1. National Orientation Guide: Initial Assessment and Operational Planning Sept 23, 2013

2. PEPFAR Implementing Partner Introduction to Initial Assessment and Operational Planning Your responsibility as National Health Care Waste Management (HCWM) Activity Manager includes developing a HCWM Operational Plan for your country that addresses the entire HCWM cycle. That operational plan for HCWM must be based upon data from an initial assessment which provides details about your country. The Voluntary Medical Male Circumcision (VMMC) Initial Assessment Tools facilitate the collection of data about the country’s: infrastructure, tools, systems, processes, and human resource capacity. HCWM enabling environment (i.e., relevant legislation and regulations, and the role of key stakeholders). problematic issues and gaps. Your analysis of the data from the initial assessment will enable you to prioritize actions for creating a realistic and implementable HCWM Operational Plan. 2

3. PEPFAR Implementing Partner Topics Covered in This Module How to conduct an initial assessment How to draft a HCWM Operational Plan 3

4. PEPFAR Implementing Partner Module Objectives After completing this orientation, you will: be able to use the VMMC Initial Assessment Tool to gather critical information needed to develop a robust, actionable HCWM Plan to guide campaign planning and implementation. know how to develop a HCWM Operational Plan that is customized to fit into your country’s overall VMMC campaign strategy. be familiar with the HCWM training modules available and the mechanism for cascading HCWM training to staff at all levels of the campaign in order to be able to include that information in the HCWM Operational Plan. 4

5. PEPFAR Implementing Partner SOPs Associated with This Module SOP-PQAU001-001 HCRW Worker Health & Safety SOP-PQAU001-002 Incident Management SOP-PQAU001-003 Injury on Duty and Needle-stick Injury Procedures SOP-PQAU001-004 General and Antiseptic Hand Hygiene SOP-PQAU001-005 Decontamination of General Surfaces SOP-PQAU001-006 Decontamination of Disposable Metal Instruments SOP-PQAU001-007 Sterilization of Reusable Instruments. SOP-PQAU001-008 Identification, Segregation & Packaging SOP-PQAU001-009 Handling & Packing Procedures SOP-PQAU001-010 On-site Transport SOP-PQAU001-011 Spill Management SOP-PQAU001-012 Storage Criteria & Guidance SOP-PQAU001-013 Waste Quantification SOP-PQAU001-014 Document Flow SOP-PQAU001-015 HCRW Transport Requirements SOP-PQAU001-016 Transport Emergency Response 5

6. PEPFAR Implementing Partner Resources for Conducting an Initial Assessment and Creating a HCWM Operational Plan VMMC Guidance Document: Developing a health care waste management plan VMMC HCWM Initial Assessment Tools Roll-out Scheme for All HCWM Training National Orientation Guide: Preparing to Roll-out HCWM Training at MC Sites ( which includes): Customization Guide Trainers’ Guide Eight HCWM Training Modules with tests 6

7. PEPFAR Implementing Partner The Resources 7

8. PEPFAR Implementing Partner Topic 1: How to Conduct an Initial Assessment 8

9. PEPFAR Implementing Partner Introduction to the Initial Assessment HCWM activity contexts can vary significantly from country to country. Even before a HCWM Plan for a VMMC campaign can be created, an Initial assessment must be conducted to help determine the full country context. That initial assessment results in: an understanding of the country’s infrastructure requirements. the identification of relevant in-country regulations, policies and guidelines. an understanding of the strengths and weaknesses of the existing HCWM and environmental hygiene system in the country. The initial assessment is conducted using MS Excel based VMMC HCWM Initial Assessment Tools. 9

10. PEPFAR Implementing Partner The Initial Assessment Tools Data collected using the VMMC HCWM Initial Assessment Tools provide you with a better understanding of what is required to create a HCWM Operational Plan that: can be implemented and managed correctly. is based on achievable timelines. allocates resources for cost-effective solutions. 10

11. PEPFAR Implementing Partner Background About the Initial Assessment Tools These tools were adapted from the "Health Care Waste Management Rapid Assessment Tool" (RAT) developed by the World Health Organization (WHO) and the United Nations Environment Programme (UNEP). 11 The Initial Assessment Tools expand upon the RAT by including key stakeholders outside the health care establishment, adopting a cradle-to-grave approach to waste management and including environmental hygiene.

12. PEPFAR Implementing Partner Sections of the Tools 12

13. PEPFAR Implementing Partner How to Use the Initial Assessment Tools 1.Review the “about the tool” and “preparation” sections. 2.Go through each tool (A1 through G) to make sure you understand the questions. 3.Establish contact with target stakeholders well in advance of your assessment/visits. Describe the purpose of the assessment, anticipated duration of visit and how the results will be used. 4.During the assessment visit, engage relevant stakeholders by using tools A1-A2, B, C1-C6 and D. (If relevant for your country, also answer the questions in tools E, F and G). 13

14. PEPFAR Implementing Partner How to Use the Initial Assessment Tools 5.Data collected should be as complete, brief and precise as possible. 6.The data can be captured as: [B] Boolean (yes/no) [C] multiple choice [T] text [N] numerical (quantitative) [Q] qualitative (ranking from 1-5). 7.Seek assistance from appropriate national or international experts/groups before conducting the proposed assessment if you do not have the appropriate expertise and experience. 14

15. PEPFAR Implementing Partner Analysis & Reporting of Data from the Initial Assessment Tools Once you have completed your initial assessment, results should be entered into a database for manipulation and analysis. Additional comments and observations should be coded, if feasible, for qualitative analysis. Results from this initial assessment will directly feed into the various sections of your HCWM Operational Plan. 15

16. PEPFAR Implementing Partner Time required for Initial Assessment It should be possible to gather the essential data necessary from key stakeholder groups to create a comprehensive and achievable HCWM Operational Plan within approximately 2 weeks. 16

17. PEPFAR Implementing Partner Review of the Initial Assessment Tools 17

18. PEPFAR Implementing Partner Topic 2: How to draft a HCWM Operational Plan 18

19. PEPFAR Implementing Partner Introduction to Drafting a HCWM Operational Plan Operational planning is the process of identifying and scheduling implementation activities to achieve campaign objectives. While developing the HCWM Operational Plan for your country, you will be performing the operational planning required to help your country’s VMMC campaign achieve its HCWM objectives. 19

20. PEPFAR Implementing Partner Crucial Elements of a Successful HCWM Operational Plan Realistic timelines to achieve objectives within a 12- month period. A country map in which all potential and feasible high- impact VMMC sites are plotted in relation to existing HCFs, and treatment and/or disposal facilities or sites. A site map of each feasible MC site that clearly defines the point of waste generation within the sites (e.g., blood drawing area, operating theater, testing area, or recovery area, etc.). Outline of HCWM product requirements and minimum specifications. 20 More Crucial Elements

21. PEPFAR Implementing Partner Crucial Elements of a Successful HCWM Operational Plan Detailed procedures, communications materials, and training requirements related to the identification, segregation, packaging, storage, transport, treatment, and/or disposal of HCW. Requirements for a monitoring and evaluation plan, including an incident reporting system. Selection of environmentally sound treatment and/or disposal methods. An organizational chart (organogram) including staffing requirements and delineated roles and responsibilities. 21

22. PEPFAR Implementing Partner Sections of a HCWM Operational Plan Executive Summary Background on the country’s VMMC Campaign Campaign Scope Campaign Charter Current Medical Waste Handling and Treatment Procedures and Regulations Plans to address identified shortcomings HCWM Implementation Plan Procedures and training requirements Monitoring and evaluation plan Incident Management System HCWM product requirements and specifications Treatment and/or disposal methods Roles and Responsibilities Stakeholder communication plan 22 Campaign Activity Schedule Budget HR Plan Organizational Chart Hiring Plan Training Plan Annexes Country map showing planned MC sites Site maps of each planned MC site Commodity List.

23. PEPFAR Implementing Partner Steps to Developing a HCWM Operational Plan Develop the components in the following order: 1.HCWM activity schedule 2.HCWM budget 3.Human resources plan 4.HCWM Campaign charter 5.Stakeholder communication plan The “Voluntary Medical Male Circumcision Guidance Document: Developing a health care waste management plan” document provides detailed guidance on how to create these 5 sections of a HCWM Operational Plan. 23

24. PEPFAR Implementing Partner The Campaign Activity Schedule HCWM activity schedule contains a breakdown of each activity and how it relates to other activities. Each activity should define the following key characteristics: Number of people needed to complete the activity Activity duration Non-human resources needed to complete the activity When during implementation an activity should take place Estimated cost to complete the activity Dependencies of this activity in relation to other HCWM activity activities (i.e., whether other activities are dependent on an activity ending before they can begin, or vice versa) 24

25. PEPFAR Implementing Partner The HCWM activity Budget The HCWM activity Budget should contain each activity’s estimated costs (from the HCWM activity schedule) combined into an overall budget. 25

26. PEPFAR Implementing Partner The Human Resources Plan The HR plan ensures that the team has enough staff on board and trained in time for each activity at the appropriate times and places. An organizational chart helps clarify the reporting relationships and roles and responsibilities. 26 Director of Clinical Services (national) Clinical StaffOrderlies Infection Control Officer VMMC Site Manager (Site) Non-Clinical Staff (Site) Campaign Infection Control Manager(national) Central Warehouse Manager(national)

27. PEPFAR Implementing Partner Example of a Campaign Charter 27

28. PEPFAR Implementing Partner Campaign Scope The campaign scope can be defined in terms of target population, sites or other criteria important to the stakeholders. Clarifying what is not in the scope of the HCWM activity is just as important as outlining what is in the scope. 28

29. PEPFAR Implementing Partner The Stakeholder communication plan A Stakeholder Communication Plan can be based on a stakeholder registry matrix. The matrix displays data from the initial assessment to identify key HCWM activity stakeholders and how and when to communicate with these stakeholders. 29

30. PEPFAR Implementing Partner Review of Guidance Document on Developing a Health Care Waste Management Plan 30

31. PEPFAR Implementing Partner Example of Data from Initial Assessment Analyzed and Incorporated into the HCWM Operational Plan C5 of the Initial Assessment Tool asks the following questions about each specific healthcare facility: 31 No.TopicQuestionTypeDataComments/Multiple Choice 1711 For HCF with incinerators only Does this HCF have an incinerator on-site? B Enter "0" [zero] if not available. 1712 For HCF with incinerators only Is the incinerator fully functional? B If no, record any issues (e.g. maintenance contract not in place, fuel shortage, funding shortage, spare parts not available, damaged chamber). 1713 For HCF with incinerators only How often is the incinerator used? C [0] not functioning; [1] daily; [2] at least once a week; [3] twice a month; [4] once a month; [5] less than once a month; [6] other, specify: 1714 For HCF with incinerators only What is the current incinerator capacity (in kg/day)? N Enter "0" [zero] if not functioning. Example continued

32. PEPFAR Implementing Partner If the answers for MC Site X are as shown below… 32 No.TopicQuestionTypeDataComments/Multiple Choice 1711 For HCF with incinerators only Does this HCF have an incinerator on-site? B Yes Enter "0" [zero] if not available. 1712 For HCF with incinerators only Is the incinerator fully functional? B No damaged chamber If no, record any issues (e.g. maintenance contract not in place, fuel shortage, funding shortage, spare parts not available, damaged chamber). 1713 For HCF with incinerators only How often is the incinerator used? C 0 [0] not functioning; [1] daily; [2] at least once a week; [3] twice a month; [4] once a month; [5] less than once a month; [6] other, specify: 1714 For HCF with incinerators only What is the current incinerator capacity (in kg/day)? N 0 Enter "0" [zero] if not functioning. Example of Data from Initial Assessment Analyzed and Incorporated into the HCWM Operational Plan Example continued

33. PEPFAR Implementing Partner Based on those assessment results, the HCWM Operational Plan would include the following in the sections listed below: Section on Current Medical Waste Handling and Treatment Procedures Incinerator assessed at site X is not operational and cannot be repaired – it needs to be replaced. Section on Plans To Address Identified Shortcomings Purchase and install new incinerator (250+ kg/hr burn rate) for site X Section on Budget Costs associated with the purchase and installation of the new incinerator and to provide adequate staff and pay scale to operate the incinerator at site X 33 Example of Data from Initial Assessment Analyzed and Incorporated into the HCWM Operational Plan Example continued

34. PEPFAR Implementing Partner Example of Data from Initial Assessment Analyzed and Incorporated into the HCWM Operational Plan Section on Roles and Responsibilities (Recommending which individuals or organizations should be responsible for completing these tasks) Complete purchase and installation of new incinerators (250+ kg/hr burn rate) for site X Contract with an incinerator manufacturer for a two-year service- level agreement for incinerator maintenance and repair. Arrange for removal of old incinerator from Site X Provide adequate personnel and pay scale to operate the incinerator at site X Contract with an incinerator manufacturer to provide semiannual comprehensive training on operation, safety and maintenance of incinerators. All activities associated with the new incinerator at MC site X would be included in the implementation timeline. 34

35. PEPFAR Implementing Partner Summary The National HCWM Activity Manager develops a HCWM Operational Plan for the country based upon data collected using VMMC Initial Assessment Tools during an initial assessment. Voluntary Medical Male Circumcision Guidance Document: Developing a Health Care Waste Management Plan provides detailed guidance on how to create a HCWM Operational Plan. National Orientation Guide: Preparing to Roll-out HCWM Training MC Sites provides all the required information and resources to fulfill training requirements associated with the HCWM Operational Plan. 35 More Summary

36. PEPFAR Implementing Partner Summary Crucial Elements of a Successful HCWM Operational Plan include: Realistic timelines Country and site maps HCWM product requirements. Detailed HCWM procedures including treatment and/or disposal methods. Requirements for a monitoring and evaluation plan, including an incident reporting system. An organizational chart and delineated roles and responsibilities. When writing a HCWM Operational Plan, clarifying what is not in the scope of the HCWM activity is just as important as outlining what is in the scope. 36

37. PEPFAR Implementing Partner Rate Your Confidence Now that you have completed this orientation, please rate your level of confidence in being able to achieve the orientation’s objectives 37

38. PEPFAR Implementing Partner Rate Your Confidence In 38 Not Confident Somewhat Confident ConfidentVery Confident Being able to use the VMMC Initial Assessment Tool to gather critical information needed to develop a robust, actionable HCWM Plan to guide campaign planning and implementation Being able to develop a HCWM Operational Plan that is customized to fit into your country’s overall VMMC campaign strategy. Being able to include information about the mechanism for cascading HCWM training to staff at all levels of the campaign in the HCWM Operational Plan.