Project activities Potential environmental and health impacts Proposed mitigation measures Institutional responsibilities Cost Estimates* Comments Site specific EMPs To mitigate imapcts of the interim , and central storage facilities To be determined 100,000 Sorting Risk of infection, contamination and injury to all persons exposed Daily training for staff on sorting methods Compliance with sorting required methods according to the good management procedures manual Ministry of Public Health Health care facility To be part of the operational budget of the jealth carse facility Training of all heath care facility staff Packaging and collection Risk of contamination (injury and infection) in the exposed population Risk of hazardous seepage Risk of contamination from biological and infectious wastes Visual and olfactory gene Application of good management techniques, as defined by the good management procedures manual Use of appropriate containers and bags Ensure complete sealing of waste infectious bags and boxes Acquisition of standardized consumable materials Ministry of Public Health Health care facility To be part of the collection and transport contract Standardized specifications and colors common in all health care facilities Interim refrigerated storage Poor space occupation Psycho-motor traumas Visual and olfactory problems Site identification Appropriate specific interim storage areas for each floor and service Application of good management techniques, as defined by the good management procedures manual Preparation of an environmental and social management plan Ministry of Public Health Health care facility 818,000 Central refrigerated storage facilities Concentration of contaminated waste in one area Potential risk of bacterial and viral propagation Visual and olfactory problems Risk of passengers and contamination Appropriate areas planning (sealed, water-tight, spacious, ventilated, appropriate lighting at distance from health activities), refrigerated Acquisition and regular maintenance of equipment restricting, restricted access of the facility, except for staff from the management and treatment company Cleaning and disinfection of storage after stored waste removal Ministry of Public Health Health care facility ANGed ANPE
Risk of contamination in natural environment (soil, air, water, fauna and flora) Site identification Intramural transport Risk of infection, contamination or injury to all exposed persons Contamination from collection carts Contamination of collection carts Contamination of elevators and stairwells Use of appropriate techniques, as defined by the good management procedures manual Use of appropriate intramural transport equipment Appropriate selection of transport times Carts cleaning and disinfecting Ensure cleanliness of elevators and/or stairwells after use Transport personnel must be trained and qualified to perform this task Ministry of Public Health Health care facility 630,000 Preference for IBC carts use Collection and extramural transport Traffic congestion around the facility Traffic congestion on roads and risk of accidents i.e., contaminated waste spills Application of good management techniques, as defined by the good management procedures manual Collection ensured by trained and qualified staff Bar codes and traceability, including remote monitoring (by GPS or a computer network) Compliance with hazardous substances transport regulations Optimization, as much of possible, of the transport itinerary, during off- peak hours and away from national roadways Private companies authorized by MEDD Cost borne by a private waste treatment company Approved company for HCW collection, transport and treatment Treatment (shredding + sterilization) and disposal in landfills Risk of injury and infections for all exposed staff Not appropriate for of wastes treatment required (burying) Risk of water and treated contaminated waste of spillage in case equipment malfunction Waste handling precautions Maintenance of equipment Proper area ventilation Waste treatment obligation in case of equipment malfunction (sub-contracting with companies by the Ministry of Environment and Sustainable Development for waste management) Private company authorized by MEDD ANGed Healthcare facility 6, 692,000 cost by Countepart funding Approved companies for HCW collection, transport and treatment
Environmental and Social Monitoring Framework Proposed mitigation measures Parameter Checklist Sites Data and/or measures Frequency of measurement Required norms and standards Responsibilities Cost ($) Sorting Quantities of HCW generated Healthcare facilities Weight scales Visual oversight One daily, during waste removal Decree no. 2008-274 of July 28, 2008 Good management procedures manual Healthcare staff DHPME (oversight) ANPE (oversight) Part of the budget of health care facilities Packaging Condition of filled bags and containers Labeling healthcare facility visual Twice a day Decree no. 2008-2745 of July 28, 2008 Good management manual of procedures Healthcare facility personnel (oversight) ) idem Interim storage Site cleanliness Every team and every floor visual Twice a day Decree no. 2008-2745 of July 28, 2008 Good management manual of procedures Healthcare facility personnel DHMPE (oversight) ANPE (oversight) idem Collection at healthcare facilities Condition of and cleanliness of sites after collection Hallways, stairwells and elevators used by IBC carts visual Twice a day Decree no. 2008-275 of 28 July 2008 Good management manual of procedures Healthcare facility personnel DHMPE (oversight) ANPE (oversight) idem Central refrigerated storage Cleanliness of area, temperature control Storage area Visual, thermometer Once a day Decree no. 2008-2745 of July 28, 2008 Good management procedures manual Healthcare facility personnel DHMPE (oversight) ANPE (oversight) idem Extramural collection and transport Condition of transport vehicle Conditions of containers Itinerary visual During each facility visit Law on transport of hazardous material Healthcare facility staff Part of the operaional
Roadmaps, dockets, registries Good management procedures manual ANPE (oversight) Private companies contract of the operator Treatment (shredding + steam sterilization) Machinery condition Quality of treated Quality of wastewater in ONAS network Atmospheric waste from vertical autoclave with shredder Vertical autoclave with shredder Treatment unit visual Treated analysis through germicidal and disinfection tubes Bacteriological waste analysis Air quality analysis Every semester Decree no. 2008-2745 of July 28, 2008 Tunisian Norm 106-02 Tunisian Norm 106-04 Private companies ANPE (oversight) part of the contract of the operator Disposal in landfills Quantity of treated HCW Landfills Weighbridge at landfills Every day Initialed register Private companies Healthcare facilities Part of the contract of the operator
Strengthening of ANPE through the hiring of an environmental engineer with experience in healthcare During project Compliance with required mitigation measures Cost of the institutional strengthening US$239,000 Training activity Participants Type of training Content EMP ANGed ANPE DHMPE Healthcare facilities HCW management approved companies Training on HCW separation, packaging and storage Regulatory requirements and practices as defined in the good management procedures manual Environmental Process, methods and equipment ANGed ANPE MEDD Ministry of Public health Consulting firms NGOs Training in equipment handling, operation and maintenance of interim and central storage facilities, and intramural and extramural transport Information seminars Information on available technology and HCW management good practices Environmental policies and program Regional healthcare section chiefs, Heads of HCW management units, doctors, nurses, and others, Laborers, Healthcare waste treatment service providers Cleaning, HCW management etc. Healthcare waste management supervisors All person involved in HCW management activities. Development of a training plan Training programs in waste sorting, storage, transport and handling of various types of HCW Strategies and objectives of the environmental policy in Tunisia and programs training cost US$522,000 activities Participants Type of training Content Organization of large-scale workshops ANGed ANPE DHMPE Healthcare facilities HCW management approved companies Preparation of an awareness-raising plan HCW minimization program Technical guides, brochures, didactic, billboards, etc. Regulatory requirements and good management procedures manual practices Total cost of awareness-raising US$252,000 Implementation timetable for the HCW components and sub-components activities
Project Activity Potential Impacts on the Environment and Health Proposed Mitigation Measures Institutional Responsibilities Cost Estimates Comments Dismantling and Collection Pollution of soil, surface and groundwater by accidental oil spills. Risk of injury/accidents for staff and laborers. Risk of contamination of and flora. Use of leak-proof retention tanks. Operations should be conducted qualified agents of specialized company. The collected substance should be stored in a tank or appropriate container. Precautions must be to ensure laborer and passenger safety. Good management procedures manual must be complied with for each operation. Holding entity. Private company Licensed company in handling of equipment containing PCB oils Transport to interim storage areas Traffic congestion. Risk of PCB oil seepage which can pollute the natural environment and public health along the transport route. Compliance with hazardous material transport regulations. Use of appropriate sealed containers to avoid seepage, equipped with leak-free collection system. Compulsory labeling for contaminated equipment. Private company Licensed companies specialized transport of hazardous material Storage Area Risk of contaminated debris spills which can pollute the natural environment (groundwater, surface water runoff, fauna and flora) and negatively affect public health The area must be closed off and well protected against human and animal intrusions. The area must be closed off and well protected against human and animal intrusions. Access doors must have locks , danger and restricted access signage The grounds must be divided into blocks separated by paths wide enough for container access and be inspected against leakage Each storage facility must be equipped with appropriate emergency equipment ANGed and/or a private company Preparation of ESIA required for future interim storage facility Drainage and liquid collection Risk of oil seepage. Laborers and agents can come into direct contact with contaminated oils during handling phases. Contamination of soil, surface water, fauna and flora. Precautions must be taken to ensure the safety of laborers and passengers The operation must be conducted by a specialized company qualified in this type of hazardous material handling Operations must be conducted using a leak- proof retention basin adapted to the equipment dimensions Allow sufficient time to complete drainage, i.e., until the last drop of oil has fallen on the equipment Private company Licensed company specialized in handling containing PCB oils equipment
400,000 (Technical Assistance) Compliance with the good management procedures manual Packaging Laborers and agents can come into direct contact with contaminated oils Rinse water can contaminate soils or infiltrate groundwater in ONAS network. This contaminated water poses a risk to local fauna and flora The operation must be conducted at the drainage site without removing the retention Compliance with the good management procedures manual Compulsory labeling If transformers are rinsed with a solvent, potential exposure to these solvents must be acknowledged and appropriate remedial measures must be taken. Private company Licensed company specialized in handling equipment containing PCB oils Secondary transport (land and sea) Traffic congestion Optimization of transport itinerary, avoiding peak hours and national roadways as much as possible Compliance with hazardous material transport regulations Private company Licensed company specialized in hazardous material transport Export and treatment of PCB equipment and waste to Europe Treatment will take place in a licensed and specialized facility MEDD ANGed Holding company Technical assistance required Site Risk of spreading pollution to other areas Risk of laborers contaminating Dust formation Risk of accident or spillage of contaminated debris during transport human health along transport routes which can pollute the natural environment and negatively affect human health along transport routes Environmental and geotechnical assessment of the contaminated area. Precautions must be to ensure laborers and passengers safety Collection and treatment of contaminated soil (considered PCB waste) in leak-proof and covered metal container Transport of this debris is considered hazardous material transport and must be in compliance with hazardous material transport regulations Treatment of this soil, debris and contaminated equipment Treatment of this soil, debris and contaminated equipment Compliance with the good management procedures manual Holding company Private company ANGed Authorities 154,,000 (environmental audits and site characterization 515,000 activities) Licensed and specialized company in of polluted soil Requirement to carry out ESIAs and EMPs for individual or group sites
Environmental and Social Monitoring Framework Proposed Mitigation Measures Parameter Checklist Sites Data and/or measures Frequency of Measures and Requirements to be enforced Responsibilities Cost (US$) Dismantling and collection Confirmation of PCB presence Leaks and oils Original site Oil analysis Visual One measure per treatment facility Presence of 50 ppm of PCBs in oil Holding entity ANGed Private companies US$ 200/position Site decontamination Contamination specifications Contaminated surface PCB concentration Original site Visual Olfactory Control and validation of contamination specification and environmental Final analyses following decontamination Based on study and survey Following decontamination works PCB presence ANPE Private companies Holding entities US$500/site Transport to interim storage site Transport vehicle Condition of substance container Visual Every transport operation Hazardous material transport law Authorities Private companies - Drainage and liquid collection Condition of retention basin Equipment to be used Operator safety requirements Original storage site Visual drainage operation ANPE Private companies - Packaging Equipment to be used Operator safety requirements Interim storage site visual Every packaging operation ANPE ANGed -
Institutional strengthening activities Preparation of a good management manual PMU months after loan signing PMU and ANGed Environmental audits PMU During project and prior to implementation PMU, ANGed and consulting firms Mitigation PMU (within ANGed) From project launch completion Implementation, monitoring, evaluation and organization of workshops during project implementation Monitoring PMU From Project completion Compliance with timetable and monitoring of compliance with mitigation measures Cost of Institutional Strengthening and awarenss US$558,000 Training Activities Participants Type of Training Content Timetable EMP ANGed ANPE MEDD Contaminated waste holding parties Private companies Seminars General project data, including plan and an environmental monitoring plan PCB Contaminated waste handling International law and agreement on PCB management and exports of hazardous waste First year of PCB management project plan Environmental process, methodology and equipment ANGed ANPE MEDD Consulting firms Private companies Seminars and public information day Information on PCB available management technologies and international management practices Periodically, during the first two years of project planning Environmental policy and program ANGed ANPE MEDD Holding entities Consulting firms Seminars and workshops Strategies and objectives of the environmental policy for PCB management In Tunisia Periodically, during the third year of project planning Training Cost and Technical Assistance US$271,000