Waste Management Planning Process in St Louis - Sénégal

1. Waste Management Planning Process in St Louis - Sénégal P. Jaillard, AMP, CVP/PATH SIGN Meeting, Phnom Penh

2. Planning process, 5 steps • Situation analysis on vaccination safety • Training of contractors on incinerator building • Injection safety and waste management policy • Planning of waste management system • Implementation of waste management plan

3. Situation analysis (1) • EPI regional review (May 2002) • Interviews and observations ; • 1 regional health office, 5 district health office, 5 health centers, 33 health posts ; • Results on vaccination safety : • Use of both sterilizable, single use, AD material • Syringe re-used by 25% of health facilities • AEFI noticed by 86% of vaccinators / 6 months • 53% of health workers injured by needles / 12 months • 10% of HF use safety box; 42% use empty bottle • 8% use incinerator; 60% burn waste; 5% leave waste in open air

4. Situation analysis (2) • Injection safety national assessment (April 02) • Interviews and observations • 8 districts, 10 health center/post • Results : • No policy on injection safety and waste management; • 67% use sterilizable syringes; 58% equiped with sterilizer ! • 49% of health worker re-cap needles ; • 70% reporting needle stick injuriy ; • 45% of health facilities with used seringes/needles around; • 7,5% with fonctional incinerator; • 68% burn waste.

5. Training of contractors • June 2002, in Mpal (St Louis region) ; • 5 contractors pre-selected ; • 1 of them contracted for building ; • 2 incinerators tested (DeMontfort 8a, Medicin 400) ; • Trained on site by DeMontfort ingeneers ; • Registred for invitation to bid ; • Participation of Regional Service of Hygiene and Sanitation  discussion on implementation, monitoring and supervision process.

6. Planing workshop • September 2002 in Saint Louis • 2 regions, 5 districts, National Division of Prevention, partenairs (CVP, WHO, UNICEF) • Objectives : • To agree on the main points regarding the national policy on injection safety and waste management ; • To define plan of action for waste management in the districts of St Louis and Matam Region

7. Planing workshop (2) • Activities • Demonstration of AD syringes, safety boxes, needle removal/disposal, incinerators • Presentation on training and supervision issues • Discussion on disposal systems and training issues • Presentation of draft policy on sharps disposal • Round table discussion on policy issues ; • District planning of waste management system.

8. Planing workshop (3) • Main issues on policy making : • Use of AD syringes and safety boxes, • Use of needle puller coupled with protected pit, • Incinerators : installation, maintenance, training • Collection and transport of waste : integration, • Monitoring of waste disposal (n° of syringes/n° of boxes…), • Human ressources management : training, supervision, definition of responsabilities, • Community and local authorities must be involved (advocacy) • Sustainability to be prospected for each operational decision

9. Planing workshop (4) • Main issues on planning activity • Mapping of health facilities in the district ; • Evaluation of waste volume ; • Daily collection of waste in urban areas, monthly collection in rural areas ; • Needle removal/disposal and burning of syringes in remote areas ; • Definition of responsabilities for each level of waste management system ; • Has to be finalized in the districts and communicate to the region

10. Next steps • National policy on injection safety and waste disposal to be approved • Introduction of waste management in microplan • Mobilization of ressources for implementation • Invitation of contractors to bid (incinerators). • Test of needle removal/disposal in a small scale  By 2003, every district should have a functional waste management system