PROPOSAL DISTRICT LEVEL CAPACITY BUILDING ON WASTE MANAGEMENT IN HOSPITAL (activity 1)

1. Project Title and Project Number District Level Capacity Building on Waste Management in Hospital Project number: Project Activity: 2. Background Medical 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 of nonincineration treatment technology so that it can 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.

3. Objectives The 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 Outcome a. 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 in Yogyakarta 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 Justification It 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 pollutants. 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. Methods a. Preparation meeting Discuss the policy of non-incineration health care waste management system with associated stakeholders. b. Coordination meeting Advocacy and technology familiarization for district stakeholders c. Training module & survey instrument development Developing 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 Health Observe 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 Up The 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 nonincineration treatment on improving medical waste management, with the objective to show to other health care facilities that they can replicate the project.

8. Time Schedule (biennium per semester) 2012 Sep Oct Nov a. Preparation b. Coordination c. Module d. Survey

Des

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

Budget Estimation District Level Capacity Building on Waste Management in Hospital No - Local Transport - Venue Hiring Item of Expenditure Calculation 15 persons 1 day 1 room 1 day Rp Rp Unit Cost 300,000 1,000,000 Amount 5,500,000 4,500,000 1,000,000 12,415,000 800,000 2,120,000 300,000 225,000 1,000,000 3,200,000 4,240,000 600,000 3,375,000 1,000,000 26,500,000 1 person 2 months Rp 10,000,000 Rp Rp Rp 300,000 1,000,000 1,000,000 20,000,000 4,500,000 1,000,000 1,000,000 10,090,000 2 persons 3 day s 2 persons 1 return 2 persons 1 return 2 persons 1 day Rp Rp Rp Rp 800,000 2,120,000 300,000 225,000 4,800,000 4,240,000 600,000 450,000

1 Preparation meeting (regulation discussion central stakeholders)

2 Coordination meeting (advocacy and technology familiarization for district stakeholders) A. Central - Per diem - Air transport Jkt-Jog-Jkt - Lump sum allow ance B. Prov ince - Local Transport - Venue Hiring 3 Training module & survey instrument development A. Hiring national consultant B. Module & Instrument Dev elopment Meeting - Local Transport - Venue Hiring C. Copy and binding 4 Survey with team from Hospital and District Health Office A. Central - Per diem - Air transport Jkt-Jog-Jkt - Lump sum allow ance B. Prov ince - Local Transport 15 persons 1 day 1 room 1 day 15 persons 1 day 1 room 1 day Rp Rp 2 persons 2 day s 2 persons 1 return 2 persons 1 return Rp Rp Rp

5 Others A. Communication B. Stationeries Total (in IDR) Total (in USD; assumption $ 1 = Rp 9,493) 1 pack 50 persons Rp Rp 500,000 20,000

1,500,000 500,000 1,000,000 56,005,000 5,900