District Level Capacity Building on Waste Management in Hospital Proposal (Activity 1)

7/27/2019 District Level Capacity Building on Waste Management in Hospital Proposal (Activity 1)

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PROPOSAL

DISTRICT LEVEL CAPACITY BUILDING

ON WASTE MANAGEMENT IN HOSPITAL (activity 1)

1. Project Title and Project NumberDistrict Level Capacity Building on Waste Management in Hospital

Project number:

Project Activity:

2. BackgroundMedical waste, if not treated properly, represents a hazard to health care workers, patients, the public, and

the environment. This is a problem in Indonesia, where health care systems are improving but the medical waste

management systems have not been strengthened to the same extent. Indonesia has ratified the Stockholm and

Basel Conventions, in accordance to WHO Policy Paper on safe healthcare waste management (WHO 2004) also

supports the Stockholm and Basel Conventions. It also directs countries to develop and implement plans,

policies, legislation, and manual on safe medical waste management; allocate human and financial resources for

safe medical waste management and scale up the promotion of non-incineration treatment alternatives.

Article 5 of the POPs Convention urges countries to take measures to further reduce releases of POPs from

unintended production with the goal of their continuing minimization and, where feasible, ultimate

elimination. Article 11 require parties within their capabilities, at the national and international levels, to

encourage and/or undertake appropriate research, development, monitoring and cooperation pertaining to

persistent organic pollutants and, where relevant, to their alternatives including on their sources and releases

into the environment, and release reduction and/or elimination. Indonesia has ratified the Stockholm

Convention on Persistent Organic Pollutants (POPs) and thus has obligations to implement the Convention

including support for alternative technologies.

. Indonesia has relied on incinerators as medical waste treatment, although alternative technologies have

been used for decades in many industrialized countries in place of medical waste incinerators. Monitoring and

evaluation of health care waste management in Indonesia has reported many problems with smallscale

incinerators but little familiarity with alternative technologies. The problems reported include the poor physical

state of smallscale incinerators constructed onsite in several hospitals, low capacity of incinerators, complaints

from local communities about the smoke, low efficiency in reaching the desired burning temperature because

the high cost of the fuel used to operate the incinerator, and it is tricky to have operational license of

incinerator.

Steambased systems such as autoclaves can be used to disinfect infectious waste. They are effective and

also avoid the dioxin and furan emissions associated with medical waste incinerators. However, the technique is

hardly used in Indonesia, partly because there is little experience with the technique. This capacity building

therefore intended to demonstrate how autoclaving as non-incineration waste treatment technology could be

employed in a typical Indonesian District Hospital that of Yogyakarta.

It will take almost a year to design, construct, test, train, and evaluate the technologies and management on

non-incineration health care waste treatment. The capacity building at a hospital in one of the Indonesia district

therefore proposed in order to demonstrate an alternative ofnonincineration treatment technology so that itcan be evaluated, and the experience gained on Indonesian setting can guide countries in developing the

national plans and facilitate the rapid and successful deployment of the technologies.


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3. ObjectivesThe main objective of this activity is to advocate, install, demonstrate, train, and evaluate the management

of non-incineration health care waste treatment technologies on Indonesian District Hospital in Yogyakarta

Province.

4. Expected Outcomea. To elevate knowledge of the workers in non-incineration health care waste management system.b. To act as a showcase for best environmental technology to minimize or eliminate the release of dioxins and

furans (PCDD/PCDF), NOx, SOx, and CO.

c. To assist in improving the health care waste management system on Indonesian District Hospital inYogyakarta Province.

d. To identify design issues that could be incorporated into the Indonesian setting.e. To facilitate the development of a recycling system for plastics and other recyclable waste.

5. Challenge and JustificationIt is a signatory to the Stockholm Convention on Persistent Organic Pollutants (POPs), a global convention

with the aim of eliminating some of the most longlived anthropogenic po llutants. The Convention has listed

polychlorinated dibenzopdioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs) among initial 12 POPs

and, under Annex C, cites incineration of medical waste as one of the major source of PCDDs and PCDFs. The

wastes that are treated in these incinerators include plastic materials, especially polyvinyl chloride (PVC), whose

incineration is strongly associated with emissions of dioxins and furans. Incineration of medical waste can also

lead to release of heavy metals (e.g. mercury, from broken thermometers, or lead or cadmium from plastics) and

acid gases, such as sulphur oxides, hydrogen chloride, nitrogenous gases and particulates. These toxins, if not

trapped in pollution control devices, will be released into the air. Liquid effluent from air pollution devices can

carry pollution into water bodies. Moreover, incineration ash needs to be disposed of as hazardous waste as it

contains heavy metals and persistent organic pollutants. If it is not disposed of in secured landfills, it can

contaminate soil and groundwater. These routes can all lead to food chain contamination.

6. Methodsa. Preparation meeting

Discuss the policy of non-incineration health care waste management system with associated stakeholders.

b. Coordination meetingAdvocacy and technology familiarization for district stakeholders

c. Training module & survey instrument developmentDeveloping module to guide and train the workers to elevate their knowledge on non-incineration health

care waste management system.

d. Survey with team from Hospital and District HealthObserve hospital waste management system by sampling the air quality in hospital before the

implementation of non-incineration health care waste management system.

7. Evaluation and Follow UpThe project will be monitored on the benefits of non-incineration health care waste management. It is also

will be evaluated after the being implemented and the treatment operation procedure will be reported whether

is effective and efficient or not. Workshop will be held to show the effectiveness and efficiency of non-

incineration treatment on improving medical waste management, with the objective to show to other health

care facilities that they can replicate the project.


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8. Time Schedule (biennium per semester)2012

Sep Oct Nov Des

a. Preparationb. Coordinationc. Moduled. Survey

9. Detailed Budget (attached)Total 55,005,000 IDR (5,917 USD)


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No Item of Expenditure Amount

1 Preparation meeting (regulation discussion central stakeholders) 5,500,000

- Local Transport 15 persons 1 day Rp 300,000 4,500,000

- Venue Hiring 1 room 1 day Rp 1,000,000 1,000,000

2 Coordination meeting (advocacy and technology familiar ization for distr ict stakeholders) 12,415,000

A. Central

- Per diem 2 persons 2 day s Rp 800,000 3,200,000

- Air transport Jkt-Jog-Jkt 2 persons 1 return Rp 2,120,000 4,240,000

- Lump sum allow ance 2 persons 1 return Rp 300,000 600,000

B. Province



3 Training module & survey instrument development 26,500,000

A. Hiring national consultant 1 person 2 months Rp 10,000,000 20,000,000

B. Module & Instrument Dev elopment Meeting



C. Copy and binding Rp 1,000,000 1,000,000

4 Survey with team from Hospital and District Health Office 10,090,000

A. Central

- Per diem 2 persons 3 day s Rp 800,000 4,800,000

- Air transport Jkt-Jog-Jkt 2 persons 1 return Rp 2,120,000 4,240,000

- Lump sum allow ance 2 persons 1 return Rp 300,000 600,000

B. Province

- Local Transport 2 persons 1 day Rp 225,000 450,000

5 Others 1,500,000

A. Communication 1 pack Rp 500,000 500,000

B. Stationeries 50 persons Rp 20,000 1,000,000

Total (in IDR) 56,005,000

Total (in USD; assumption $ 1 = Rp 9,493) 5,900

Budget Estimation

District Level Capacity Building on Waste Management in Hospital

Calculation Unit Cost

Documents

District Level Capacity Building on Waste Management in Hospital Proposal (Activity 1)