Health care waste management in the context of COVID-19 in Lao PDR

1. Healthcare Waste in Lao
PDR
Key findings and analysis
THONGDEUANE NANTHANAVONE
Learning from China’s Experience to Improve the Ability of
Response to COVID-19 in Asia and the Pacific Region
Regional Summary Workshop
27-28 October 2022
1

2. PEOPLE
AWARENESS, TRAINING AND SUPPORTIVE
SUPERVISION
ADHERENCE AND COMPLIANCE
2

3. AWARENESS, TRAINING & SUPPORTIVE SUPERVISION
• All provincial and district hospital
has the infection prevention and
control committee or IPC,
• Most of the IPC members
received trainings on various
HCWM topics,
• The IPC provided trainings and
supervision support to their staff,
developed guidelines, posters,
and SOPs for their own facility.
3

4. 4
Three broad categories of training
• On new laws regulations/guidelines
• Project specific support training.
• For example, “GDF project” training on WASH FIT to
21 HCFs
• When new equipment is distributed.
• However, sometime the training is not adequate,
back stop support is needed. Often this is not
happening due budget constraint
It is important to note that most provincial
hospitals have contracted a private company to
provide sanitation/cleaning services. Target for
training should also include their staff
AWARENESS, TRAINING & SUPPORTIVE SUPERVISION

5. 5
ADHERENCE AND COMPLIANCE
perform
well
partially
well
perform
poorly
no
record
Waste
segregates at
source
60% 11% 2% 27%
Waste collection 70% 8,33%) 13,33% 8.34%
Waste Storage
Sites
43,75% 4,16% 18,75% 33,34%
Infectious Waste
Management
29% 4.91% 16.08% 50%

6. 6
ADHERENCE AND COMPLIANCE
SURVEY: 1223 HCFS INCLUDING PH, DH AND HC (WHO, 2021)

7. 7
PROCESSES
NATIONAL POLICIES AND STRATEGIC PLANS
BUDGET AND PLANNING
PRACTICAL GUIDANCE

8. 8
PROCESSE
S
NATIONAL POLICIES AND STRATEGIC PLANS; BUDGET AND PLANNING PRACTICAL
GUIDANCE
Laws, regulations, administrative orders, etc.
1. Law on Immunization 2018, Article 30: Destruction of Vaccines and Immunization Equipment.
2. Law on Prevention and Disease Control 2017, Article 17: Hygiene and Environment Protection.
3. Law on Health Care 2014, Article 23: Medical Materials and Equipment.
4. Ministerial Decision on Environmental and Hygiene at Health Facilities 2018.
5. Ministerial Instruction on Hazardous Waste Management 2015.
6. Regulation on National Biosafety 2019.
7. the Minister of Health’s Decision on Health-care Waste Management 2017
National policy on HCW
1. National Policy for Health Laboratories 2012 (MoH)
National strategy on HCW
1. National Pollution Control Strategy and Action Plan 2018-2025, with Vision to 2030 (Full draft
#16), Chapter I.3.6: Hazardous Waste.
National action plan or Implementation plan
1. National Deployment and Vaccination Plan for COVID-19 Vaccines, Chapter 7.2: Biohazard and
Immunization Waste Management (May 2021, MOH)
Technical guidelines
1. Guideline on Hygiene and Disinfection for COVID-19 Prevention 2021 (Department of Hygiene
and Health Promotion, MOH).
2. National Guideline for Domestic Specimen Packaging and Transportation 2020 (National Center
for Laboratories and Epidemiology, MOH).
3. Guideline on Sharps Waste Management 2019 (Department of Planning and Cooperation, MOH).
4. National Laboratory Quality Standard 2018 (National Center for Laboratories and Epidemiology,
MOH).
5. Guidelines on National Biosafety 2016 (National Center for Laboratories and Epidemiology,
MOH).
6. Guideline on Prevention and Infectious Control at Primary and Secondary Healthcare Facilities
2016 (Department of Healthcare and Rehabilitation, MOH)

9. BUDGET AND PLANNING
KII and survey findings show that
• All provincial hospitals and Covid-
19 treatment centers faced
insufficient budget for HCWM.
• 21 HCFs surveyed reported
insufficient budget
• Budgeting process has not been
based on need assessment, partly
because there is no good quality
statistics but also the funding is
simply not available even with
“evidence-based” budgeting.
9
Source: WB
2017

10. PRACTICAL GUIDANCE
10
PROCESSES
Compliance to WHO international guidelines Section Yes/Partially/No
Definitions of HCW categories 2 Yes
- Minimum approach to segregation, storage and transport 7.8 Yes
- Guidance for waste minimization, reuse and recycling 6 Yes
- Guidance for safely collecting HCW within health-care
facilities
7.3 Yes
- Guidance for interim storage within medical departments 7.4 No
- Guidance for onsite transport of waste 7.5 Yes
- Guidance for central storage within health-care facilities 7.6 Yes
- Guidance for offsite transport of waste 7.7 Partially
- Guidance on permissible waste treatment technologies for
specific waste categories?
o Sharps
o Pathogenic
o Chemical
o Pharmaceutical
o Cytotoxic
o Waste containing heavy metals
8.11 Yes
- Guidance on minimum approach to treatment and disposal 8.13 Yes
- Guidance on collection and treatment of wastewater from
health-care facilities
9 Partial

11. TECHNOLOGY
AVAILABLITY AND USE OF TECHNOLOGY AND
EQUIPMENT
11

12. TECHNOLOGY AND EQUIPMENT - AVAILABILITY &
USE
12
Central
hospita
l
province
hospital
district
hospital
Health
Center
Total
Total
Hospital
8 17 135 1,074 1,234
Hospital
with
autoclave
8 17 78 n/a 103
% with
autoclave
100% 100% 58% n/a

13. TECHNOLOGY AND EQUIPMENT - AVAILABILITY &
USE
13
Commonly observed
healthcare waste
treatment technologies
• Medium temperature
incineration
• Low temperature
incineration
• Waste burial
• Steam autoclave and
• Chemical disinfection

14. BENCHMARKING
NATIONAL HEALTH CARE WASTE MANAGEMENT
SYSTEM
BENCHMARKED AGAINST THE GAVI MATURITY
MODEL
14

15. BENCHMARK AGAINST GAVI MATURITY MODEL – LAO
PDR
9
P
EOPLE
1. Awareness,
Training, and
Supportive
Supervision
3
2. Adherence and
compliance
2
P
ROCESSES
3. National Policy and
Strategic Plans
3
4. Budget and
Planning
2
5. Practical Guidance
(HCWM)
2
T
ECHNOLOGY
6. Technology and
Equipment
Availability and
Use
2
Total Score 14
Overall Score (14/6) 2.3

16. RECOMMENDATIONS
• PEOPLE
• PROCESSES
• TECHNOLOGY
16

17. RECOMMENDATIONS: PEOPLE
• Provide training on waste
management and disposal to the
IPC, health staff, and cleaners in all
HCFs.
• Develop a facility specific annual
plan for health care waste
management and disposal including
monitoring and evaluation system
17

18. RECOMMENDATIONS:
PROCESSES
• Develop and update guidelines,
SOPs and communication
materials of HCWM, covering a
whole process of HCWM
18

19. RECOMMENDATIONS:
TECHNOLOGY
• Provide autoclave to all HCFs that
do not have one yet, including
training of use and maintenance
• Help build a wastewater
treatment model that can be
scaled up
19

20. 9
BENCHMARK DRR SCORING AGAINST GAVI MATURITY
MODEL
55%
46%
29% 29%
39%
27%
23%
20%
27%
39%
27%
38%
20%
29%
36%
30%
27%
34%
2% 0% 2% 0% 0% 0%
0%
20%
40%
60%
80%
100%
120%
Awareness, training
and supportive
supervision
Adherence and
compliance
National
policy/strategic
plans
Budget and
planning
Practical guidance Technology and
equipment
availability and use
Level 1 Level 2 Level 3 Level 4 Level 5

21. THANK YOU!
TD.NANTNANAVONE@GMAIL.COM