Table 3: Handling and Disposal of Wastes for Vaccine Extension Workers at Community level (Mid-wives, LHVs/LHWs, etc.) Type of Waste Handling of Material Prior to Use Handling of Used Material/Waste Storage/Disinfection of Waste Final Disposal Used syringes, Used gloves Extension workers/field staff should: Always use WHO AD syringes cannot be reused EPI allows only WHO AD syringes and these must be used with extreme safety pre-requisites There should not be recapping to avoid accidental pricking. There should not be double/multiple handling Waste should be segregated at source Avoid leaving unpacked syringes/sharps unguarded. In-charge should: Provide posters at needle exchange places indicating the methods of use and cleansing and disposal of waste. Collect the sharp waste generated in dedicated safety boxes for safe disposal. Wear non-pierce able gloves when handling the sharps. Discard sharps immediately after us into puncture-resistant safety boxes. Disinfect (him/herself & used equipment) as per recommended guidelines and procedure. All containers, safety boxes, and waste bags to be collected and sent for pit burial and burning (pit burning and burial will be carried out by the healthcare facility, eg, Basic Heath Unit) Note: For details, please refer to the Pakistan Hospital Waste Management Rules, 2005. Table 4: Handling and Disposal of Wastes for Tertiary Level Healthcare Facilities (BHUs/RHCs)
5: Summary of Environmental and Social Concerns during consultation Concerns Mitigation Measures Environmental Aspects No proper solid waste management system No proper disinfecting arrangements Poor hygienic condition of the health Lack of hygiene awareness and education in staff and community Unavailability of clean and safe drinking water Unavailability of safe sanitation facilities (latrines & drains) In to address the concerns mitigation options include effective cold chain management, proper handling and disposal of waste. Details on impacts and their mitigations are given in section 6 of this document. Social Aspects Unavailability of female staff Staff training and capacity building on public dealing Lack of awareness on basic health Accessibility problems due to poor transportation & road infrastructure Gender based violence issues Social problems in case of presence of staff Low numbers of health facilities Unavailability of mobile networks and CNIC for female community members In to address the concerns mitigation options include setting up of OSS at an accessible location, presence of female staff and an effective GRM. Details are given in section 6 of this document. Ensure supply side functions are gender sensitive, as far as possible in the circumstances. Consultations during Project Implementation Consultations will not be limited to one time interaction during ESMP preparation but will be an ongoing process and would continue throughout project implementation. These consultations will be carried out on a quarterly basis with the stakeholders including but not limited to the local NGOs/CBOs, concerned government departments, local administration and the community representatives. The overarching goal of consultations, beneficiary engagement, outreach and communications is to support and facilitate the design and implementation of the FATA TDP-ERP. Stakeholder consultations will take place during implementation through the following means: Social Mobilization at the community level Awareness campaign for all stakeholders and
regularly conducted for the NADRA OSS and FATA department of health staff. These trainings will developed by the NADRA’s training coordinator in consultation with the DoH ESM FP and will based on the WHO’s formats/documents. Table 8: Training Sessions and Schedule Training Session Learning Objectives Target* Groups Training Schedule 1. Vaccine administration, management (including procurement, quality and supply) and storage Understanding of WHO standards on vaccine constitution, reconstitution, temperature control, and related issues OSS and concerned BHU staff As per regular training schedules at the federal and FATA levels, and should be given adequate weightage in curricula of different trainings. 2. Environmental and Social Hazards associated with Health service provision Understanding of environmental issues, social conflicts and abandonments, legal obligations, environmental assessment, infection control, sharps handling, and waste disposal OSS and concerned BHU staff Same as above 3. ESMP implementation Understanding of implementation requirements and and responsibilities OSS and concerned BHU staff Same as above 5. Hospital Waste Management System Understanding of legal requirements, waste management system, roles and responsibilities, monitoring, reporting and record keeping. OSS and concerned BHU staff Same as 6. Social aspects of child health service Programs Awareness about the importance of basic health care and its long term benefits, Understanding the social barriers in accessing health programs. Provider’s attitude towards the women beneficiaries. Development of flexible schedules tailored to the availability of women. OSS and concerned BHU staff DoH
Annex 3: Names of the consultation participants representing NGOs and CBOs S.No Name Organization Designation 1 Adil FDMA( FATA Disaster Management Authority) Operation Officer 2 Hamayun Khan LHO( Lawari Humanitarian Organization) Coordinator 3 Adrian Thompson MSF (Medecines Sans Frontieres) Project Coordinator 4 Dr. Mian Naveed MSF (Medecines Sans Frontieres) Base Medical Doctor 5 Tariq Ali CDO/SWA (Community Development Organization Swabi) Team Leader 6 Irshed Ali HF (Hayat Foundation) Project Manager 7 Ishaq Israr HF (Hayat Foundation) Program Specialist 8 Shaista Bibi Asia Humanitarian Organization Grants Coordinator 9 Alamzeb Qazi (Holistic Understanding for Justified Research and Action) Program Officer DRR/FSL