GLOBAL ENVIRONMENT FACILITY UNITED NATIONS DEVELOPMENT PROGRAMME PROJECT DOCUMENT Project Title: Demonstrating and Promoting Best Techniques and Practices for Reducing Health- Care Waste to Avoid Environmental Releases of Dioxins and Mercury Project PIMSs Number: 2596 GEF Focal Area: Persistent Organic Pollutants with linkages to International Waters through OP 10 GEF Operational Programme: OP 14 with linkage to OP 10 Geographical Scope: Argentina, India, Latvia, Lebanon, Philippines, Senegal, Tanzania, Vietnam GEF Implementing Agency: United Nations Development Programme (UNDP) Project Executing Agency: United Nations Office of Project Services (UNOPS) Principle Cooperating Agencies: World Health Organization (WHO) Health Care Without Harm (HCWH) Duration of Project: 4 years Commencing: October 2006 Completion: September 2010 GEF Contribution US$ 10,326,455 Country co-financing US$ 9,753,437 Partner co-financing US$ 3,791,000 Total Co-financing US$ 13,544,437 Total Full-Project Budget US$ 23,870,892 PDF A US$ 25,000 PDF B US$ 699,948 Total Project Budget including PDF A and PDF B US$ 24,595,840 1 PROJECT SUMMARY The overall objective of the full Project, implemented by the UNDP, is to demonstrate and promote best practices and techniques for health-care waste management in order to minimize or eliminate releases of persistent organic pollutants and mercury to the environment. The Project will demonstrate the effectiveness of non-burn health-care waste treatment technologies, waste management practices and other techniques to avoid environmental releases of dioxins and mercury in seven strategically selected countries – Argentina, India, Latvia, Lebanon, the Philippines, Senegal and Vietnam – representing a range of income and indebtedness classifications, four of the six official U.N. languages and all of the world’s five development regions. In each participating country, the Project will develop best practice health-care waste management models through collaborations with at least one large hospital, as well as with an appropriate combination of smaller clinics, rural health and/or injection programs and pre-existing central treatment facilities. The selected model facilities and technologies represent a range of scenarios that serve to demonstrate the general applicability of the Project’s approach to a diverse set of global conditions. The Project will also lay the groundwork for sustainability, replicability and the scaling-up of best techniques and practices beyond the model facilities and the Project countries by establishing or enhancing national training programs, pursuing policy reform, developing replication toolkits and awareness-raising materials, and disseminating these materials nationally and globally. An additional component aimed at developing locally-produced, affordable, non-burn health-care waste treatment technologies will be executed in Tanzania. The Project’s ultimate goal is the protection of public health and the global environment from the impacts of dioxin and mercury releases. The Project presents the GEF with a strategic opportunity to effectively reduce the transport of these pollutants from the health sector to the global environment. The Project will achieve: (1) the establishment of model facilities and programs to exemplify best practices in health-care waste management, and the development of materials to facilitate replication; (2) the deployment and evaluation of commercially-available, non-incineration health-care waste treatment technologies appropriate to the needs of each facility or cluster; (3) the development, testing, manufacture and deployment of affordable, small- scale non-incineration technologies for appropriate use in small and medium-size facilities in sub-Saharan Africa, and preparation and dissemination of manuals for their manufacture, installation, operation, maintenance and repair; (4) the introduction of mercury-free devices in model facilities, evaluation of their acceptability and efficacy, and development and dissemination of awareness-raising and educational materials related to mercury; (5) the establishment or enhancement of training programs to build capacity for implementation of best practices and appropriate technologies beyond the model facilities and programs; (6) the review of relevant policies, seeking of agreement by relevant authorities on recommended updates or reformulations if needed, seeking of agreement on an implementation plan, and if appropriate, assistance in holding a policy review conference for these purposes; (7) the distribution of Project results on best techniques and practices to relevant stakeholders, dissemination of materials, and holding of conferences or workshops to encourage replication; and (8) the making available of Project results on demonstrated best techniques and practices for dissemination and scaling-up regionally and globally. The majority of Project activities will be completed in the first three years of the Project. The Project is consistent with the GEF Focal Area of Persistent Organic Pollutants (POPs) under Operational Program (OP) 14, and the GEF OP 10: the Contaminants-Based Operational Program of the International Waters Portfolio. Project activities consistent with OP 14 include: building capacity; strengthening policy and regulatory frameworks; strengthening monitoring capacity; developing capacity to assess technologies and management practices; developing and implementing public awareness, information and environmental education programs; facilitating dissemination of experiences and lessons learned and promoting information exchange; promoting access to, and the transfer of, clean and environmentally sound alternative technologies; and demonstrating viable and cost-effective alternatives to the processes and practices that lead to the release of POPs. OP 10 supports demonstration activities that prevent or reduce releases of mercury, in particular targeting technical demonstration and capacity-building projects to demonstrate alternatives to mercury-containing instruments and proper cleanup and management of mercury wastes; and to help raise awareness and serve as a means for encouraging use of best practices and the formulation of policies for innovative institutional approaches. The Project objectives build on the Stockholm Convention on POPs, the International Waters Global Programme of Action (GPA), the Strategic Approach to International Chemicals Management (SAICM) and the World Health Organization’s policies on safe health-care waste management and on mercury in health care. An ancillary benefit of 2 this Project is the improvement of health-delivery systems through the fostering of good health-care waste management practices, thereby contributing to the achievement of the U.N. Millennium Development Goals. During the PDF B, consultations were undertaken with stakeholders including representatives of the public and private sectors, health professionals and other relevant groups within civil society at local, national and global levels. These have identified technical needs and provided open discussion of assumptions, potential risks and barriers to success. The participating countries (except Tanzania) have already created National Project Steering Committees and National Working Groups to facilitate Project implementation, and have effective ownership of the Project. The full involvement of stakeholders, supported by the creation and improvement of education and training systems, will help to ensure that the adoption of best health-care waste management practices and technologies achieved by the Project will be sustained and replicated after the Project is completed. In addition to each country’s National Project Steering Committee and National Working Group, Project participation will also be facilitated through the Global Project Steering Committee (GPSC), the Global Expert Team (GET) and the National Consultants (NCs). Working collaboratively, these groups are tasked with identifying and solving any Project difficulties and ensuring institutionalization of the Project’s gains. The methods used during the Project will be replicable in other projects and other areas. The model of fostering local and national “champions” to ensure the sustainability and replicability of Project achievements long after official completion is one example of the Project’s replicable methods. It should be noted that the Project is not an investment project to reduce nationwide releases of POPs, but rather is intended to demonstrate barrier-reduction leading to replication of best environmental practices and technologies in facilities nationwide. While facility-level implementation will result in reductions of dioxins and furans at the local level, the widespread replication and sustainability of these practices and techniques, through barrier-reduction strategies such as national training programs and information dissemination, have the potential of producing even greater decreases in dioxin and furan releases nationwide. LIST OF ACRONYMS AAMMA Asociación Argentina de Médicos por el Medio Ambiente/Argentine Association of Doctors for the Environment BAT Best available techniques BEP Best environmental practices BMW Bio-medical waste CTF Central Treatment Facility DANIDA Danish Development Agency the GEF The Global Environment Facility GET Global Expert Team GLC Great Lakes Center (Chicago Great Lakes Center for Environmental and Occupational Safety and Health) GPA Global Programme of Action GPSC Global Project