry of Health in the successful implementation of the plan. Mr. Abdulla Nazim Ibrahim Minister of Health National Healthcare Waste Management Strategic Plan Lead Authors Dr. Ute Pieper, Environmental consultant Dr. Asma Ibrahim, Director General, Maldivian Blood Services Ms. Aminath Shaufa, Public Health Program Coordinator, Health Protection Agency Working Group Members • Abdulla Nishan, Assistant Manager, Senahiya • Aishath Rashfa, Assistant Director, Ministry of Environment and Energy • Aishath Sumayyath, Registered Nurse, Maldives Blood Services • Aminath Dhifleen, Medica Hospital • Aminath Mohamed, Senior Community Health Officer, Vilimale Hospital • Aminath Mohamed, Environment Analyst, Environment Protection Agency • Aminath Shama, Assistant Project Officer, Ministry of Environment and Energy • Aminath Shaliny, Project Officer, UNDP • Arham Abdul Raheem, Facilities Manager, Waste Management Corporation • Dr. Ibrahim Sujau, Consultant Medicine, IGM Hospital • Fathimath Nasheeda, Director, Ministry of Health • Fathimath Sara, Senior Nurse Manager, IGMH • Fathimath Soliha, Senior Nurse Manager, IGMH • Haleemath Nahula, Public Health Program Assistant, health Protection Agency • Hidhaya Shahid, Admin Officer, Ministry of Health • Ibrahim Waheed, Pharmaceutical officer, Maldives Food, and Drug Authority • Mariyam Raufa, Senior Project Officer, Ministry of Health • Mariyam Rifan, Registered Nurse, Vilimale Hospital • Mohamed Ahmed, Support staff Grade 4, IGM Hospital • Mohamed Fazeen, Director Pharmaceuticals, Maldives Food and Drug Authority • Mohamed Meezan, Director, Ministry of Health • Mohamed Nizar, President PCB, Ministry of Finance and Treasury • Moosa Shifaz, Operations Manager, ADK Hospital • Muthau Shaheem, Lecturer, Maldives National University • Nasiha Mohamed, Ward Manager, IGM Hospital • Saeema Thaufeeq, Senior Nurse Manager, Hulhumale’ Hospital • Zifla Ibrahim, House Keeping Manager, ADK Hospital National Healthcare Waste Management Strategic Plan Introduction and Justification Healthcare waste poses risks to human health and to the environment when managed inappropriately. The Ministry of Health (MoH) of the Republic of Maldives, recognies the need to improve the management of healthcare waste in the country. Hence, the “National Healthcare Waste Management Policy 2016” states the following vision: “Ensuring that all waste generated within the health sector is managed without adverse effects on human health and environment in an integrated manner that is environmental ly and economically sustainable.” In this Strategic Plan the gaps of the current healthcare waste management system in the country are identified and accordingly objectives, key statements and priorities of actions are outlined to improve the management of healthcare waste in the country. Health Master Plan 2016-2025 identifies healthcare waste management as an area of con cern for health care quality. It states the enforcement of regulations and standards on the management of waste and waste reduction, including healthcare waste. The purpose of this Strategic plan is to enforce the “National Healthcare Waste Manage ment Policy” by establishing a countrywide integrated healthcare waste system, which is managed without adverse effects on human health and environment, and that is environ mentally and economically sustainable. National Healthcare Waste Management Strategic Plan Strategic Approaches This strategic plan and strategic plan was developed in consultation with the fol lowing stakeholders; 1. Ministry of Health 2. Ministry of Environment and Energy 3. Ministry of Finance and Treasury 4. Environment Protection Agency 5. Maldives Food and Drug Authority 6. Health Protection Agency 7. Faculty of Health Science 8. Indira Gandhi Memorial Hospital 9. Hulhumale’ Hospital 10. Villimale Hospital 11. Waste Management Cooperation Ltd 12. Medica Hospital 13. ADK Hospital 14. Maldivian Blood Services 15. Senahiya 16. UNDP The implementation plan is based on the identified priority areas, objectives, and activi ties. A phased implementation is envisaged, which will start with the improvement of the legal framework, capacity building, public awareness building activities and the initiation of a pilot project. This strategic plan is developed in line with the “National Waste Management Policy” and “Waste Management Strategic Action Plan” endorsed by the Ministry of Environment and Energy which envisages the establishment of Waste Centres on each inhabited island and the construction of Regional Waste Management Facilities. National Healthcare Waste Management Strategic Plan Strategic Priorities An assessment was done to identify the current practices of health care waste manage ment in Maldives. The following areas were identified based on the findings: Strategic Priority 1: Improving the legal framework for healthcare waste management Requirements for the safe management of healthcare waste need to be reflected within various legal instruments. Therefore, the revision of the existing legal framework and the development of new instruments which are in line with this strategic plan are needed. Strategic Priority 2: Improving knowledge management and capacity building To promote proper knowledge management on healthcare waste by institute training programs and raising awareness among policy makers, healthcare workers, waste han dlers, patients and the general public. Strategic Priority 3: Implementing of an integrated healthcare waste management system In order to improve the safe management of healthcare waste without adverse effects to the human health and environment, an integrated healthcare waste management system will be implemented in line with national waste management requirements and interna tional treaties. Strategic Priority 4: Improving and adapting of national and local monitoring and evalua tion process Good governance requires periodic monitoring of health care waste management activi ties and corrective actions. Strategic Priority 5: Resource Mobilization Resource mobilization will ensure different types of support such as physical, financial, technical, and human capacity to achieve the strategic plan. Objectives to implement the strategic priorities Based on the above-outlined priority areas, the objectives and general activities needed to implement the strategic plan are outlined. The comprehensive approach of this strategic plan needs to aim all different kinds of waste generated in healthcare facilities (general waste, infectious and sharp waste, pharmaceutical waste, pathological waste, hazardous waste and chemical waste) from point of generation to disposal. Here, the measures need to be planned for each waste management step: waste minimization, Segregation, internal transport, storage, treatment, external transport, and disposal. National Healthcare Waste Management Strategic Plan Strategic Priority 1 Objectives: Review and revise existing legal documents Strengthen policy and regulatory structures for HCWM Strategic Priority 2 Objectives: Develop national training packages on health care waste management Implementation of developed HCWM training programs Increase advocacy awareness for behavioural change Promote Research, new technologies and innovative methods for sound management of HCW Strategic Priority 3 Objectives: Assessment of the current waste management situation Set up of an integrated system in a pilot Atoll HCWM Planning Promote green procurement and minimizing waste Improvement of Infectious Waste and Sharp Waste Management Improvement of Pharmaceutical and Chemical Waste Management Strategic Priority 4 Objectives: Assessment of current monitoring situation Strengthen reporting, monitoring, and evaluation mechanism on HCWM Regular monitoring and evaluation of the Health Care Waste Management System and performance of the equipment Strategic Priority 5 Objectives: Establish sustainable sources of funding Budget completion Strategic Plan Implementation and Monitoring The implementation of the strategic plan will be achieved through the development and integration of the proper management of healthcare waste into the current waste man agement activities. Furthermore, the annual action plans of city/atoll/island councils will contribute to the implementation of the Strategic plan. Decisions on the adjustments of the Plan will be taken on the basis of monitoring and evaluation of the implementation of annual plans. MOH plays the role of coordination of the process of implementation and monitoring and is responsible for: a systematic analysis and evaluation of the annual reports on the status of implementa tion;  The validity of the necessary costs for the implementation of strategic activities;  Identify possible sources of funding the implementation of measures;  Organization monitoring and evaluation system,  Identify deviations from the stated goals and objectives, analyse the causes and make the necessary adjustments.  Dissemination of the results of monitoring and reporting to relevant stakeholders. National Healthcare Waste Management Strategic Plan Implementation Plan 2016 – 2021 1.1 Strategic Priority 1: Improving of the legal framework on healthcare waste management # Objectives Measures / Actions Expected results 2016 2017 2018 2019 2020 2021 Responsible agency (ies) Budget USD Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 1 Review and revise exist ing legal doc uments Identify gaps and outdated legal docu ments, Identify over lapping mandates of authorities and rele vant stakeholder Clear understand ing of terminology, overlapping man dates and roles and responsibilities identified HPA, MoH, MoEE 0 Review and revise existing legal docu ments Existing legal docu ments are revised HPA, MoH, MoEE 3,000 2 Strengthen Policy and regulatory structures for HCWM Develop and update missing and outdated legal documents in the area of healthcare waste management Legal documents developed and up dated Foreign Ministry, MoH, HPA, Labour relations Authori ty, WAMCO, MoEE, EPA, MoT, LGA, 6,500 Disseminate strategic plan and legal docu ments on HCWM to relevant stakeholders Relevant stakehold ers are informed about the strategic plan and legal doc uments on HCWM HPA 3,000 Clear definition and approval of roles and responsibilities Roles and responsi bilities are docu mented and ap proved Foreign Ministry, MoH, HPA, Labour relations Authori ty, WAMCO, MoEE, EPA, MoT, 0 National Healthcare Waste Management Strategic Plan # Objectives Measures / Actions Expected results 2016 2017 2018 2019 2020 2021 Responsible agency (ies) Budget USD LGA, National Healthcare Waste Management Strategic Plan 1.2 Strategic Priority 2: Improving of knowledge management and capacity building # Objectives Measures / Ac tions Expected results 2016 2017 2018 2019 2020 2021 Responsible agency (ies) Budget USD Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 1 Develop na tional training packages on health care waste man agement Identify gaps and needs of the cur rent training sys tem for healthcare waste manage ment Gaps and needs are identified MoH / HPA 0 Develop a training package for health care workers and conduct a trial training for the final revision of the training pack age. The training package is available, trial training conducted and training package finalized. MoH 16,000 Develop an online training tool for regular refresher training activities – trial testing and revision Online training tool is developed, tested and revised MoH 4,000 Liaise with rele vant government bodies to approve HCWM component to be included in the curriculum Content approved HPA 0 Consultative meet ings with Universi A national train ing/capacity building MOH/MNU & MOE 11,300 National Healthcare Waste Management Strategic Plan # Objectives Measures / Ac tions Expected results 2016 2017 2018 2019 2020 2021 Responsible agency (ies) Budget USD ty, Education Min istry & Ministry of Health: Develop and incorporate HCWM for various categories of training /assessments for HC waste man agement in the edu cation sector is de veloped Resource map ping to identify trainers trained on HCWM Trained trainers are identified and docu mented. HPA 0 2 Implementation of developed HCWM training programs Train and certify master trainers from MNU cam puses and schools, create pool of trainers at region al level Master trainer and pool of trainers are trained MNU/HPA/MoH 130,000 Assign a focal point in HCWM in each health facility and train focal points by the mas ter trainers at re gional level Have a trained per son in HCWM in each health care facility MoH / Health facilities 9000.00 Mandatory sensi tization programs to Policymakers Policy makers and Hospital managers are trained HPA with insti tutions 2,500 National Healthcare Waste Management Strategic Plan # Objectives Measures / Ac tions Expected results 2016 2017 2018 2019 2020 2021 Responsible agency (ies) Budget USD and Hospital managers Mandatory basic training for vari ous cadres by the trained focal per sons of the healthcare facili ties: Attendants / Housekeeping, staff/contractors, waste handlers outside hospital, waste equipment operators, focal points from island councils Personnel from vari ous cadres are trained on HCWM HC facilities 0 Follow up & re fresher training on annual basis at regional level Follow up done and refresher conducted on annual basis HPA with insti tutions 0 Introduce and provide an online mandatory train ing and assess ment module for all levels of staff employed in a health care facility. The online training introduced and used. MoH 0 3 Increase advo cacy awareness for behavioral Develop and dis seminate “Infor mation, Education Leaf lets/posters/Ads developed and dis HPA 6,500 National Healthcare Waste Management Strategic Plan # Objectives Measures / Ac tions Expected results 2016 2017 2018 2019 2020 2021 Responsible agency (ies) Budget USD change and Communica tion” materials to create awareness seminated Promote aware ness on HCWM for Policymakers (Green and environment friendly procure ment) and waste handlers by picto rial reminders, promote guide lines and SOPs Improved aware ness among policy makers and relevant stakeholders HPA / Institu tions 6,500 Increase aware ness by Radio, TV ads and social media, Mobile phone Applica tions Improved aware ness of the public HPA / Institu tions 4,000 4 Promote Re search, new technologies and innovative methods for sound man agement of HCW Enhance collabo ration between MNU/private col leges faculties and other stakeholders in order to facili tate research in the area of HCWM Locally adapted methods identified / Global best practices contextualized HPA / MoEE / MNU / MoE 0 Conduct research on healthcare waste incinerator/waste Research paper is written and dissemi nated MoEE / EPA / MNU 10,000 National Healthcare Waste Management Strategic Plan # Objectives Measures / Ac tions Expected results 2016 2017 2018 2019 2020 2021 Responsible agency (ies) Budget USD burning emission in the Republic of Maldives National Healthcare Waste Management Strategic Plan 1.3 Strategic Priority 3: Implementing of an integrated healthcare waste management system # Objectives Measures / Actions Expected results 2016 2017 2018 2019 2020 2021 Responsible agency (ies) Budget USD Q 1 Q 2 Q 3 Q 4 Q 1 Q 2 Q 3 Q 4 Q 1 Q 2 Q 3 Q 4 Q 1 Q 2 Q 3 Q 4 Q 1 Q 2 Q 3 Q 4 Q 1 Q 2 Q 3 Q 4 1 Assessment of the current waste man agement sit uation Carry out a baseline survey in collaboration with MoEE and disseminate the report (online) Baseline study on cur rent hcwm in the Republic is available and dissemi nated HPA and MoEE 0 Conduct feasibility assessment for non-burn technology Feasibility Study on non-burn technologies is available and dissemi nated. HPA / MNU 0 Identification and detailed as sessment of pilot area Assessment was done and report dis seminated UNDP / WHO / MoH 6,500 2 Set up of an integrated system in a pilot Atoll Planning, purchase, commis sioning and training for needed waste equipment Equipment available and installed UNDP / WHO / MoH 130,000 Planning and building of need ed infrastructure Infrastruc ture available and opera tional UNDP / WHO / MoH 20,000 Capacity building and raising awareness Relevant council staffs UNDP / WHO 32,500.00( National Healthcare Waste Management Strategic Plan # Objectives Measures / Actions Expected results 2016 2017 2018 2019 2020 2021 Responsible agency (ies) Budget USD and health facility staffs trained and awareness created / MoH 6,500 per atoll) Conduct stakeholders’ meeting to share the results of the pilot project Pilot project result shared with relevant stakeholders UNDP / WHO / MoH 2,000 Development of HCWM plans templates specific to the kind and level of institution Templates on HCWM plans are developed and dissemi nated Health Facili ties 0 3 Improving HCWM Plan ning and pro curement process Develop a proper procurement plan (annual plan) Annual plans are available RAHSD / MOH 0 Disseminate the specifications of the consuma bles/commodities/supplies Specifica tions are available and disseminated RAHSD / MOH 0 Calculation of annual budget needed for HCWM at each HCF and provided as a separate budget line. Annual op eration and maintenance costs are calculated and available. Healthcare facilities, councils, MoH, MoFT 0 4 Promote green pro curement and minimizing Developing a Resource Toolkit for Green procurement Green pro curement toolkit devel oped HPA and MoEE / EPA 2,500 National Healthcare Waste Management Strategic Plan # Objectives Measures / Actions Expected results 2016 2017 2018 2019 2020 2021 Responsible agency (ies) Budget USD waste Develop an E-Library for Green Procurement E-Library for Green Pro curement is accessible to for all facili ties Need basis 3,500 Developing Case Studies and Best practices Sharing of knowledge among stakeholders through an nual forums All relevant stakehold ers/HCF 0 Develop and share institutional SOP’s of a proper stock man agement to utilize the medi cines before the expiry date by exchanging within the units and wards (Hospital level) Institutional SOPs devel oped and shared MFDA / MoH 0 5 Improvement of Infectious Waste and Sharp Waste Management Set up a waste segregation sys tem based on guideline Proper seg regation sys tems are available in all HCF Health facili ties / MoH / RAHSD 16,800.00 (4200.00 per atoll) Establishment of waste storage facilities in accordance with national guideline (based on the needs) Storage are as for infec tious and sharp waste are available in all HCF RAHSD, MoH / HPA 206,800.00 (For one hospital 51,700.00) Establish treatment technolo gies depending on the waste Treatment technologies RAHSD, MoH / HPA 460,000.00 (per year National Healthcare Waste Management Strategic Plan # Objectives Measures / Actions Expected results 2016 2017 2018 2019 2020 2021 Responsible agency (ies) Budget USD generated for infectious and sharp waste are available and operational for all HCF 115000.00 6 Improvement of Pharma ceutical and Chemical Waste Man agement Establishment of storage areas for pharmaceutical and chemi cal waste in the HCF in accord ance with national guideline Storage are as for phar maceutical and chemical waste are available in all HCF MoH/ RAHSD/HPA 0 Ensure regular collection and treatment of pharmaceutical and chemical waste on regional/national level Regular col lection con tracted and contracts available MoH/MFDA / RAHSD / HPA 0 National Healthcare Waste Management Strategic Plan 1.4 Strategic Priority 4: Improving and adopting of national and local monitoring and evaluation process # Objectives Measures / Actions Expected re sults 2016 2017 2018 2019 2020 2021 Responsible agency (ies) Budget USD Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 1 Assessment of the current monitoring situation Develop assessment tools and user guideline (e.g. ques tionnaire, survey forms) Tools and guide line developed HPA / QAD 0 Conduct the as sessment of current monitoring situation Assessment re port is available and disseminated HPA / QAD 0 2 Strengthen report ing, monitoring, and evaluation mechanism on HCWM Develop monitoring tools and auditing tool Monitoring and auditing tools are available and shared with rele vant stakeholder HPA / QAD 1,500 Trial testing of the tool in 1 Atoll Trial test con ducted and weak points identified HPA / QAD 3,500 Finalize the moni toring and audit tools Tools are finalized and ready to use HPA / QAD 0 Training of focal points from all the health care facilities Focal points are trained and certi fied HPA / QAD 9,000 3 Regular monitor ing and evaluation of the Health Care Waste Manage ment system and Monitoring and providing feedback at least every 12 months Monitoring re ports generated and shared HPA/ RAHSD/QA 0 Develop and main- Web-based sys- HPA/MoH/NCIT 0 National Healthcare Waste Management Strategic Plan # Objectives Measures / Actions Expected re sults 2016 2017 2018 2019 2020 2021 Responsible agency (ies) Budget USD performance of the equipment tain the web-based information system / Integrate infor mation into National Information System tem developed / Information inte grated into Na tional Infor mation System National Healthcare Waste Management Strategic Plan 1.5 Strategic Priority 5: Resource Mobilization # Objectives Measures / Actions Expected re sults 2016 2017 2018 2019 2020 2021 Responsible agency (ies) Budget USD Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 1 Establish sus tainable fund ing sources Listing down pipeline projects Pipeline pro jects identified HPA / stakeholders 0 Identify co-financing possibilities Co-financing possibilities identified HPA / stakeholders 0 Donor Forum (local and international) Sustaining HCWM system MoH/WAMCO/MoEE 5,000 Undertake resource mapping of all health facilities and identify gaps in funding Resource map ping was done and gaps identi fied HPA/RAHSD, MoH 0 2 Budget com pletion Complete budget cal culation of the strate gic plan Budget calcula tion completed and reviewed MoH/HPA Approval of budget Budget ap proved MoH / MoFT National Healthcare Waste Management Strategic Plan