therefore there is no requirement for land acquisition. Construction Phase Flora and Fauna The rehabilitation, refurbishment and upgrading of existing healthcare facilities result in some clearing and depletion of vegetation that could result in loss of tree/plant cover within the existing premises Soil and Land Pollution Earth-moving equipment such as excavators will be used in excavation work. This could potentially/temporarily decrease the drainage of the area resulting in water logging. The risk of accidental discharge of hazardous products, leakage of hydrocarbons, oils or grease from construction machinery also constitute potential sources of soils and water pollution. Vehicular Traffic Construction works will result in a higher volume of traffic around the healthcare facilities and within the neighborhood. This could result in obstruction of normal traffic, disruption of access of the community and road safety around the construction site. The noise and movement could also affect normal hospital operations while impacting patient well-being through noise and dust. Management Activities at construction sites will produce construction wastes such as excavated soils and cement bags, paint
: Implementation responsibilities by Component Strategies Activities Levels of implementation Who is responsible Objectively verifiable Indicators of verification Risk Assumptions 1.1 Develop National HCWMG Stakeholder Support 1.1.1 Organise national workshop to modify and validate the HWMG and set-up specific task groups National and District HCWMG modified and validated Report of the workshop availability of funds 1.2 Identify coordination 1.2.1 Set-up a National Steering Committee on HCWM Establishment of District Steering Committees National/District MOHS/DEHS Membership list, stipulation of objectives, scheduling of regular meetings Minutes of meetings held 1.2.2 Designate of a National/ District Coordinator Designate of HCWM Officers at Council National and District MOHS/DEHS/Council Job description with clear listing of tasks Name of coordinator required 1.3 Develop National and District evaluation and reporting system 1.3.1 Establish evaluation criteria for HCWM National and District MOHS/DEHS Established indicators Reports of indictors 1.3.2 Establishment of District Steering Committees Membership list, stipulation of objectives, scheduling of regular meetings Minutes of meetings held 1.4 Identify implementing agents 1.4.1 Designate of HCWM Officers at agencies Support private initiatives and partnership in HCWM National and District NGO/CBO Job description with clear listing of tasks Identifiable agent HCWM Officer Develop HCWM Legal and Regulatory Framework Develop HCWM guidelines and SOP National and District MOHS/DEHS 1.5 Make the general Television messages National and District NGO/CBO/ EHD/MoHS Reaching the public Presentation on
public aware of the risks linked to HCW Radio messages Posters in health facilities facilities National TV, Local radios 1.6 Support the execution of HCWM Plan Monitor the execution (national and local level) Evaluation of the HCWM POA (halfway and final) MOHS/DEHS/ Council Plan HCWM activities Plan HCWM activities develop Standardise HCWM Practices Enforce the use of colour containers for specific HCW at all facilities Organize national , and District level workshop for stake holders on HCWM practices National and District
Potential partners and field of intervention Delivery of essential health services and the fight against Ebola and proper waste management relies on the involvement of a wide range of actors -- public and private sectors, NGOs, and civil society. It is therefore necessary to establish a partnership framework to identify the roles and responsibilities of each category of actor. Table : Potential field of intervention Actors Potential field of intervention Technical services of the Government (MoHS) inform the and national authorities facilitate co-ordination of HCWM plan activities supply technical expertise develop guidelines for HCWM develop M&E execute control and monitoring of activities the health staff/supervisors monitoring and evaluation of HCWM Implementation of the service agreement over sees the planning process and implementing the recovery Directorate of Environmental Health and Sanitation Will monitor ESMF and EMWMP The government Coordinate the post Ebola recovery planning in all sectors City councils/district governments participate in the mobilization of populations ensure HCW are properly disposed in their landfill participate in training, monitoring and evaluation world bank project team & safeguard specialists .Conduct supervision Provide safeguard enhancement Ensure Policies are followed Conduct reviews Environmental protection Agency To ensure effective protection and management of the environment. Review and sub-projects according to EPA Act 2008 as amended in 2010 Issue EIA licenses Monitor the compliance level of projects Private operators Invest in HCWM (e.g., treatment, transport, disposal) Supervised and monitor by MHS operate as sub-contractors (City Assemblies / District Government Health Facilities) Monitor by MOHS NGOs and CBOs inform, educate and make population aware participate in / offer training activities Ministry of Works Provide Infrastructural development Min. of Lands, Housing, Country Planning and the Environment Provide primary disposal sites and landfill sites Directorate of Environmental Health and Sanitation Revitalization of the existing Public Health Aide Improve the implementation of the environmental strategy Primary Health Care Strengthen the existing community Health Worker cadre and their linkages to the Peripheral Health Units Directorate of Health System and planning Planning and supervision monitoring and evaluation (HMIS development, publication of the quarterly HMIS bulletin organization of special sector studies (NHA, health sector financing
Issues to consider ASPECT description Potential (under normal, abnormal or emergency situations, as required) Applicable Other and Guidance Rating Action required / Responsible party Status of measures The list of impact types is not exhaustive and will vary between projects (see additional guidance on page 2 of this How do the project activities interact with the environment in terms of the issues in the left hand column? E.g. Debris from bridge repairs falls into river; or New road reduces congestion in town centre What change (impact) would this aspect of the activity have on the environment? Impacts may be positive(+) or negative(-) E.g. Debris pollutes river; or Improved air quality, reduced noise List relevant legislation and regulations, related of the or contract and any relevant guidance Low, Medium or High – see the below Identify whether the impact can be controlled or influenced by UNOPS and if so, what action is required E.g. Erect shuttering to prevent debris falling into river, or incorporate green design, or to be managed by contractor on site according to REI Who is responsible, eg: A named person within UNOPS or Contractor Sign off the aspect once proposed actions and issues (i.e. planning 1. Transportation of materials to site, movement of construction crews 2. Establishment of a construction camp 1. Interference with traffic, obstructing patients and health service providers 2. Conflict between construction workers and community, inadequate welfare facilities for employees Public Health Act (2004) L H 1. Good planning of Route and time of movements, coordination with Hospital Management 2. Refer to UNOPS construction camp guideline GHS14. Have communication /consultation process with relevant stakeholders Project Manager (PM) Click here to enter text.
Landscape & visual impact, and cultural heritage Location of structures and placement of debris and materials Visual intrusion from works may affect the appearance of the scenery or interfere if structures of cultural or other significance UNOPS Guideline GEM 06 L Ensure hospital land ownership, consider appropriate scenery, culture and any other issues they may be important to the local population when siting works PM waste area selected together with staff operating the as well as hospital to ensure lower impact Ecology (habitats, flora and fauna) Clearing land for building incinerators Destruction of flora and fauna, damage to habitats, loss of endangered species Act (2008) M Keep to area, if available- choose lowest impact area for specific site PM of the dedicated area included in the SoW
Air quality (emissions and indoor air quality) 1. Handling of materials, excavations 2. Incineration process 1. Release of dust into the air and onto vegetation and building, occupational exposure, 2. Under designed, easy to use incinerator might not sufficiently destroy pathogens in highly infectious waste therefore contaminating surroundings e.g. through fall-out dust or residues. Act (2008) Public Health Act (2004) M H Watering down, covering materials e.g. during delivery, PPE and administrative controls to limit employee exposure. 2. UNOPS will supply lower temperature incinerator for the medium size Health centre incinerators. Host Government and Donor shall formally acknowledge that this is the practical solution they requested and commit to put in place training and other arrangements for identification and further treatment of waste that cannot be incinerated in these units. UNOPS shall impart skills for running and maintaining the units installed. Residual from low temperature incineration will be temporary Site PM with other partners providing “high tech” to cope with the gap
stored in the “sharp” pit Water (usage, discharges and risk of floods) Siting of incinerator, placing of material, removed soil Negative effect on drainage, erosion, siltation Local Act (2004) M Weekly inspection program (using attached form ) will identify issues that need correction. Site Click here to enter text. Interaction with existing waste on surface or in excavated materials. Spreading of contaminated areas, exposure of construction workers to disease. Public Health Act (2004) M Contractor to do risk assessment (refer to attached form - Health and safety system) if contamination is suspected. PM Click here to enter text. Energy (usage, source, cost etc) Design of Triage and incinerators, training and handover of facilities Damage to the environment because of poor energy source, Depletion of source energy resources Act (2008) M 1. Sustainable energy solution to be part of the design solution. Consideration for potential to use renewable/ clean, readily available source of energy. Consideration for local ability to maintain a solution with a particular energy source. PM de Montfort has been chosen because of its low fuel in terms of low running cost as well as easier
Materials (quantity and type used) 1. Materials supplied or disposed of by 1. Damage to environment from poor practices by supplier Act (2008) M 1. Use that are authorized by the local authority. Ensure that they employ friendly practices e.g at the quarry or where they dispose waste from the site. PM relevant included in the ToR for the of the works Waste 1. Generation of waste from construction process, 2. Considerations for waste management during operations of completed facility 1. Pollution from poorly managed waste. Lost opportunity to waste, 2. Contamination from poorly managed medical waste Local Act (2004) Public Health Act (2004) H 1. Segregate waste- do not mix hazardous waste such oil contaminated materials, cement washings, medical wastes with domestic waste. Separate reusable materials. Decide good practice for a site based on UNOPS guideline on waste management (GEM02), the health facility’s plan, also refer to ESMF document. PM protocols included in the ToR for the of the works Transport (transport / traffic plans) Construction of materials, personnel Causing traffic congestion, reducing access of service providers, the public or medical teams M Good planning of Route and time of movements coordination with Hospital management Site Click here to enter text.
Emergency Plan (Is a project one required?) Who would be the principal agency? Emergency situations arising during construction Damage to property, flora, fauna, injuries to personnel H 1. Prepare emergency preparedness plan: site evacuation, emergency numbers. Carry out awareness training, e.g. spill clean-up process, Including medical emergency if project get injured or start showing signs of Ebola infection. Test procedures through drills. PM here to enter text. 1. Employing personnel directly or through contractors, stakeholder consultations. 2. Getting service providers and procuring materials. 1. Some members of the community may be side lined in employment, consultations, etc. 2. Local personnel, contractors and suppliers may be side lined. UN gender policies, M M 1. UNOPS gender mainstreaming principles 2. Encourage participation of local personnel, contractors and suppliers may be side lined. Seek to develop local capacity. PM PM Click here to enter text. Click here to enter text. Click here to enter text.
S. Type of Waste Location Color coding End Treatment 1 Human tissue, body parts and placenta OT, Labour room, Wards . Infectious Clinical Waste Hazardous Poses a known or potential risk of infection including anatomical waste, Human tissue, body parts and placenta To be collected in red plastic bags kept in tight lid buckets Waste Unit site by collection covered vehicle Incinerator 2 Cotton, gauze dressing, Pop’s soiled with blood, pus and other human discharges. unsoiled dressing, gauze and cotton All OT, Labour rooms, Lab, ICU, Acute wards, Isolation wards . Infectious Clinical Waste Hazardous Poses a known or potential risk of infection including anatomical waste, diagnostic specimens, regent or test vials bucket lined with yellow plastic liners Waste Unit site by waste collection covered vehicle Autoclave 3 All types of plastics i.e. plastic syringes, I.V. lines, I.V. bottles, bags All wards and Infectious Clinical Waste Hazardous a known or potential risk of infection including anatomical waste, diagnostic specimens, regent or test vials buckets lined with yellow plastic liner 5% Hypo chlorite solution for 30 minutes site by waste collection vehicle Autoclave and shredding 4. Discarded medicines and Cytotoxic and heavy chemicals Stores Hormone and cancer treatment medicinal must be separated from other medicinal waste bucket with yellow plastic liners, Board site Sent by waste collection covered vehicle Deep burial Transport
9. Toxic drugs and expired drugs Kept at medical stores from Controlled must be denatured to render them safe and without value and then disposed of with other nonhazardous waste medicines. Kept in secured box in medical stores, then put in yellow bags Board site by vehicle No treatment required Microbiology and other pathological waste Labs Infectious Clinical Waste Hazardous Poses a known or potential risk of infection including anatomical waste, diagnostic specimens, regent or test vials lid bucket 5% solution for 30 minutes in drainage site by vehicle Auto Liquid from wards, Department and autopsy room All wards/ Autopsy rooms Infectious Clinical Waste Hazardous Poses a known or potential risk of infection including diagnostic specimens, regent or test vials and liquid waste lid bucket 5% Hypo chlorite for 30 minutes in drainage site by vehicle In Broken thermometers and All wards/ Infectious Clinical Waste Hazardous a known or potential risk of injure including radioactive waste Glass bottle with water Waste Unit site by vehicle Deep burial-
Chemicals used in disinfection All wards and Infectious Clinical Hazardous Poses a known or potential risk of infection including chemical reaction Waste 5% Hypo chlorite for 30 minutes in drainage site by vehicle In Heavy chemicals containers/ aero containers OT, Surgery Depts., other Depts. Infectious Clinical Waste Hazardous a known or potential risk of infection including chemical reaction collection 5% Hypo Chlorite for 30 minutes site by vehicle Mutilated in shredder Discarded expired infected or its products. Blood bank . Infectious Clinical Waste Hazardous Poses a known or potential risk of infection including blood tissue products waste Tight Lid bucket with 5%hypo chlorite solution 5% hypo chlorite solution for 30 minutes and liquid in main drainage site by vehicle Incinerator Card kitchen waste, papers, cartons Office, kitchen, store General Waste: These are waste that are not Tight Lid bag Burning pit site by vehicle Burnt in a burning pit Collection within the health-care facility Collection times should be fixed and appropriate to the quantity of waste produced in each area of the healthcare facility. General waste should not be collected at the same time or in the same trolley as infectious or other hazardous wastes. Waste bags and sharps containers should be filled to no more than three quarters full. Once this level is reached, they should be sealed ready for collection. Plastic bags should never be stapled but may be tied or sealed with a plastic tag or tie. Replacement bags or containers should be available at each waste-collection location so that full ones can immediately be