1. 10/07/02 Waste Management Planning Process in St Louis - Sénégal P. Jaillard, AMP, CVP/PATH SIGN Meeting, Phnom Penh

2. 10/07/02 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. 10/07/02 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. 10/07/02 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. 10/07/02 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. 10/07/02 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. 10/07/02 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. 10/07/02 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. 10/07/02 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. 10/07/02 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