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REPUBLIC OF SIERRA LEONE
MINISTRY OF HEALTH AND SANITATION
INTEGRATED NATIONAL WASTE MANAGEMENT STRATEGIC PLAN
2012-2016
DRAFT “1”
“Keep Sierra Leone Clean, Play your Role for Change”
October, 2011
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FOREWORD
Improving the health of the nation is one of the key priorities of our Government. Formulation and launch of this Integrated National Waste Management Strategic Plan (2012 – 2016) for further development of our country’s waste management is a major achievement. Considerable effort is required in properly managing healthcare waste, municipal solid waste, liquid waste and industrial waste in Sierra Leone. This strategic plan is thus in line with the government need for attaining the Millennium Development Goals, for which six out of 8 goals are being addressed. Proper waste management will minimize transmission of water borne diseases (diarrhea, cholera, etc), malaria (by destroying habitats for mosquitoes, and increase environmental sustainability in Sierra Leone.
Nonetheless, women continue to die at childbirth due to malaria, too many children die of easily preventable diseases like malaria and diarrhea, for which cost effective interventions exist and sadly, much remains to be done with regard to tackling ill health related to poverty and environmental mismanagement.
The INWMSP provides the framework that will guide the efforts of the Ministry of Health and Sanitation (MoHS) and its partners over the next five years in attaining the health related MDGs. It reflects the Ministry’s fundamental belief that waste management and sanitation is a measure of human health and poverty. While we are striving to make sure that health services are made available, accessible and affordable to all people without discrimination, we are made by this plan to look on the other side, whereby waste management services become accessible to all Sierra Leoneans. The Plan further reflects the belief that waste management fundamentally affects individual productivity (in business facilities, households, in health and industrial facilities) and is therefore a critical input for long-term development of the country.
The strategies contained in the Plan focus especially on the needs of health workers, community members in cities and towns, household members, industrial workers, etc. For these vulnerable groups, ill health due to poor waste management is not only a personal tragedy but also an economic burden that reinforces poverty nationally. Whilst laying emphasis on these beneficiaries, the Plan concomitantly emphasizes strengthening of the entire waste management system as a key strategy to enhancing efficiency and effectiveness in provision of quality services that will ultimately improve health outcomes.
In cognisance of the aforementioned, the plan is developed around strengthening of six key pillars of the health system, namely: (1) leadership and governance, (2) service
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delivery, (3) human resources for waste management, (4) waste management equipment and technologies, (5) waste management financing, and (6) waste management information systems. Our priorities are to improve waste management with the aim of progressively moving towards universal coverage, reducing the burden of communicable diseases and improving the quality of services provided by retaining highly qualified and motivated staff in an enabling environment through training.
From the very outset, the government of Sierra Leone has recognized that environmental health problems in the country are huge in magnitude and complex in nature. We are also aware that solving these multi-faceted problems of the health sector requires time and the concerted efforts of the government, the private sector, non-governmental organizations, multilateral and bilateral development partners, and above all the public at large. Therefore, harmonizing the efforts of all stakeholders has been one of the most important agenda during preparation of the National Integrated Waste Management Strategic Plan.
At this point, when we are nearing 2015, and as we start the implementation of this strategic plan before the MDGs target year, I would like to assure all development partners, and my colleagues in the health sector, that the Ministry of Health and Sanitation is ready and committed to continue playing the leading role in working hard to achieve what we have targeted in this plan.
For the implementation of this plan, the Ministry depends on the continued dedication of its entire staff and those of its partner organizations. The Ministry’s goals for system-wide improvement require sustained provision of public funds as well as financial and technical assistance from development partners within the framework of the PRSPII.
This Plan ushers in a new beginning towards a direction that the Ministry hopes will result in a sector-wide approach to managing and coordinating our individual and collective interventions in waste management. We welcome the support of our national and international development partners and gratefully acknowledge their contribution towards the development of our waste management system.
Finally, I would like to appreciate and thank all institutions and individuals who have been involved in the preparation of this valuable document. I also would like to thank all development partners for their valuable contributions and comments during the preparation of the strategic document and above all for their endorsement as a common guiding reference for our operations for the coming five years.
Minister for Health and Sanitation
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ACKNOWLEDGMENTS
This first Integrated National Waste Management Strategic Plan (INWMSP) is a product of a long and complex process of intensive consultations, teamwork on specific assignments, detailed studies and information gathering. The process involved service providers, civil society groups, community members, the private sector, development partners and other stakeholders.
The Ministry is very grateful to everyone who contributed to the successful development of this strategic plan. Special thanks go to the members of the Technical Working Group (TWG) that was tasked to write this document, using the health systems strengthening approach based on the 6 pillars of the health system. These building blocks were brought together and synthesized into the INWMSP.
Most important has been the concerted effort to involve all directorates, programs and other units within MoHS to ensure understanding and ownership of the plan. The Top Management Team (TMT) of the Ministry spearheaded the coordination and finalization of this document.
The Government appreciates the financial and technical support given by the World Health Organization (WHO) for the development of this plan. WHO and all our partners have been helpful and encouraging in this attempt to chart a new course for Sierra Leone’s health sector.
Finally, the Ministry expresses its appreciation to all other individuals and institutions who continue to contribute towards improving the environmental health of the people of Sierra Leone. We hope that together we can achieve our Millennium Development Goals.
Permanent Secretary, Ministry of Health and Sanitation
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TABLE OF CONTENTS
FOREWORD ................................................................................................................... 2 ACKNOWLEDGMENTS ................................................................................................. 4 CHAPTER ONE ............................................................................................................ 10 1.0 INTRODUCTION ..................................................................................................... 10
1.1 The Need for Integrated Waste Management ...................................................... 10 1.2 The Health Sector in Sierra Leone ....................................................................... 11 1.3 Environmental Standards ..................................................................................... 11 1.4 Responsibilities of the Ministry of Health and Sanitation ...................................... 11 1.5 Legislations .......................................................................................................... 12 1.6 Policy Objectives .................................................................................................. 13
1.6.1 Specific Objectives for HCWM ....................................................................... 13 1.6.2 Specific Policy Objectives for MSWM ............................................................. 13 1.6.3 Specific Policy Objectives for Liquid Waste Management .............................. 14 1.6.4 Specific Policy Objectives for Industrial Waste Management ......................... 14 1.6.5 Specific Policy Objectives for Hygiene and Sanitation ................................... 15 1.6.6 Specific Policy Objectives for Institutional, Legal and Regulatory Framework 15
1.7 Responsibilities of Key Players in Waste Management ........................................ 16 1.7.1 Responsibilities of Donor Organizations and Development Partners ............. 16 1.7.2 Responsibilities of Non-Governmental and Civil Society Organizations ......... 16 1.7.3 Responsibilities of Households ....................................................................... 16 1.7.4 Responsibilities of the Private Sector ............................................................. 17
1.8 Background/Overview .......................................................................................... 17 1.8.1 Why is strategic planning (SP) needed? ........................................................ 17 1.8.2 Why do Strategic Planning for Waste Management Now? ............................. 18 1.8.3 The Time Period of this Strategic Plan ........................................................... 18
CHAPTER TWO............................................................................................................ 19 2.0 COUNTRY PROFILE .............................................................................................. 19
2.1 Socioeconomic Determinants of Health in Sierra Leone ...................................... 19 2.2 Leadership and Governance ................................................................................ 20 2.3 Economic and Social Development ...................................................................... 20 2.4 The Country (post-conflict situation) in the Healthcare Sector ............................. 21
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2.5 Current Distribution of Health Facilities in Sierra Leone ....................................... 21 CHAPTER THREE ........................................................................................................ 24 3.0 VALUE COMMITMENTS AND STRATEGIC DIRECTION ..................................... 24
3.1 Vision, Mission and Goals of MoHS on INWM ..................................................... 24 3.2 Stakeholders Analysis .......................................................................................... 26
CHAPTER FOUR .......................................................................................................... 29 4.0 SITUATION ANALYSIS RESULTS ........................................................................ 29
4.1 General Situation on Waste Management ............................................................ 29 4.2 Healthcare Waste Management Practices ........................................................... 30 4.3 Municipal Solid Waste Management Practices .................................................... 31 4.4 Industrial Waste Management Practices .............................................................. 33
CHAPTER FIVE ............................................................................................................ 35 5.0 STRATEGIC PLAN ................................................................................................. 35
5.1 Plan of Action for Healthcare Waste Management ............................................... 35 5.1.1 Key Findings in Context ................................................................................. 35 5.1.2 Goals and Objectives of the HCWM Plan of Action ........................................ 36 5.1.3 Treatment and Disposal Systems ................................................................... 37 5.1.4 Logical Framework for HCWM POA ............................................................... 39 5.1.5 Implementation of the Action Plan .................................................................. 41 5.1.6 Partnership Framework and Funding ............................................................. 42 5.1.7 Environmental and Social Measures .............................................................. 43 5.1.8 The Monitoring Plan for HCWM ...................................................................... 44 5.1.9 Institutional Framework and Implementation Responsibilities ........................ 46 5.1.10 HCWM Plan of Action - Costs ...................................................................... 53
5.2 Plan of Action for Municipal Solid Waste Management ........................................ 57 5.2.1 Authority and Purpose .................................................................................... 57 5.2.3 The MSW Plan of Action ................................................................................ 57 5.2.4 Logical Framework for MSWM Plan of Action ................................................ 64 5.2.5 Institutional Arrangements .............................................................................. 70 5.2.6 Partnership Framework and Funding ............................................................. 70 5.2.7 Environmental and Social Mitigation Measures .............................................. 72 5.2.8 Action Plan Capacity Building Elements ......................................................... 80 5.2.9 The Monitoring Plan ....................................................................................... 81 5.2.9 Institutional Framework and Implementation Responsibilities ........................ 83 5.2.10 MSWM Plan of Action - Costs ...................................................................... 95
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5.3 Plan of Action for Industrial Waste Management.................................................. 99 5.3.1 Key Findings in Context ................................................................................. 99 5.3.2 Methodology, Focus and Goals for Developing the IWM Plan of Action ...... 100 5.3.3 Problem Analysis .......................................................................................... 102 5.3.5 Components of the Strategic Plan for IWM .................................................. 104 5.3.6 Institutional Arrangements and Allocation of Responsibilities ...................... 112 5.3.7 Stakeholders Analysis, Partnerships and Funding ....................................... 113 5.3.8 Risk Analysis for the Plan of Action .............................................................. 115 5.3.9 Plan of Action Implementation Time Table for IWM ..................................... 118 5.3.10 IWM Plan of Action - Costs ......................................................................... 121
CHAPTER SIX ............................................................................................................ 125 6.0 M&E SYSTEM FOR INWMSP IMPLEMENTATION ............................................. 125
6.1 Introduction ........................................................................................................ 125 6.2 Indicators for IWMSP Implementation ................................................................ 126 6.3 Sources of Information for Monitoring the INWMSP ........................................... 126 6.4 Evaluating Progress ........................................................................................... 127
6.4.1 Quarterly reports .......................................................................................... 127 6.4.2 Annual environmental health performance reports ....................................... 127 6.4.3 Mid-term Review and End-term Evaluation .................................................. 127 6.4.4 Integrated Supportive Supervision (ISS) and Inspection .............................. 127
6.5 Reporting Mechanism ........................................................................................ 130 6.6 Performance Monitoring and Quality Improvement ............................................ 130 6.7 Evaluation/operational Research........................................................................ 131
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ACRONYMS ABFP Annual Budget framework paper AEHR Annual environmental health performance reports AIDS Acquired Immunodeficiency Syndrome BOO Build, own and operate BOOT Build, own, operate and transfer CBO Community Based Organization CSO Combined sewer overflows ECOWAS Economic Community of West African States EHD Environmental Health Division EIA Environmental Impact Assessment EPA Environmental Protection Act EPI Extended Program on Immunization FCC Freetown City Council FWMC Freetown Waste Management Company GDP Gross Domestic Product HBV Hepatitis B virus HCV Hepatitis C virus HCW Healthcare waste HCWM Healthcare waste management HF Health facility HIV Human immunodeficiency virus HPI Human Poverty Index IPC Infection Prevention and Control ISS Integrated Supportive Supervision IWM Industrial waste management LFA Logical frame analysis LGA Local Government Authority LTEF Long term expenditure framework M&E Monitoring and Evaluation MDGs Millennium Development Goals MICS Multiple Indicator Cluster Survey MoHS Ministry of Health and Sanitation MRU Mano River Union MSc Master of Science MSW Municipal Solid Waste MSWM Municipal Solid Waste Management MTEF Short term expenditure framework NGOs Non-governmental organizations
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NSI Needlestick injuries PEP Post-exposure prophylaxis POA Plan of Action PPE Personal protective equipment PPP Public-Private Partnership PRS Poverty Reduction Strategy QIP Quality Improvement Process SP Strategic Plan TB Tuberculosis TMT Top Management Team ToT Training if Trainers TWG Technical Working Group UNDP United Nations Development Program UNEP United Nations Environment Program WHO World Health Organization WM Waste Minimization WMS Waste Management and Sanitation
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CHAPTER ONE
1.0 INTRODUCTION
1.1 The Need for Integrated Waste Management
Under the United Nations’ umbrella, much of the activities under solid waste management are a subset of the activities under the broader topic of human settlements management. Chapter 21 of Agenda 21 on solid waste management and sewage related issues comprises of four program areas: (a) Waste minimization; (b) Promotion of waste recycling and reuse; (c) Promoting environmentally sound waste disposal; and (d) Extending waste disposal service coverage.
Program area A is linked to reducing unsustainable consumption patterns, and as such, requires national level policies. Program are B requires collaboration of local authorities with the local informal sector given this area's presence in recycling based income generation potential, particularly in the developing countries. Program area C requires the collaboration of local and national authorities, based on appropriate and sustainable legal instruments and their effective implementation. Such legal instruments may need to re-consider the application of the "polluter pays principle" to the case of solid waste management. Program area D is an area of joint programming with both the formal and informal waste management sectors playing a key role. Efforts in this area need to take into account income-based differences in willingness to pay.
There is much scope for improving the real value of current and future investments already made in the formal and informal waste management sector. For example, studies carried out by the United Nations (UNCHS, Habitat, UNDP) and World Bank have shown that highly developed and active informal waste management networks exist, particularly in the developing countries. Similarly, many local authorities and their organizations are taking initiatives to share techniques through partnerships and twinning, to deal with the growing solid waste issue.
Encouraging and supportive policies from central governments would assist the efforts of both the formal and the informal solid waste management sectors. In the case of the latter, further support could not only drastically reduce waste collection costs but could also improve income-generation and employment opportunities of the urban poor. Knowing the aspect, WHO is dedicated to support the development of the national policy and the implement the strategies.
The principal role of UN agencies in catalyzing action under Chapter 21 is focused at strengthen the indigenous capacities of developing countries to manage wastes. The challenge for the United Nations Agencies is to act as a vehicle for technology transfer
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between developing countries and to draw the attention of formal waste management authorities to the technological potentials of the informal sector. Further technology development must adapt indigenous research and development.
1.2 The Health Sector in Sierra Leone
The health sector is relatively grossly undeveloped. Improving the health status of Sierra Leoneans is one of the biggest challenges facing the Government. In order to improve access to quality healthcare for all, the Government has embarked on construction of peripheral health units (PHUs), and rehabilitation and construction of secondary hospitals in the districts. Adequate healthcare waste management in these planned projects would be prerequisite for standard operations.
The main objective is to improve the health of both urban and rural communities through increased access to health services, which goes together with sanitation services and improved hygiene practices. In order to achieve this, access to adequate health and sanitation service levels need to be increased to at least 66% of the population by 2015.
1.3 Environmental Standards
The integrated waste management guidelines in Sierra Leone have been based on scientific environmental standards. Adherence to established environment standards should be observed in all waste management and sanitation development activities. Protection of the environment by appropriate legal mechanism shall be applied, including, when necessary, prosecution of individuals and institutions which provide inadequate services which impact negatively on the environment. Sierra Leone is also signatories to several international agreements on environmental practices and policies.
1.4 Responsibilities of the Ministry of Health and Sanitation
The Ministry of Health and Sanitation shall continue to be responsible in ensuring that the Environmental Health Division acts as the leading body to over-see the waste management activities in the country, using the Integrated National Waste Management Policy (INWMP). It will also be responsible for developing waste management and sanitation strategies.
It will closely work with the Ministry of Internal Affairs, Local Government and Rural Development which is responsible for leading the implementation of the sanitation and hygiene strategies, together with the Ministry responsible for water (Policy and planning section) to ensure that integrated water, sanitation and hygiene education/promotion programs are implemented by Local Councils, urban and rural communities in accordance with the Policy objectives.
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In addition, the Ministry of Health’s responsibilities in respect to sanitation will include: a) Overall coordination of waste management and sanitation activities at national
level. Ministry of Health through its Department of Environmental Health shall take the lead in the promotion of waste management sanitation and hygiene programs, in close co-operation with the Ministries responsible for Water, Local Governments, Education, and other key stakeholders, including donor organizations, Non-Governmental Organizations (NGOs) and Civil Society Organizations (CSO).
b) Provision of technical advisory service on setting minimum standards and levels of service related to waste management and sanitation.
c) Solicitation of funds for waste management and sanitation projects. d) Development of criteria for allocation of national funds, which will ensure optimal
utilization of funds obtained in form of grants or loans for waste management and sanitation improvement programs.
e) Development of a framework for technical assistance for sanitation projects. f) Preparation of waste management and sanitation guidelines. g) Promotion and advocating of waste management and sanitation improvements
programs at national level. h) Development of monitoring and evaluation of waste management sanitation
activities nationwide.
1.5 Legislations
Legislations affecting the waste management and sanitation in Sierra Leone comprise of the following:
a) The Environmental Protection Act (2008): An Act (amended in 2010) which empowers the Minister of Lands, Country Planning and the Environment to make regulations and guidelines which protect the environment. This act created and empowered the Environment Protection agency which has the overall mandate of setting and monitoring environmental standards.
b) Local Government Act (2004): An Act which enables the establishment of nineteen local councils and provides for decentralization and devolution of functions, powers and services to local councils. The Act devolves the water supply and sanitation responsibilities to District and Town Councils.
c) Public Health Act 1996 and the 2004 Addendum: An Act which vests the responsibility for environmental sanitation in the Ministry of Health.
d) Fishery Products Regulations (2007): Despite the high contribution of fishery industry to the waste generation in Sierra Leone, the Fishery Products Regulation did not give due attention on the waste management issues. Part XII of the regulation mentioned the Best Waste Disposal Practices (Para 218), but could not stipulate the regulations in details. This part gives in a very narrow style, the scope of best waste disposal practices as treatment of by-products, separation of
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edible from non-edible byproducts, and draining and treatment of sewage emanating from fishery byproducts processing. Thus, the integrated national waste management guidelines act a better tool for the industries in managing the waste they produce.
1.6 Policy Objectives
1.6.1 Specific Objectives for HCWM
The national policy on HCWM is aimed at providing a framework of healthcare waste management strategies to assist in the day to day and long term management of healthcare waste in the health facilities by implementing the following essential strategies:
• Waste management committees, plans and waste audits • Waste minimization, avoidance, segregation, recycling and re-use • Waste container labeling and waste containment • Proper healthcare waste handling, storage and transport • Correct healthcare waste treatment and disposal.
1.6.2 Specific Policy Objectives for MSWM
It is the purpose of this policy to: 1) protect the public health and safety, protect and preserve the environment of this
country, and recover resources which have the potential for further usefulness by providing for, in the most environmentally safe, economically feasible and cost-effective manner, the storage, collection, transport, separation, treatment, processing, recycling, and disposal of solid waste;
2) establish and maintain a national program for providing planning assistance, technical assistance, and financial assistance to local governments for municipal solid waste management;
3) require local governments to adequately plan for and provide efficient, environmentally acceptable solid waste management services and programs;
4) promote the establishment of resource recovery systems that preserve and enhance the quality of air, water, and land resources from pollution;
5) ensure that solid waste is transported, stored, treated, processed, and disposed of in a manner adequate to protect human health, safety, and welfare and the environment;
6) promote the reduction, recycling, reuse, and treatment of municipal solid waste, and the recycling of materials which would otherwise be disposed of as solid waste;
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7) encourage local governments to contract with private entities to provide management services or operate management facilities on behalf of the local government, when it is cost effective to do so;
8) promote the education of the general public and the training of municipal solid waste professionals to reduce the generation of solid waste, to ensure proper disposal of solid waste, and to encourage recycling;
9) encourage the development of waste reduction and recycling programs through planning assistance, technical assistance, grants, and other incentives;
10) encourage the development of recycling industries by promoting the successful development of markets for recycled items and by promoting the acceleration and advancement of the technology used in manufacturing processes that use recycled items;
11) require municipalities to develop and implement source separation, resource recovery, or recycling programs, or all of the above, or enhance existing programs so that valuable materials may be returned to productive use, energy and natural resources conserved, and the useful life of solid waste management facilities extended;
12) require local governments and national agencies to determine the full cost of providing storage, collection, transport, separation, treatment, recycling, and disposal of solid waste in an environmentally safe manner; and
13) Encourage local governments to pursue regional approach to solid waste management.
1.6.3 Specific Policy Objectives for Liquid Waste Management
Specifically, the policy objectives for LWM include: (i) To improve sewerage and non-sewerage sanitation coverage for the population
in urban centers from 31% to 66% by 2015. (ii) To improve water and sewage disposal services in low income areas. (iii) To develop waste water treatment systems that meet national environmental
standards. (iv) To encourage private sector participation in provision of liquid waste
management and related services. (v) To develop human resources for carrying out sustainable sewerage services.
1.6.4 Specific Policy Objectives for Industrial Waste Management
Industrial waste management generally refers to a set of strategies and approaches that aim to eliminate, reduce, reprocess or dispose of waste produced in an industrial setting. The policy objectives for Industrial Waste Management include:
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1) Provide the Ministry of Health the necessary tools and powers to monitor waste management within the industries.
2) Provide facility managers, national and tribal regulators, and the interested public with recommendations and tools to better address the management of land-disposed, non-hazardous industrial wastes
3) Help facility managers make environmentally responsible decisions while working in partnership with national and tribal regulators and the public
4) Serve as a handy implementation reference tool for regulators to complement existing programs and help address any gaps in industrial waste management
5) Help the public become more informed and more knowledgeable in addressing waste management issues in the community.
1.6.5 Specific Policy Objectives for Hygiene and Sanitation The main objective is to improve the health of communities and ensure that the majority of the population (66%) has access to sanitation services by 2015. Specific objectives include:
(i) To support and provide sanitation and hygiene education that will improve peoples’ health and quality of life through acceptable hygienic practices.
(ii) To improve communality involvement in sanitation projects for sustainable success.
(iii) To develop and improve the capacity of communities and the involvement of people in community project decision making.
(iv) To minimize pollution from sanitation systems. (v) To develop a sustainable approach for financing urban and rural sanitation
involving increased community participation. (vi) To have sanitation systems that are designed and constructed in a manner that
they provide effective protection against disease transmission and environmental impact of waste disposal.
1.6.6 Specific Policy Objectives for Institutional, Legal and Regulatory Framework Sustainable waste management, sanitation and hygiene require an effective institutional setup and legal framework which addresses the growing challenges in the sector. Specific objectives are:
(i) To establish institutional roles and responsibilities of the various institutions involved in the implementation of the National Environmental Health Policy.
(ii) To establish a regulatory regime for regulating waste management and sewerage services which effectively balances economic, financial and social objectives.
(iii) To review existing Environmental Health related legislations, which are outdated.
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1.7 Responsibilities of Key Players in Waste Management
1.7.1 Responsibilities of Donor Organizations and Development Partners (i) Development of waste management and sanitation schemes needs substantial
financial investments. Such investments could only be available and accessible to the Government of Sierra Leone from Donor Organizations and Developing Partners, if national guidelines and strategic plan are in place.
(ii) The Government of Sierra Leone will collaborate with these institutions and ensure availability of the needed funds for waste management and sanitation sector.
(iii) The Government of Sierra Leone will ensure there is coordination and synergies are obtained from the various developments.
1.7.2 Responsibilities of Non-Governmental and Civil Society Organizations
(i) Non-governmental organizations (NGOs) have over many years played an important role in Sierra Leone environmental health sector. Their contribution to the waste management is more pronounced in rural areas where many NGOs have been working, providing all types of water and sanitation services.
(ii) The Government of Sierra Leone will closely collaborate with NGOs through the Planning Section of the MoHS to enhance the role of NGOs and Civil society organizations in the waste management and sanitation activities.
(iii) Specifically, the Government will seek the assistance of NGOs in Sierra Leone to effectively carry out various waste management, sanitation and hygiene activities, including:
a) Training and capacity building b) Assisting communities with the planning and implementation of waste
management and sanitation projects c) Providing health, hygiene and sanitation education promotion, and d) Financing of waste management and sanitation projects.
1.7.3 Responsibilities of Households Primary responsibility for household waste management and sanitation provision rests with the household itself, and all levels of government interventions are basically in the role of facilitating this, or of carrying out those functions which are more efficiently executed at a community level, district or national level. Households will be required to observe this responsibility.
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1.7.4 Responsibilities of the Private Sector The intention of the Environmental Health Policy is wherever possible to increase the role of the private sector in the development and provision of waste disposal services and sanitation (WMS) activities. The improvement of waste management and sanitation services cannot be seen as a Government obligation by itself. While many of the water supply and sanitation improvements may require significant support from Government and its agencies, it is intended that in carrying out such activities there will be partnerships between public and private sector organizations. The Private Sector contribution could include, but is not limited to:
(a) Project design and contract supervision (a) Construction by large and small contractors (b) Construction, operation and maintenance of facilities such as sewage works and
public toilets. (c) Preparation of behavioral change communications materials (d) Training and capacity building (e) Supply of materials and equipment for waste management and sanitation (f) Research on improvement of WMS facilities and approaches (g) Provision of consultancy services (technical assistance) on WMS (h) Monitoring and evaluation of existing WMS projects (i) Project financing.
1.8 Background/Overview
1.8.1 Why is strategic planning (SP) needed? The Integrated Waste Management Strategic Plan (INWMSP) has been developed to provide a common strategic framework for the plan period covering 1st July 2012 to 31st June, 2016. The strategic plan is meant to be a guide for all interventions, all stakeholders, all development partners, and all levels of governance in Sierra Leone. The IWMSP will be used as a basis for developing long term expenditure framework LTEF), medium term expenditure framework (MTEF) and as a basis for development of the annual budget framework paper (ABFP) for MoHS. The strategic plan for waste management in Sierra Leone is needed in order to address and attain the Millennium Development Goals (MDGs), which aim at encouraging development by improving social and economic conditions in the world's poorest countries. The strategic plan on waste management touches six (6) aspects of the MDGs such that all goals (with exception of Goals 2 and 3) are addressed.
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Table 1.1: Relationship between the Waste Management Strategic Plan and the MDGs Goal No. MDG Statement Relationship with Waste Management Strategic Plan Goal 1 Eradicate
extreme poverty and hunger
Poor waste management is an indication of poverty. Waste management activities can lead to income generation and improved standard of living
Goal 4 Reduce child mortality rates
Improved waste management will minimize chances of malaria, cholera, diarrhea and other water related diseases which contribute strongly to child mortality
Goal 5 Improve maternal health
Malaria affects pregnant women, killing both the infants and mothers at birth. By improving waste management to eradicate the breeding sites for mosquitoes, the maternal health will be improved. Poor HCWM, especially sharps waste management increases the chance of infections for HIV and other blood borne pathogens, through Needlestick injuries (NSI). This strategic plan addresses this issue
Goal 6 Combat HIV/AIDS, malaria, and other diseases
Goal 7 Ensure environmental sustainability
Environmental sustainability has remained an outstanding challenge to Sierra Leone and other developing countries. Environmental sustainability will be achieved through well planned and strategized effort
Goal 8 Develop a global partnership for development
This goal is being addressed via collaborative efforts between Sierra Leone Government, WHO and other agencies: UNDP, UNICEF and UNEP.
1.8.2 Why do Strategic Planning for Waste Management Now? The need for SP is based on the fact that the addressing of the waste management issues must be planned. The government of Sierra Leone must show openly the way it wants to follow towards achieving the intended goal so that other players can follow or provide assistance in the form of financing or technical expertise. The following problems have been also identified by UNDP in 2008, but were not attended due to lack of existing strategic plan:
1) Indiscriminate disposal of waste (solid waste, liquid waste, industrial waste and healthcare waste)
2) Lack of disposal equipment and technologies 3) Insufficient trash cans and industrial waste bins 4) Lack of awareness and understanding on behalf of the population 5) Lack of data and information on the waste characteristics and generation rate 6) Lack of systematic management system.
1.8.3 The Time Period of this Strategic Plan The strategic plan covers five (5) years from July 2012 to June 2016.
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CHAPTER TWO
2.0 COUNTRY PROFILE
2.1 Socioeconomic Determinants of Health in Sierra Leone
Sierra Leone is located in the West African coast, bounded on the west by the Atlantic Ocean, on the North and East by Guinea and on the Southeast by Liberia. Population movement across these borders is very high. Sierra Leone has a surface area of 71,740 square kilometers. This tropical country averages an annual rainfall of 3,150 mm and rainfall along the coast can reach 495 cm a year, making it one of the wettest places along the coastal Western Africa, which can also cause occasional floods. The vegetation ranges from mangrove along the coast to forest covered hills and savannah further inland, which can harbor some vectors of diseases, like malaria.
Administratively, Sierra Leone is divided into the Western Area and three provinces – Eastern, Northern and Southern provinces. About two thirds of the population lives in rural areas while a third live in urban areas, mainly in the capital city of Freetown. The population of Sierra Leone, estimated 5.5 million in 2008, has a natural increase rate of 2.3%, with children 0-14 years representing about 45% of the population, as shown in Table 1. The crude birth and death rates are 45 and 22 per 1 000 population, respectively. The total fertility rate, estimated at 6.3 per woman, is amongst the highest in the world. However, life expectancy at birth is estimated at 49.4 years, and is associated with the high child and maternal mortality rates, as well as the heavy burden of communicable and non-communicable diseases in the country. The underlying factors are pervasive poverty, high level of illiteracy especially among females, limited access to safe drinking water and adequate sanitation, poor feeding and hygienic practices, overcrowded housing and limited access to high quality healthcare services.
Table 2.1: Socioeconomic Development Indicators Indicator1 Value Population Size (2008) 5,473,530 Annual population growth rate (%) (2008) 2.3 Population urbanized (%) (1996) 30 Life expectancy at birth (2007) 49.4 GDP per capita (PPP, US$) (2007) 700
1 Multiple Indicator Cluster Survey (MICS 3) 2005; EPI MoHS Report 2007; Census 2004 (Projection 2007)
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Population below poverty line (%) (2004) 70.2 Adult literacy rate (%) (2002/3) 25
2.2 Leadership and Governance
Sierra Leone is politically a constitutional democratic country, with 124 seats. The country gained independence from Britain on 27 April 1961 and became a Republic on 19 April 1971. Between 1961 and 1990, the country witnessed steady development of constitutional democracy, rule of law and transparent governance of national institutions, the basis for enduring health and socio-economic development. The civil war which lasted from 1991 to 2002, destroyed basic health infrastructure and displaced health personnel, compromising healthcare at all levels in the country.
With the support of the United Nations and developmental partners, Sierra Leone commenced the rebuilding of governance infrastructure, beginning with the disarmament and demobilization of ex-combatants in February 2002. This was followed by successful presidential and parliamentary elections on 14 May 2002 and 28 July 2007.
2.3 Economic and Social Development
Sierra Leone ranks as the least developed country in the world, based on its 2007 Human Development Report ranking of 158th out of 177 countries1. The country is extremely resource-poor, with a GDP per capita (PPP) of US$ 700; it ranked 102 out of 108 countries in the Human Poverty Report, with Human Poverty Index (HPI) of 51.72. Nearly half of the working-age population engages in subsistence agriculture.
However, progress is being made especially in creating an enabling environment for socioeconomic development. In response to these socioeconomic challenges, the government of Sierra Leone has developed the Sierra Leone Vision 2025 and the Sierra Leone Poverty Reduction Strategy (PRS) that guides the government’s efforts toward improving the current socioeconomic situation. Inter-country collaboration is carried out through the Mano River Union (MRU) as well as the Economic Community of West African States (ECOWAS). In 2006, the economy witnessed an overall impressive performance with real GDP growth estimated at 7.8%. Growth was driven by a revitalized bauxite and futile mining sector, coupled with sustained agricultural output and service delivery.2
Following the identification of the country’s health and development challenges in 2008, the national response was directed in the following areas:
• Improving the social-economic development including health service 2 WHO Country Cooperation Strategy 2008–2013, Sierra Leone
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• Identification of the burden of communicable diseases (malaria, HIV/AIDS, TB and Leprosy, Tropical diseases, etc.)
• Identification of the burden of childhood and maternal diseases. The health system’s response (aimed at improving access to quality promotive, preventive, curative and rehabilitative services), is currently improving. However, in its response, poor waste management which creates a suitable environment for malaria and water borne diseases was not identified as a key problem that needed special response. 2.4 The Country (post-conflict situation) in the Healthcare Sector
The ten-year old conflict (1991 to 2001) was accompanied by a deterioration of the health status of majority of Sierra Leoneans. The Human Development Report, July 2000, estimates a life expectancy of 37.9 years. The healthcare delivery system is divided into National, District, and Chiefdom levels. The epidemiological picture is characterized by a high prevalence of communicable diseases like malaria, respiratory tract and skin infections. There is an explosion of sexually transmitted infections, and emerging epidemic of HlV/AIDS. According to MoHS sources, over half the healthcare facilities country-wide were not functioning by the year 2000 due to a variety of reasons that include damaged infrastructure, lack of staff, lack of drugs, and medical supplies. The MoHS expects that the thrust of their activities for 2002 will be targeted at rehabilitating the devastated healthcare services, and extending them to newly accessible areas countrywide. 2.5 Current Distribution of Health Facilities in Sierra Leone
According to the data presented by the National Health Sector Strategic Plan (NHSSP 2010-2015), the distribution of health facilities in the country is highly concentrated in Western Area. In Freetown, for example, the largest number of health facilities is mainly government owned, although the contribution of the private sector, mission and NGOs stands to be recognized, especially in the urban areas, as shown in Figures 2.1 and 2.2.
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Figure 2.1 Number of health facilities in Freetown rural and urban areas by numbers (NHSSP, 2101-2015)
Rural Freetown Urban Freetown
Overall Freetown
Nationwide Figure 2.2 Distribution of health facilities in Freetown (rural and urban areas) and nationwide by ownership
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Based on this analysis, it can be summarized that: 1) Nationwide, the hospitals in Sierra Leone owned by the government comprise of
68.2% while those owned by private, mission and NGOs comprise of 31.8%. 2) For the clinics, however, only 9.9% are government owned while the rest (90%) are
owned by the private, mission and NGOs. 3) All CHPs and MCHPs are government owned in Sierra Leone. 4) Most of the private, mission and NGO owned HFs are concentrated in Western area,
especially in urban Freetown. 5) The government of Sierra Leone has taken a leading role in locating health facilities
in rural areas of Freetown (77%) and also nationwide (86%) 6) The role of the private sector should be encouraged. It has contributed in the
establishment of health facilities and health service delivery in Sierra Leone, being second next to government in all scenarios.
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CHAPTER THREE
3.0 VALUE COMMITMENTS AND STRATEGIC DIRECTION
3.1 Vision, Mission and Goals of MoHS on INWM
The vision, mission and goal are derived from the National Health Policy and are aimed at contributing to the achievement of the goals of the PRSP II (An “Agenda for Change”), the Ouagadougou Declaration and the MDGs. Vision A functional national integrated waste management system delivering efficient, high quality services that are accessible, equitable and affordable for all citizens in Sierra Leone. Mission To contribute to socio-economic development by promoting waste management and ensuring access to quality services by the population of Sierra Leone through effectively functioning national waste management systems for all identified waste categories: healthcare waste, municipal solid waste, liquid waste and industrial waste. Goal The Goal of the INWMSP is to minimize the impact of communicable diseases related to poor waste management (water borne diseases, airborne diseases, vector transmitted diseases) reduce mothers and children mortality and minimize poverty by involving the private sector, finally to attain healthy environment for Sierra Leone. This goal translates the overall mission and vision of the National Health Policy into policy objectives that are in line with the “Agenda for Change”, the Ouagadougou Declaration and the MDGs. The inputs required to influence the above performance criteria form the basis for the specific objectives of the INWMSP. These inputs correspond to the national health priority areas identified in the “Agenda for Change” document, highlighted above. The objectives for the INWMSP are thus given under the following 6 building blocks derived from the NHSSP.
1. Governance 2. Services delivery
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3. Human Resources 4. Health Financing 5. Medical Products and Technologies 6. Health Information
The key intervention areas under the appropriate leadership and management of the MoHS will provide the operational dimensions of the policy objectives. This integrated approach aims at bringing all waste management programs and partners together, so as to enhance synergy and complementarities, thus improving efficiency and effectiveness of waste management services delivery. The strategic plan provides a comprehensive list of services to be offered, namely: the community level, the municipal level, district levels and in the health facilities. The criteria for defining the Sierra Leonean INWMSP are: (i) services which will have the greatest impact on the major health problems (ii) services that are cost-effective in addressing the problems faced by many people (iii) services which can be delivered to give equal access to both rural and urban populations with a special emphasis on community based waste management interventions. Core Values
1. Right to health 2. Equity 3. Pro-poor 4. Cultural sensitivity 5. Solidarity 6. Friendliness
Services Values
1. Strong districts and councils 2. Good quality services - well managed, sensibly integrated, available, accessible,
accountable, affordable and sustainable 3. Strategic planning and priority setting based on achieving agreed Millennium
Development Goals (MDGs) and reducing poverty. 4. Quality improvement and training for actors.
Working Principles
1. Accountable central governance and provision of effective and efficient local waste management services composed of a comprehensive and integrated range of services across the nation.
2. Devolution of decision making and priority setting to local councils 3. Active promotion of lifestyles and health-seeking behavior among the population
in the area of waste generation and management
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4. Priority emphasis on prevention and control of communicable diseases, as well as on trauma and related injury from hazardous waste
5. Capacity building, including human resource development 6. Appropriate deployment and distribution of the waste management work force 7. A genuine desire to listen to what communities say and to encourage their
contribution 8. Increased and more diverse public-private collaboration in waste management 9. Evidence-based, quality interventions based on considered use of reliable waste
management information. The values, goals and working principles noted above provide the basis for this integrated national waste management strategic plan. 3.2 Stakeholders Analysis
The organizational assessment also included a stakeholder analysis that looked at six categories: community; Parliaments, Prime Minister’s Office, Council of Ministers, Regional Governments; Line Ministries; Development Partners; CSOs, NGOs, Diaspora, Professional Associations; Private for profit; and Civil Servants. Within each stakeholder category, the analysis looked into: behaviors we desire; their needs; resistance issues; their influence; and institutional response. The attainment of missions and objectives of the Integrated National Waste Management Strategic Plan (INWMSP) is largely dependent on the collective efforts and roles played by different stakeholders. It will help to clarify contributions expected from each actor; and to describe possible areas of collaboration that would create synergy toward INWMSP strategic objectives.
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Table 3.1: Stakeholders analysis
Stakeholders Behaviors we desire Their needs Resistance
issues Their influence Institutional response
Local government • Implementation of the strategic plan through the Environmental Health Sections
• Ownership of the waste management activities
• Healthy life style of the community members
• Devolvement of staff from MoHS (Government Ministry)
• Transfer of funds from the central government
• Information • Consultations with
MoHS
• Politics • Skills • Priority setting • Financial
burden
High • Community mobilization, ensure participation
• Strengthen Health committee in LGA
• Contracting • Public Private
Partnerships • Private Sector
Participation
Community • Ownership • Healthy life style
• Empowerment, • Information • Access to quality of
health care • Stewardship
• Dissatisfaction • Opting for
unsafe alternatives
• Underutilization
High • Community mobilization, ensure participation
• Strengthen Health committee
• Quality, equitable service
Parliaments, Prime Minister’s Office, Council of Ministers, Regional Governments
• Ratification of proclamations, policies, etc.
• Resources allocation
• Implementation of proclamations, policy, etc.
• Equity & quality • Plans & Reports
Organizational restructuring
High Put in place strong M&E system & comprehensive capacity building mechanisms
Line Ministries (Education, Water, Finance, Labor, Women’s Affairs, Agriculture, etc.)
Intersectoral collaboration
• Evidence-based plans; Reports
• Effective & efficient use of resources & coordination
• Technical support
• Fragmentation • Dissatisfaction • Considering
health as low priority
Medium • Collaboration • Transparency • Advocacy
Development Partners • Harmonized& aligned
• Financial system accountable &
• Fragmentation • High
Medium
• Government leadership • Transparency
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Stakeholders Behaviors we desire Their needs Resistance
issues Their influence Institutional response
• Participation • More financing • Technical
support
transparent • Involved in planning,
implementation & M&E
transaction cost • Inefficiency &
ineffective
• Efficient resource use • Build financial mgmt
capacity
CSOs, NGOs, Diaspora, Professional Associations
• Harmonization& alignment
• Participation, resource & TA
Involvement in planning, implementation & M&E
• Dissatisfaction • Fragmentation
Medium
• Transparency • Advocacy • Capacity building
Private for profit Quality Partnership, Rules & regulations
Low quality Medium • Transparency • Collaboration • Advocacy
Civil servants • Commitment • Participation
• Conducive environment
• Transparency
• Dissatisfaction • Unproductive
Medium • Motivation • Involvement
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CHAPTER FOUR
4.0 SITUATION ANALYSIS RESULTS
4.1 General Situation on Waste Management
According to the Community Health and Urban Slum Improvement program, which was however, focused on Freetown (2006-2008), the main issues in the environmental policy and health policy did not cover waste management. Despite the fact that urbanization in Sierra Leone has progressed slowly due to slow rate of industrialization, the trend has been high in Freetown, increasing from 5.9% in 1963(127,917) to 15.9% by 2004 (786,900). This growth has increased the waste generation rate in Freetown for all the waste types, reaching unmanageable levels. The slum locations, on the other hand, have greatly expanded further compounding the problems of housing, water, waste disposal as well as healthcare services. The increased waste generation rate in Freetown, for instance, has been due to escalating demand for healthcare services, and due to rural-to-urban migration, which forces the poor residents to reside in the highly congested slum areas like Mabella, Sussanne Bay, etc. Although this increased population gives a supply of cheap labor in the informal and formal sector, poor education and low valued jobs are leading to poor waste management practices by generators and an increased burned to the waste management budget on the cities and town councils. Poor solid waste, liquid waste and healthcare waste management, is highly connected to high infant and under-five deaths because of increased incidences of malaria, diarrhea and cholera. It is evident that the poor environmental sanitation, poor community and personal hygiene practices, lead to spread of malaria, diarrhea and cholera.
In the urban areas, environmental sanitation problems arise mainly due to poor systems of waste disposal. Most households dispose of refuse by dumping on roadsides, in drainage s (especially in a hilly topography like Freetown), in backyards, all of which encourage active habitats for malaria and diarrhea vectors.
By recognizing the efforts made by UNDP in collaboration with both bilateral and multi-lateral external support agencies in improving solid waste management in the local councils, WHO has supported the government of Sierra Leone in laying down Integrated National Waste Management Policy Guidelines and Strategic Plan.
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Up to 2011, solid waste management consisted of a wide range of problems, including low waste collection coverage and efficiency, irregular waste collection services, crude open dumping (in the heart of the city for Freetown), burning municipal solid waste and healthcare waste without considering air pollution control, lack of control regarding informal waste scavenging and foraging animals, high proximity of dumpsites to squatters, etc.
Using the Freetown Waste Management Company, the city council has not been able deliver quality waste management services and health education to the local population mainly due to lower revenue collection from services offered, due to low financial capability, lack of technical expertise and other technical deficiencies. Moreover, the MOHS has not been able to implement its role in the waste management issues for the similar reasons.
By building capacity of the local councils and the MOHS, including councils to work closely with communities, training MOHS staff on management of different waste categories, the Sierra Leone government, WHO and other development partners will enable all residents of the urban areas in the local councils to benefit from living in cleaner and healthier environment. As a result, the environment in Sierra Leone will exhibit reduced incidences of malaria, cholera, typhoid, diarrhea and other water-borne diseases.
4.2 Healthcare Waste Management Practices
The key findings can be summarized as: 1) Healthcare waste management practices depend on the level of health facility,
ownership of the facility and also on location of the health facility. 2) The technical and administrative skills on healthcare waste management are low
in the health facilities, leading to poor practices. 3) Inadequate training for health workers on healthcare waste management was
also identified to be the cause of poor practices. 4) Lack of guidelines and standard operating procedures on healthcare waste
management were also identified to be the causes of poor practices. 5) The infrastructure for healthcare waste management is very weak (waste
collection, transportation, sterilization equipment and chemicals, treatment facilities, etc.) due to lack of priority, planning and budgeting which eventually leads to poor practices.
6) The critical problems on HCWM were identified to be lack of funds to build infrastructure, lack of supplies (PPE, waste collection bags, sharps waste containers, etc.), and insufficient staff and time dedicated for healthcare waste management.
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7) In the area of treatment and disposal, a series of problems were identified. The critical problems were lack of: PPE, standard operating procedures (SOPs), appropriate treatment and disposal technologies (poor incinerator designs), waste transportation facilities and lack of land areas for burying waste where applicable.
8) Treatment of infectious waste through incineration, or by disinfection (including autoclaving) is a problematic area in Sierra Leone. In the case of incineration this may be done within the hospital premises or in a centralized facility. An incinerator is difficult and expensive to maintain, so it should be located in a hospital only when the hospital is large or where it provides services to other nearby hospitals. Otherwise, a centralized incinerator that provides services to hospitals in one region or city is more appropriate. In the case of disinfection, residues from these processes should still be treated as special wastes, unless a detailed bacteriological analysis is carried out.
4.3 Municipal Solid Waste Management Practices
The key findings can be summarized as: 1) Garbage disposal country wide is practiced by crude dumping in open dumpsites
and open burning. 2) Municipal solid waste management in Sierra Leone and Freetown in particular,
has been characterized by trials and failures since 1971 to date. Even with the initiation of the private company (FWMC), the problem has remained unresolved since 2008 to date. A national intervention is required.
3) The problems facing waste management in Sierra Leone range from lack of legal framework for control of solid and liquid waste, weak waste transportation system, and low crew productivity.
4) The waste generation rate estimates require validation by actual measurements. In this study, a waste generation index of 0.5 kg/person.day was used with a population of 2.2 million people. Waste collection rate was based on the number of trips made by each of the waste transportation equipment of known capacity. An additional 10% of total waste was implemented to represent waste collected by other means.
5) A very small fraction of waste generated in Freetown is collected and transported to dumpsites (37.8%) leaving the rest (62.8%) uncollected. This portion piles in the city posing to health risks to community members. The solid waste collection efficiency in Freetown is reduced by several factors including the type of containers used, road conditions, congestion in the city buildings, traffic conditions, etc.
6) The dumpsites used in Freetown are very old (1946 and 1986 for Kingtom and Granville Brook, respectively), and surrounded by residential slums, with leachate flow threatening the water bodies in rivers and the ocean. The dumpsites are poorly managed, without restriction to animals. There are
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excessive scavenging operations, even during rainy season. A detailed characterization of the two dumpsites was made in t is study, in order to provide details to the decision making process.
7) The status of sanitation in Sierra Leone is characterized as poor, with inadequate disposal of human excreta. Very little portion of the city is covered by sewerage system in the provincial headquarter towns (Bo, Kenema and Makeni) as well as capital city of Freetown. However, the systems are very inadequate due to degradation and poor maintenance.
8) The liquid waste components in Freetown and other cities/towns are fecal matter and grey water from the communities. From the industries, the liquid waste contains additional components, that is, industrial wastewater. The liquid waste management systems are poorly designed without pump stations, sludge treatment.
9) The financing and cost recovery mechanisms currently existing in Freetown require review. The community members are willing to pay for waste collection services, but the services are below standard.
10) Private sector participation is weak in MSWM in Sierra Leone, and requires improvements.
11) Community mobilization and awareness rising is weak. A massive campaign is required.
12) The EHD staff members require training in order to implement the Strategic Plan on waste management in towns and cities. There is inherent low capacity technically and administratively in the division.
Lessons Learned include: • There is a need for greater co-ordination in the implementation of waste
management plans and programs, and also in the overall management of hazardous and non-hazardous waste. In order to achieve a network of integrated waste management facilities, much more effective national, regional and District co-operation is required.
• There is a need for better enforcement of existing waste legislation and bye-laws to prevent for example, illegal disposal of waste. Waste is often dumped without proper authorization and this is becoming a more significant problem
• There is the need to adopt a framework which encourages more private investment in infrastructure, as well as encouraging more Public Private Partnerships (PPPs) and Private Sector Participation (PSP).
• Unless the waste management sector is recognized, and supported by sufficient human resource and training, the sector will not attract qualified professionals. This will make implementation of any good waste management policy difficult.
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• One other important lesson learnt is the roles and responsibilities of citizens in waste management. Waste management is not the sole responsibility of local government or the District Councils.
• Major groups and individual citizens also have critical roles to play. When we continue to assume that government institutions and local government only have that responsibility, these institutions get overwhelmed with the waste problem, whiles citizens stand aloof and even act negatively to pollute the environment instead of facilitating the rendering of the service. In setting up efficient waste management system therefore, the potential roles of all the sectors of society must be carefully considered and adequate measures put in place to realize them.
4.4 Industrial Waste Management Practices
The key findings can be summarized as: 1) Despite the fact that the number and capacity of industries in Sierra Leone small,
and that the waste generated is comparable small compared to municipal solid waste, the industrial waste needs close attention, due to the hazardous nature of the waste.
2) The industrial activities carried out in Sierra Leone are mainly chemical industry which poses high risk to the environment in terms of the hazardous nature of the waste generated. A number of major industrial waste generated have been studied in details to guide decision making processes at the national level (e.g., waste from metal industry, chemical industry, plastic waste, leather, etc.).
3) The number of items from industrial waste that are entering the recycle system is still low covering plastics, scrap metal, waste paper, and biodegradable waste. Efforts should be made to increase the list.
4) The extent of waste segregation in the industries is still limited to few companies. Moreover, labeling of industrial waste containers is partially practiced in industries.
5) Waste storage in the industrial facilities is facing critical problems in terms of storage containers, such that surface impoundments are highly practiced compared to tanks, containment building and drip pads.
6) The private sector participation in industrial waste collection and transportation is still low in Sierra Leone, and requires advocacy.
7) The critical industrial waste management challenges include lack of coordination and policy, lack of planning, lack of waste management equipment and vehicles, lack of qualified contractors for industrial waste collection and transportation, unreliable waste collection system, and high charges for waste collection.
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8) Most of the industries have not yet implemented current approaches for waste minimization such as equipment or process modifications recycle and re-use of waste materials, partnerships with municipalities, etc.
9) The main waste disposal method used in Sierra Leone is dumping in open crude dumpsites, which are having limited space and major management drawbacks.
10) Lack of legal documents for industrial waste management is high in industries and workers lack access to information and training on proper industrial waste management
11) Supervisory visits to the industries are only aimed at inspection, with most industries being visited at least once a year. The visits are mainly made by MoHS staff, labor and ward environmental officers, durations of which are mainly within 1 hour. The actions taken whenever problems are identified are seating and discussing on the means of rectifying the situation. In some cases visit reports are given to the industry within which recommendations are provided.
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CHAPTER FIVE
5.0 STRATEGIC PLAN
5.1 Plan of Action for Healthcare Waste Management
5.1.1 Key Findings in Context The situation analysis observed that the main constraints in HCWM are:
1. The institutional and legal framework is weak: HCWM is not a priority in the national health policy, and the institutional framework is marked by a lack of national strategy, clear responsibilities, specific guidelines and procedures in HCWM.
2. Organization, collection, transportation, storage and treatment of HCW are deficient: In spite of remarkable efforts in some health facilities (hospitals, clinics, MCHPs and CHPs), the organization of HCWM by health facilities leaves a lot to be desired: absence of reliable data on amount of waste produced; no person/team responsible for HCW issues; insufficient protective equipment for staff; lack of HCW segregation; inadequate pre-collection, collection and storage containers; unsustainable HCW treatment systems; and inadequate financial resources.
3. Knowledge and good HCWM practices are generally insufficient: Several socio-professional categories (hospital staff, collection staff, scavengers, people using recycled objects, etc.) come into direct contact with HCW and are at direct risk for HIV/AIDS contamination. Generally, health workers are relatively conscious of the risks associated with HCW manipulation, even though most of them were not trained in HCW management. Ward attendants, ground staff and cleaners (responsible for the removal and emptying of wastes dustbins within the health facilities) have little awareness of the impacts and effects of bad HCW management. Health workers responsible for collection generally have a low level of education. Most of them work in poor hygienic and protective conditions: not enough safety equipment, etc. Informal scavenging and recycling activities in the garbage dumps are opportunities and sources of income for poor people. Due to their very low level of education and precarious living conditions, it is difficult for them to understand the dangers related to waste scavenging and handling. The general public needs information about the dangers related to the
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materials collected from HCW, especially people using recycled products and those giving and/or receiving healthcare at home.
4. Private companies are not involved in HCWM: In Sierra Leone, no private companies are involved in solid waste collection except Freetown Waste Management Company (FWMC perform this function). For external transportation of HCW, the inexistence of specialized companies constitutes a major constraint for the health facilities in need of external treatment.
5. Financial resources allocated to HCW are not sufficient: Solid waste management suffers from lack of financial support from the government and local governments. In health facilities, financial resources are generally highly allocated to clinical services than to waste management, as depicted from the NHSSP (2010-2015).
In order to address these weaknesses, a health care waste management plan of action has been developed. 5.1.2 Goals and Objectives of the HCWM Plan of Action 5.1.2.1 Goal The goal of the Plan of Action (POA) is to prevent and mitigate the environmental and health impact of HCW on healthcare staff, the general public and the environment. 5.1.2.2 Objectives of the Strategic Plan (i) to reduce infections due to HCW (ii) to improve service in HCWM and mitigate the impacts of HCW on individuals and
communities (iii) to establish a well-managed multi-sector institutional framework for co-ordination
and implementation of HCWM measures 5.1.2.3 Components of the Strategic Plan Measures advocated in the HCWM plan have been structured around the following components: Objective 1: Improve the institutional and legal framework for HCWM Activities:
• Set up a structure for co -ordination and follow up of the HCWM plan • Develop regulations for HCWM • Develop technical guidelines for HCWM.
Objective 2: Improve HCWM in health facilities Activities:
• Regulate HCWM in the health facilities
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• Supply the health facilities with materials and equipment for HCWM as starter packs
• Ensure appropriate protection equipment to health staff • Set up procedures of control in HCW management • Allocate financial resources for HCWM activities.
Objective 3: Train the hospital staff and the HCW handlers Activities:
• Develop training programs • Train trainers • Train all staff working in health care waste management • Evaluate implementation of the training program
Objective 4: Make the general public aware of the risks linked to HCWM Activities:
• Inform public of dangers linked with HCW and reuse of scavenged materials • Ensure sound HCWM in the household (home-based care).
Objective 5: Support private initiatives and partnership in HCWM Activities:
• Inform private companies of the business opportunities in solid waste management
• Set up framework and partnership between public sector and private sector in HCWM
Objective 6: Monitoring and Evaluation of HCWM plan Activities:
• Follow up the execution and evaluate the HCWM Plan 5.1.3 Treatment and Disposal Systems A comparative analysis, taking into account economic and technical criteria, resulted in the following treatment recommendations:
• Modern incinerators of adequate size with air pollution devices are required in national and district hospitals because of their fairly low cost;
• Small-scale modern incinerators in health clinics and MCHPs are required because of their very low cost and small quantities of HCW produced in these facilities;
• Waste pits are required in rural health posts because of very low HCW production;
• Pits with stabilized sides and bottom are required for CHP.
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All solid waste cannot be incinerated. Inappropriate incinerators as well as technical infeasibility of complete combustion for certain wastes (plastic, chemical and radioactive products, mercury, heavy metals, etc.) can generate air pollution. For this reason, incinerators are recommended in the action plan as part of a waste segregation strategy at the source, in order to greatly reduce the infectious wastes and restrict the contamination of other non-contagious wastes (papers, plastics, pipes, etc.). All types of wastes shall not be incinerated. Selective sifting will be used to send all non-contaminated wastes towards more classical treatment systems (disinfection, burial, garbage dumps), so that only the contaminated or risk-based wastes (needles, body parts, etc.) will be incinerated.
These categories of wastes do not emit toxic products (or very few), especially dioxins and mercury. Moreover, the system allows total melting of needles which are the most feared vectors for the accidental transmission of HIV/AIDS via Needlestick injuries (NSIs). In health facilities located in district and rural areas, the quantities of health care wastes produced are very small. If segregation is adhered to, the volume to be incinerated will be insignificant. In addition, the promotion of the use of non-chlorinated plastic bags and containers will help reduce pollution stemming from incineration.
In order for institutions to meet waste management standards, the following alternative options are proposed: chemical disinfection; safe land-filling or burial within hospital grounds (if appropriate area is available).
Other systems (autoclaving, microwaves) are not recommended because they are very expensive and require highly qualified staff for operating.
For liquid wastes, chemical disinfecting is the most effective way of treating infectious wastes. A combined system would be recommended (disinfecting and septic tank) for provincial, district and rural health facilities. In the central hospitals, due to the important volumes of waste involved, it is preferable to choose a physico-chemical treatment, including a disinfecting post. However, this system requires more detailed study in terms of feasibility.
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5.1.4 Logical Framework for HCWM POA Table 5.1: LFA for HCWM plan of action S/N Objective Result Strategies Indicators
1
Improve the institutional and legal framework for HCWM
Responsibilities, standards, and sanctions are clearly defined
Set up a structure for co -ordination and follow up of the HCWM plan
Structure put in place
Develop regulations for HCWM Regulation adopted Develop technical guidelines for HCWM Guidelines in place
2 Improve HCWM in health facilities
HCW segregated, collected, transported, stored and treated properly
Regulate HCWM in the health facilities HCWM Plan adopted Supply the health facilities with materials and equipment for HCWM
Number of equipment
Ensure appropriate protection equipment to health staff
Number of equipment
Set up procedures of control in HCW management
Procedures in place
Allocate financial resources for HCWM activities. Financial resources allocated
3 Train the hospital staff and the HCW handlers
The actors involved in HCWM are conscious of risks and demonstrate good HCWM practices
Develop training programs Programs elaborated Train trainers Number of trained trainers Train all staff working in health care waste management
Percent of trained staff
Evaluate implementation of the training program Appraisal reports
4 Make the general public aware of the risks linked to
The populations are conscious of risks linked with HCWM
Inform population of dangers linked with bad HCW management practices Posters, radio and televised
messages, public animations sessions, etc.
Inform population of dangers linked to scavenged HCW materials Inform home-based care givers/traditional healers of risks linked to improper HCW handling
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HCWM
5
Support private initiatives and partnership in HCWM
Private sectors involved in HCWM
Inform private companies of the business opportunities in solid waste management
Awareness programs
Develop sustainable financing mechanism for HCWM activities
Annual financial flows
Set up framework and partnership between public sector and private sector in HCWM
Number of partnership agreements
6
Monitoring and Evaluation of HCWM plan
HCWM activities are monitored, evaluated and documented
Monthly operational control reports Monthly reports Mid-term evaluation (end yr 2) Evaluation report Final Evaluation (end yr 5) Evaluation report
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5.1.5 Implementation of the Action Plan 5.1.5.1 Program Sequencing Before such an elaborate plan is implemented, certain activities can be started immediately, and others can be implemented over the medium/long term. a) Immediate activities The following actions could be carried out immediately:
• set up a structure for coordination and follow up of the POA • elaboration and dissemination of regulations and basic technical guidelines in
HCWM • elaboration of HCWM training program • elaboration of public awareness programs • planning of start-up activities • set up of HCWM procedures in health facilities, including health staff
responsibilities b) Short term activities
• training of trainers • training all the stakeholders involved in the HCWM • diffusing public awareness programs • assessment of training program implementation • halfway appraisal
c) Medium/longer term activities:
• improvement of HCWM in health facilities • Supporting private initiatives and partnership in HCWM • Monitoring and evaluation of the HCWM plan
5.1.5.2 Institutional Arrangements a) Improvement of the institutional and legal framework The Ministry of Health and Population (MOHP) will be responsible for the improvement of the institutional and legal framework. These activities should be conducted in the first year of the program by the Department of Preventive Health Services (DPHS) and through the Environmental Health Division (EHD). b) Training The training activities should be led by the DPHS / EHS of the MOHP. This structure has competence in HCWM and could be assisted by training institutions in this field. At
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district levels, management of training activities should be assigned to the District team. Specific training activities will be done in the first two years of the program. c) Public awareness The Health Education Unit of the MOHP will lead the activities intended to make the general public aware about HCW. At the local level, the District team will do the supervision. These activities will take place over a four year period, through district public meetings, radio and television messages, posters, etc. d) Control and Monitoring of the POA At the local level, the control and monitoring of HCWM plan implementation should be done by the District team which will ensure monthly monitoring, while the yearly follow up will be realized by EH Department. e) Evaluation and supervision of the POA The evaluation of the HCWM Plan should be assigned to international consultants (under supervision of EH Department), to ensure objectivity. This evaluation should be done halfway through (at the end of the 2nd year) and at the end of the first phase of the program (year 5). 5.1.6 Partnership Framework and Funding 5.1.6.1 Potential Partners and field of intervention Delivery of essential health services and the fight against HIV/AIDS relies on the involvement of a wide range of actors -- public and private sectors, NGOs, and civil society. So it is necessary to establish a partnership framework to identify the roles and responsibilities of each category of actor. Table 5.2: Potential field of intervention Actors Potential field of intervention Technical services of the Government (MOHS)
• inform the local and national authorities • facilitate co-ordination of HCWM plan activities • supply technical expertise • execute control and monitoring activities • train the health staff • supervise the training process, monitoring and
evaluation City councils/District Governments
• participate in the mobilization of populations • ensure HCW are properly disposed in their landfill • participate in training, monitoring and evaluation
Public health facilities / Private health facilities
• participate in training activities • supply staff with security equipment • elaborate internal plans and guidelines about
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HCWM • allocate financial resources for HCWM • ensure HCW management plan is implemented
Private operators • invest in HCWM (e.g., treatment, transport, disposal)
• operate as sub-contractors (City Assemblies / District Government Health Facilities)
NGOs and CBOs • inform, educate and make population aware • participate in / offer training activities
Training Institution
• provide health staff training
5.1.6.2 Involvement of Private Companies in HCWM HCW collection is a major concern for public and private health facilities. According to environmental regulations, health facilities must ensure sustainable management of their wastes. However, in practice health facilities have very limited financial resources, and no public health establishment has funds to pay for collection or disposal services for wastes. For health facilities having incinerators, waste collection is less of a concern. For private facilities, the major constraints are the absence of alternative solutions to their present practices: HCW co-mingled with general wastes and crude disposal. Most of them can’t afford appropriate equipment for treatment. Both public and private facility managers and staff express a willingness to participate in an institutional arrangement whereby costs of treating their HCW could be shared under a common agreement. Such a public-private partnership arrangement could be put in place on the basis of the following principles:
• selected public health facilities would be equipped with incinerators to serve a defined geographic radius;
• Health centers equipped with incinerators would agree to accept and treat HCW from private facilities and smaller health centers within their service area;
• Private health facilities receiving such HCW treatment services would agree to pay a collection treatment fee as per the terms of the cost sharing agreement.
5.1.7 Environmental and Social Measures 5.1.7.1 Measures for mitigating Negative Environmental Impacts The operation of incinerators has negative impacts on environment and health. However, the quantities of HCW to be incinerated daily by each establishment are quite small, so environmental and health impacts will not be significant and the harm caused will not be big. Nevertheless, the following measures should be taken:
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• When installing incinerators inside health facility grounds, a location should be selected that is distant from the admission rooms and health care rooms.
• To minimize noise disruption and smoke discomfort during working hours of the facility, the incinerator should be operated at night.
• To reduce polluting by-products from solid wastes incineration, non-chlorine plastic containers should be promoted; for example, they should be recommended as dustbins for waste collection.
• Incinerators should operate at sufficiently high temperature to get rid of dioxins and should also have efficient scrubbers.
For the large central disposal sites, wire fencing and locks should be installed to reinforce security and to minimize the access of scavengers and children. These protection measures will allow site managers to: (i) control and regulate access to the landfill, (ii) identify the scavengers and (iii) make users aware of danger. 5.1.7.2 Measures for Mitigating Negative Social Impacts Implementation of the HCWM Plan might have negative social impacts on scavengers earning their daily living at landfills. Their income may decrease as a result of well-organized management of HCW, particularly when segregation is done at source. Health facilities should explore developing a mechanism for giving local scavengers non-infectious reusable objects (such as empty bottles), for example, authorizing them to come and collect items according to well-defined modalities. For the populations neighboring the landfills, the risks of being driven away and resettled in other areas are minor. Generally, these populations did not come to settle around the landfills: instead, the disposals sites have been created inside these districts. There are cultural issues relating to disposal of anatomical wastes (amputated body parts, placenta, etc.), which communities may be strongly sensitive to. These cultural aspects should be taken into account in each health facility HCWM action plan, to better ensure the acceptability of disposal methods. For example:
• the placenta could be buried or put in septic pits, as it is the case presently in some health facilities;
• anatomical wastes (such as body parts) can be buried inside the hospital; • Liquid wastes from washing of the dead are generally evacuated in septic pits.
5.1.8 The Monitoring Plan for HCWM 5.1.8.1 Principle and Objective
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Waste management is a continual task demanding a permanent effort from each and every person at the health facility. During the upgrading phase, the process of HCWM must be investigated and recorded. Once the required level is reached, regular monitoring should ensure that the desired standard is maintained. The monitoring of HCWM is part of the overall quality management system. To measure the efficiency of the HCWM Plan, activities should be monitored and evaluated in collaboration with concerned institutions: MoHS, City/Town Councils, NGOs, etc. 5.1.8.2 Methodology The HCWM Plan will be executed over 5 years and implementation monitoring will be carried out as shown in Table 5.3. Table 5.3: Implementation plan for M&E Objective Timing/Period Responsible Party Institution and Legal framework
At the beginning of the program (1st year)
EHD/MoHS/OCA
Planning activities At the beginning of the program
EHD/MoHS
Implementation of the health facility HCWM plan
Yearly, according to the time table
Health facilities/EHD/MoHS
Control and follow up of the execution of the HCWM Plan activities
Daily Health facilities Monthly Health facilities/EHD Yearly EHD/MoHS
Training 1st and 2nd years EHD/Health facilities Awareness 1st and 2nd years EHD/MoHS/Health facilities
HCWM Plan Evaluation
Midterm review, half way (end of 2nd year)
EHD/HFs with support from international consultant
At the end of the 5th year EHD/HFs with support from international consultant
Supportive supervision Six-monthly EHD/MoHS Long-term private sector involvement in the HCWM business will depend on whether national, district, and municipal governments are able to put in place self-sustaining sources of financing to cover investment and operating costs for this critical environmental and public health service. If the financial problems are resolved, then private sector operators can be expected to identify their individual comparative advantage and explore contractual arrangements to provide a range of services for health facilities (e.g., transport, treatment, disposal, etc). 5.1.8.3 Measurable Indicators
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Program level indicators are presented in Table 1, the Logical Framework for the HCWM POA. At the facility level, the following framework and measurable indicators could be developed into a standard format to facilitate comparability and usefulness of the data:
• HCW management structure: reduction of waste, increase in efficiency; standard of hygiene; awareness of staff and patient; statistical data on waste generation; financial resources; functioning of responsibilities; training and awareness creation activities; monitoring and recording activities;
• HCW collection: sufficient and appropriate collection containers; efficiency of waste segregation; frequency of waste removal; environmentally friendly handling of waste; responsibilities;
• HCW transportation and storage: cleanliness and functioning of transport equipment; execution of recommended transport procedures; status of storage facilities; cleanliness; separate storage of hazardous items; emergency equipment; lock and safety measures; responsibilities;
• HCW treatment: incinerator for infectious waste; proper functioning of incinerator; maintenance procedure; safety regulation for operation; safe disposal of ash; responsibilities; sewage system; functioning of septic tanks; maintenance procedure; wastewater treatment;
• HCW disposal: proper operation of landfill site; proper operation of waste pit for infectious waste; transport of chemical and radioactive waste; responsibilities;
• General cleanliness: containers not overfilled; no used sharps outside or protruding from sharps containers; no foul-smelling waste in facility or on premises; no litter in facility or on premises; waste pits not overfilled.
5.1.9 Institutional Framework and Implementation Responsibilities 5.1.9.1 Institutional Framework At the national level, the HCWM Plan is part of the Government’s Environmental Health strategy, of which it is an important component. Implementation will be coordinated by the EHD of the MoHS, in concordance with other stakeholders (CBOs and NGOs) who will participate in a range of activities – from implementation to supervision.
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5.1.9.2 Responsibilities Part of improving HCW management involves clarifying who is responsible for what functions and identifying the fields of competencies of each institutional actor involved in this process. A brief synopsis of functions and competencies is provided below. a) At the central level: The MoHS is responsible for national health policy and ensures the guardianship of the health facilities. The Department of Preventive Health Services (Environmental Health Section) will take the lead in coordinating implementation of the HCWM plan because: (i) it is part of its mission, (ii) it has competent staff in this field, and (iii) it has decentralized services at district level. The Health Education Service Unit has a role to play because it is concerned with activities of public information and awareness rising. b) At the district level/city council level The City Assemblies and District Assemblies will need to put in place arrangements to make sure that HCW are not mixed with general wastes in their public landfills. They should also give their opinion about the HCWM plan activities proposed for health facilities in their jurisdiction, in case some may have negative impacts on the local population’s health. Coordination of the monitoring and reporting on implementation of the HCWM POA will be exercised by the Health Team, in particular the Environmental Health Officer. c) At the health facility level: The manager of each health facility shall be responsible for HCWM in his/her establishment. S/he must ensure that a HCWM plan is prepared and then watch to ensure that procedures and regulations are respected. S/he must designate the teams charged with HCW segregation, collection, transportation and treatment. 5.1.9.3 Institutional Arrangements for HCWM Component Implementation Effective implementation of the HCWM Plan components requires that institutional arrangements and responsibilities be clearly defined. The following institutional arrangements are proposed: a) Improvement of institutional and legal framework The co-ordination structure should be set up by the DPHS. This department, through the EHD, should take the lead in developing the HCW regulations and technical guidelines. National consultants, having acquired a large experience in HCWM, could realize this task under the control and supervision of EHS.
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b) Training Training activities should be led by the DPHS (EHS) of the MOHP. This structure has competence in HCWM and could be supported by training institutions like the Polytechnic, Lilongwe School for the Health Sciences, etc. At district level, management of training activities should be assigned to the District Health Management Team. The specific training activities will be done in the first two years of the program. National Consultants will train trainers in health facilities, but also in the other institutions (City/town councils, NGOs, etc.). Then trained key staff should train their employees. The EHS and the District Management teams do not have the human resources to prepare and diffuse the training courses about HCWM. The EHS could prepare the TOR, and do the control and supervision at national level while District Management teams would assume the monitoring at local level. In other words:
• The EHS prepares the Terms of Reference for developing the training programs, and does the control and supervision at national level ;
• Health Training Institutes or National Consultants having acquired a large experience in HCWM will prepare the training courses;
• In each district, a training workshop will be held and will be conducted by national facilitators, under the supervision of district management teams. The latter must prepare periodic reports to be sent to the central level (EHS/MOHP);
• In each health facility, the supervising staff trained in the district workshops will ensure the training of medical and paramedical staff, cleaners, etc., under their supervision. The heads of the health establishments must supervise this work and prepare periodic evaluation reports.
c) Population awareness The Health Education Unit of the MoHS will lead the activities intended to increase the awareness of the general public about the risks associated with HCW. At local level, District Management Teams will do the supervision. These activities will cover the 5 years of the program, through district animations, radio and television messages, posters, etc., and will be done as follows:
• The Health Education Unit of the MoHS will elaborate, with the help of the EHS, the content of these messages, of posters and district animation;
• The televised messages will be diffused by the National Station; • The radio messages will be diffused by the local radio stations, in English and
local languages, under the supervision of District management teams Private
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companies (printing enterprises) will make posters to be used in the health facilities;
• Public animation sessions will be led by NGOs acting in the health and the environmental field, under the supervision of Regional and District Management Teams.
d) Strategy for private sector involvement and partnership The elaboration of measures to involve private companies more directly in HCWM will be coordinated by the MOHP, in collaboration with district governments and City Assemblies. e) Baseline Survey and Activity Planning National consultants, supervised by district management teams and EHS, will carry out a baseline survey at the beginning of the investment phase. During this task, the consultants will indicate the situation prevailing presently in the health facilities, elaborate evaluation criteria, and prepare the execution plan. f) Monitoring of the HCWM plan At the local level, it is recommended that the District management teams ensure regular program oversight and provide monthly monitoring reports, while the six-monthly follow up will be realized by EHS/DPHS. g) Evaluation of the HCWM Plan It is recommended to assign this evaluation to international consultants (under supervision of EHD), to ensure its neutrality. This evaluation must be done halfway through (at the end of the 2nd year) and at the end of the first phase of the program (year 5). The following table shows the implementation responsibilities for the HCWM Plan. Table 5.4: Implementation Responsibilities by Component
Component and Activities Execution Control and
Supervision
Improvement of HCWM institutional and legal framework
Setup structure for coordination and follow up the POA
EHD MoHS/EHD
Develop regulations for HCWM
Consultants MoHS/EHD
Develop technical guidelines for HCWM
Consultants MoHS/EHD
Improve HCWM in health facilities
Regulate the HCWM in HFs EHD MoHS/EHD Supply HF with HCWM equipment and materials
Health facilities MoHS/EHD
Ensure appropriate Health facilities MoHS/EHD
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protection equipment for health workers Promote use of recyclablematerials
Health facilities MoHS/EHD
Setupprocedures of control in HCW management
Health facilities MoHS/EHD
Training Elaborate training programs and train trainers
Consultants/Training institutions
EHD/MoHS
Train all health workers active in HCWM
Supervising staff/Training institutions
EHD/MoHS/Health facilities
Evaluate the training program implementation
Health facility managers
EHD/MoHS/Health facilities
Public awareness
Television messages National TV EHD/MoHS Radio messages Local radios EHD/MoHS Posters in health facilities Printing companies EHD/MoHS Public animat ion sessions NGO/CBO EHD/MoHS
Support the private initiatives and partnership in HCWM
Diffuse information about business opportunities in solid waste management
EHD
MoHS
Develop partnership arrangements between public sector and private sector for HCWM
EHD /Health Facilities District and City Council
MoHS / Ministry of Local Government
Support the execution of HCWM Plan
Plan HCWM activities National consultant EHD/MoHS Monitor the execution (national and local level)
Health districts EHD/MoHS
Evaluation of the HCWM POA (halfway and final)
International consultant
EHD/MoHS/Councils
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5.1.9.4 Timetable for HCWM Implementation The following timetable shows the proposed implementation schedule of HCWM Plan over a five year period. Table 5.5: Implementation Timetable for HCWM Y1 Y2 Y3 Y4 Y5 Objectives Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
1. Improve the institutional and legal framework for HCWM
2. Improve HCWM in health facilities
3. Train the hospital staff and the HCW handlers
4. Make the general public aware of the risks linked to HCWM
5. Support private initiatives and partnership in HCWM
6. Monitoring and Evaluation of HCWM plan
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Before such an elaborate plan is implemented, certain activities can be started immediately, and others may be realized over the medium/long term. The following actions could be realized immediately:
• set up a structure for coordination and follow up of the POA • elaboration and dissemination of regulation and technical basic guidelines in
HCWM • elaboration of HCWM training program • elaboration of public awareness training modules and supports • planning of starting activities • set up HCWM procedures in health facilities, including health staff responsibilities
In short term:
• training of trainers • training all the stakeholders involved in the HCWM • diffusing of public awareness programs • assessment of training program implementation • halfway appraisal
In medium/longer term:
• improvement of the HCWM in the health facilities • Supporting of the private initiatives and partnership in HCWM • Monitoring and evaluation of the HCWM plan
5.1.10 HCWM Plan of Action - Costs The estimated cost of implementing the HCWM POA and initiating this process of proper handling, disposal and management of medical waste is 971,000 USD. Of this amount, 423,000 USD is for institutional, training, and coordination/monitoring activities, and 548,000 USD is for investments in equipment and supplies to upgrade HCWM at the health facility level. Table 6 below provides more details per component of the POA.
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Table 5.6: Implementation costs of the HCWM Plan
Objectives Strategies Unit Quantity
Unit cost (USD)
Total (USD)
Improve the institutional and legal framework for HCWM
Set up a structure for co -ordination and follow up of the HCWM plan; Develop regulations and guidelines for HCWM Man/day 60 200
12,000
Printing costs for documents # 2000 4
8,000
Subtotal
20,000
Improve HCWM in health facilities
Supply the health facilities with materials and equipment for HCWM Various Boxes for syringes
# 1000 15
15,000 Containers in healthcare rooms
# 1000 15
15,000 Boots for waste handlers/cleaners #
2,000 20
40,000 Masks for waste handlers #
10,000 2
20,000 Heavy duty gloves for waste handlers #
2,000 10
20,000 Acquire high-tech incinerator for central and district hospitals
# 12 50,000
600,000
Build small scale incinerators in clinics and health posts located in the urban
# 40 20,000
800,000
Build stabilized pits for HCW in rural areas # 60 1500
90,000
Subtotal
1,600,000
Train the hospital staff and the HCW handlers
Develop training programs training materials Days 50 200
10,000
Train trainers Days 600 50
30,000
Train all staff working in health facilities Days 3,000 50
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150,000 Evaluate implementation of the training program Days
50 200
10,000 Training of supplies staff Days
300 50
15,000Train EHD staff to MSc in Environmental Engineering and Sanitation # 3 50,000 150,000 Subtotal
215,000
Make the general public aware of the risks linked to HCWM
Television messages # 30 500
15,000
Radio messages # 150 200
30,000
Posters in health facilities # 5,000 10
50,000
Public animation sessions # 100 200
20,000
Subtotal
115,000
Support for the execution of HCWM Plan, M&E
Plan starting activities Days 30 80
2,400
Monitoring at national and local level Days 250 80
20,000
Mid-term evaluation (end yr 2) Days 30 400
12,000
Final Evaluation (end yr 5) Days 30 400
12,000
Subtotal
46,400
TOTAL
2,046,400
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5.2 Plan of Action for Municipal Solid Waste Management 5.2.1 Authority and Purpose 5.2.1.1 Authority The national laws authorize the MOHS to regulate and control the management of solid waste in this country. Thus, MoHS is required to develop a “Solid Waste Management Plan" for the entire country, including all towns, municipalities and districts. The Plan covers a 5-year planning period and describes the solid waste disposal systems, the systematic collection and disposal of solid waste by public or private entities. The Plan shall be reviewed and updated as necessary at least once every two years. When deemed necessary by MoHS must prepare an amendment to the Plan and must conduct a public hearing prior to adopting, amending or revising the Plan. 5.2.1.2 Purpose of Plan The purpose of this Plan is to describe the national programs for providing comprehensive management of solid waste generated by residential, commercial, and institutional sectors during the 5-year period from 2012 through 2016. An integrated Solid Waste Management Plan provides specific management tools to handle various components of the waste stream. The Plan establishes the framework on which current solid waste management activities are conducted and future programs are implemented. This Plan reflects the established integrated solid waste management Policy and the corresponding guidelines. A number of technical terms have been developed in connection with the integrated solid waste management system. The definitions of these terms as used in this Plan are included in Appendix A. 5.2.3 The MSW Plan of Action 5.2.3.1 Goal The goal of the Plan of Action (POA) is to prevent and mitigate the environmental and health impact of MSW on the general public, waste management companies’ staff and the environment. 5.2.3.2 Focus The government of Sierra Leone has adopted an integrated solid waste management system to achieve its goal of reducing and recycling solid waste to the maximum feasible extent. To achieve this goal, the MoHS has adopted a policy that establishes a hierarchy of solid waste management options. The most preferred management option is the reduction of solid waste at its source. The second most preferred solid waste management technique is recycling and reuse of solid waste. The goal is to achieve, maintain or exceed 50 percent recycling of municipal solid waste by the end of Calendar
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Year 2014. Solid waste remaining after reduction, recycling shall be landfilled. By shifting the focus of solid waste management to reduction and recycling, the government strives to reduce the solid waste remaining for disposal. This helps reduce reliance upon land for landfilling. Most of the actions outlined in this Plan and the decisions behind them directly address a solid waste management program that has as a major factor - protection of the environment. Education, source reduction and recycling are intended specifically to reduce waste volumes and control waste composition. This has a direct effect on the volume of residual waste that requires management, minimizing the potential for environmental degradation. 5.2.3.3 Objectives of the Strategic Plan on Municipal Solid Waste Management
1) Train the EDH staff on MSWM and Mangers of Waste Management Companies 2) Make the general public aware of the risks linked to MSWM 3) Support local efforts to identify areas with litter and illegal disposal problems, and
implement enforcement and other programs to address those problems. 4) Identify areas with inadequate collection, transportation, and/or processing
services, and plan for and implement strategies to provide those services by public or private entities.
5) Incorporate the of MSW management needs into the environmental partnership programs and other outreach efforts.
6) Clarify the role of local solid waste management plans. 7) Complete regional inventories of closed municipal solid waste landfill sites, and
establish a process to maintain those inventories. 8) Benchmark and track the effectiveness of national, regional, and local waste
reduction efforts. 9) Emphasize market-based incentives and market development for recycled
products. 10) Continue to implement efficiency improvements in MSW 11) permitting and regulatory processes 12) Identify areas with less than 10 years of municipal solid waste disposal capacity
available either within the region or through facilities in nearby and adjacent regions, and plan with public and private entities to implement regional and local strategies to develop adequate capacity reserves.
13) Monitoring and Evaluation of MSWM plan.
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5.2.3.4 Components of the MSWM Strategic Plan Objective 1: Train the EDH staff on Municipal Solid Waste Management Activities:
• Develop training programs • Train trainers • Train all staff working in municipal waste management • Evaluate implementation of the training program
Objective 2: Make the general public aware of the risks linked to MSW Activities:
• Inform public of dangers linked with MSW and reuse of scavenged materials • Ensure sound MSWM in the households, institutions, etc.
Objective 3: Identify areas with inadequate collection, transportation, and/or processing services, and plan for and implement strategies to provide those services by public or private entities Activities:
• EHD regional staff should work jointly with the LGAs to target activities to those local areas that lack basic solid waste management services, including liquid waste transportation, processing, and disposal.
• Provide basic planning and assistance tools on the Internet, for use by local communities in assessing and developing programs to effectively meet their needs, including needs for liquid waste management.
• The LGAs in their regional solid waste management plans should identify those sub-regional areas which lack adequate collection services and/or access to available disposal facilities, and identify actions to ensure that those needs are met, including liquid waste services.
• The LGAs in their regional solid waste management plans should include solutions for providing services, and should encourage use of citizens’ collection stations and transfer stations where appropriate.
• The LGAs in their regional solid waste management plans should assess liquid waste processing and disposal needs, including strategies for addressing those needs through public or private entities.
Objective 4: Support local efforts to identify areas with litter and illegal disposal problems, and implement enforcement and other programs to address those problems.
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• Encourage local entities to evaluate the factors leading to litter and illegal disposal problems, and to take the lead in implementing comprehensive remedies to address those factors, to include: education, provision of basic collection and disposal services, and increased law enforcement activities.
• Continue to provide training and education opportunities for environmental enforcement staff at the local level.
• Continue to develop and make available information and models to assist local governments to establish programs to address litter and illegal disposal activity, as well as the underlying causes of litter or illegal disposal problems in the community.
• Local governments should recognize their responsibilities for addressing problems with littering and illegal disposal of municipal solid waste, with support and assistance from the government.
• The LGAs in their solid waste management plans should identify areas with litter and illegal dumping problems, and identify entities that should establish a local enforcement program, with an emphasis on regional cooperation.
• Based on the priorities established in their regional plans, the LGAs should use the MSWM budget to support local enforcement programs (programs standardized for effectiveness).
Objective 5: Incorporate the of MSW management needs into the environmental partnership programs and other outreach efforts. Activities:
• Use the national environmental partnership programs (Clean Sierra Leone) to obtain local commitments for basic solid waste management services for residents are provided by public or private entities while addressing litter or illegal dumping and other key MSW management needs, in addition to committing to certain waste reduction goals and programs.
• Provide guidance to local governments in addressing MSWM needs (waste reduction, full-cost accounting, pay-as-you-throw, contracting for MSW collection and disposal, and providing collection services to rural areas).
• Establish and use the Sierra Leone Environmental Excellence Awards program to recognize innovative efforts by local governments and private efforts.
Objective 6: Clarify the role of local solid waste management plans in permitting processes. Activities:
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• Define how approved local solid waste management plans will be considered in MSW permitting decisions
• The LGAs should establish clearly defined processes within the LGA for how conformance recommendations will be made to the EDH.
Objective 7: Complete regional inventories of closed municipal solid waste landfill sites, and establish a process to maintain those inventories. Activities:
• Work with the LGAs to complete the inventories and incorporate those into the regional solid waste management plans
• Establish a process to maintain and update the regional inventories, once the inventories are completed and incorporated into the regional solid waste management plans
• LGA management plans to include location and status for all permitted landfills, including those that are open, inactive, partially closed, and fully closed.
Objective 8: Benchmark and track the effectiveness of national, regional, and local waste reduction efforts Activities:
• Continue to evaluate progress of the national waste reduction programs through tracking the amount of municipal solid waste disposed of and assessing changes in that amount in relation to changes in the national population and economy.
• Conduct further research and give greater consideration to the impact of economic changes (vs. population changes) on disposal rates and amounts.
• Determine an appropriate mechanism to estimate the national recycling rate on a regular basis.
• Continue to compile information on the number of recycling projects and programs conducted by local governments and businesses.
• Consideration will be given to involving the LGAs to a greater degree in conducting surveys of local governments and businesses.
• Continue to encourage landfills to install and use scales to more accurately measure the amount of waste received and disposed.
• Establish mechanisms to track the level of compliance requirements to recyclables separation and collection programs.
Objective 9: Emphasize market-based incentives and market development for recycled products Activities:
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• Compile and provide access to recyclables market information at a nationwide level.
• Work with the Recycling Market Development Board to continue to encourage purchases of recycled-content products by national agencies
• Continue the Sierra Leones Recycled voluntary marketing program for recycled-content products.
• Continue to consider improvements to the composting refund program to provide incentives to development of additional composting operations
• Educate local and regional entities on how to develop cooperative agreements and programs to enhance markets for recyclables
• The LGAs and other regional and local entities should consider establishing cooperative purchasing and market development programs to support markets for recyclable materials and for products made from those materials
• Municipalities, counties, and districts should comply with statutory requirements to establish programs for the separation and collection of recyclables at government facilities and operations, and for giving preference in purchasing to products made from recycled materials.
Objective 10: Continue to implement efficiency improvements in MSW permitting and regulatory processes Activities:
• Continue to implement efficiency improvements that began with consolidation of some permitting processes and enhancements to public participation and notice procedures
• Use alternative dispute resolution processes, as well as bifurcated hearings to settle land use concerns
• 3 Continue improvements to permit development guidance and pre-application instructions.
• Further encourage applicants to participate in pre-application meetings and discussions with permitting staff early in the process.
• The LGs should take on a greater role in helping to resolve local issues and concerns before a permit application is submitted to the EHD. As part of this role, the LGs should establish voluntary pre-application review and public participation procedures through their existing solid waste advisory committees, and should actively encourage potential applicants to participate in those processes early in planning for a SWM facility.
Objective 11: Identify areas with less than 10 years of municipal solid waste disposal capacity available either within the area or through facilities in nearby
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and adjacent regions, and plan with public and private entities to implement regional and local strategies to develop adequate capacity reserves Activities:
• Continue to assess nationwide and regional disposal capacity, and ensure that regional and local leaders are aware of when the capacity in their area has reached 10 years or less.
• Target outreach and assistance efforts by EHD regional program staff to communities that have less than 10 years of remaining capacity available, to ensure that those communities are planning to meet their needs.
• The LGAs in their regional solid waste management plans should assess disposal capacity needs, and should target local areas with less than 10 years of capacity for development of local plans or technical studies to identify the best approach to meet those local capacity needs.
• Local governments should consider establishing long-term agreements with private disposal service providers, cooperative agreements with other local governments, or other mechanisms to assure long-term availability of disposal capacity, where those options exist.
• The local governments, and landfill operators should continue to consider integrated waste management options, as well as the use of different landfill designations where appropriate, to ensure the availability of disposal capacity.
Objective 12: Involve Private Sector in the MSWM Activities:
• Increase number of contracts between LGA and private sector in waste collection, transportation and disposal
• Assign Private sector specific areas for collection, transportation and disposal • Empower the private sector in collection of MSW via training, supportive
supervision program • Empower the private companies in the data recordkeeping for MSWM activities,
financial management practices and full cost accounting
Objective 13: Monitoring and Evaluation of MSWM plan Activities:
• Follow up the execution and evaluate the MSWM Plan.
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5.2.4 Logical Framework for MSWM Plan of Action Table 5.7: LFA for Municipal Waste Management S/N Objective Result Strategies Indicators
1
Train the EDH staff on MSWM and Mangers of Waste Management Companies
The actors involved in MSWM are conscious of risks and demonstrate good MSWM practices
Develop training programs Programs elaborated Train trainers Number of trained trainers Train all MoHS staff working in MSWM and Company managers
Percent of trained staff and Company managers
Evaluate implementation of the training program Appraisal reports
2
Make the general public aware of the risks linked to MSWM
The populations are conscious of risks linked with poor MSWM
Inform population of dangers linked with bad MSW management practices Posters, radio and televised
messages, public animations sessions, etc.
Inform population of dangers linked to scavenged MSW materials Inform households of risks linked to improper MSW handling
3
Identify areas with inadequate collection, transportation, and/or processing services, and plan for and implement strategies to provide those services by public or private entities.
LGA’s plans for MSWM and LWM developed and implemented
EHD regional staff should work jointly with the LGAs to target activities to those local areas that lack basic solid waste management services, including liquid waste transportation, processing, and disposal.
Annual Reports
Provide basic planning and assistance tools on the Internet, for use by local communities in assessing and developing programs to effectively meet their needs, including needs for liquid waste management. Role of Other Entities
# of tools developed and posted on internet
The LGAs in their regional solid/liquid waste management plans should identify those sub-regional areas which lack adequate collection services and/or access to available disposal facilities, and identify actions to ensure that those needs are met.
Action plans in place
The LGAs in their regional solid waste management plans should include solutions for providing services, LGAs’ WM plans in place
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and should encourage use of citizens’ collection stations and transfer stations where appropriate. The LGAs in their regional solid waste management plans should assess liquid waste processing and disposal needs, including strategies for addressing those needs through public or private entities.
LGAs’ waste processing plans in place
4
Support local efforts to identify areas with litter and illegal disposal problems, and implement enforcement and other programs to address those problems.
Root causes of littering and illegal disposal identified and eliminated
Encourage local entities to evaluate the factors leading to litter and illegal disposal problems, and to take the lead in implementing comprehensive remedies to address those factors, to include: education, provision of basic collection and disposal services, and increased law enforcement activities.
Disposal problems in LGAs identified and solved
Continue to provide training and education opportunities for environmental enforcement staff at the local level.
# of Environmental enforcement staff trained
Continue to develop and make available information and models to assist local governments to establish programs to address litter and illegal disposal activity, as well as the underlying causes of litter or illegal disposal problems in the community.
# of Information bulletin and models on littering and illegal disposal available
Role of Other Entities Local governments should recognize their responsibilities for addressing problems with littering and illegal disposal of municipal solid waste, with support and assistance from the government.
LGAs take responsibilities for littering and illegal disposal
The LGAs in their solid waste management plans should identify areas with litter and illegal dumping problems, and identify entities that should establish a local enforcement program, with an emphasis on regional cooperation.
Enforcement program for littering and illegal disposal in place
Based on the priorities established in their regional plans, the LGAs should use the MSWM budget to support local enforcement programs (programs standardized for effectiveness).
Budget for local enforcement programs in place
5 Incorporate the of MSW management
Environmental partnerships and outreach
Use the national environmental partnership programs (Clean Sierra Leone) to obtain local commitments for basic solid waste management services for residents are
# of Local partnership programs for SWM services in place
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needs into the environmental partnership programs and other outreach efforts.
programs exist provided by public or private entities while addressing litter or illegal dumping and other key MSW management needs, in addition to committing to certain waste reduction goals and programs. Provide guidance to local governments in addressing MSWM needs (waste reduction, full-cost accounting, pay-as-you-throw, contracting for MSW collection and disposal, and providing collection services to rural areas).
Guidance bulletin for LGAs in place
Establish and use the Sierra Leone Environmental Excellence Awards program to recognize innovative efforts by local governments and private efforts.
Environmental Excellence Award in place
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Clarify the role of local solid waste management plans in permitting processes.
Define how approved local solid waste management plans will be considered in MSW permitting decisions
Permit decision criteria in place
The LGAs should establish clearly defined processes within the LGA for how conformance recommendations will be made to the EDH.
Permit application criteria in place
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Complete regional inventories of closed municipal solid waste landfill sites, and establish a process to maintain those inventories.
Regional inventories of WM sites exist
Work with the LGAs to complete the inventories and incorporate those into the regional solid waste management plans.
Inventory of closed MSWM sites included in the LGAs’ plan
Establish a process to maintain and update the regional inventories, once the inventories are completed and incorporated into the regional solid waste management plans.
Inventory of MSWM sites maintained and updated yearly
LGA management plans to include location and status for all permitted landfills, including those that are open, inactive, partially closed, and fully closed.
Status and location of landfills included in WM plans
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Benchmark and track the effectiveness of national, regional, and local waste
Continue to evaluate progress of the national waste reduction programs through tracking the amount of municipal solid waste disposed of and assessing changes in that amount in relation to changes in the national population and economy.
Annual Evaluation reports
Conduct further research and give greater consideration Research report
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reduction efforts.
to the impact of economic changes (vs. population changes) on disposal rates and amounts. Determine an appropriate mechanism to estimate the national recycling rate on a regular basis.
Mechanism developed and used
Continue to compile information on the number of recycling projects and programs conducted by local governments and businesses. Consideration will be given to involving the LGAs to a greater degree in conducting surveys of local governments and businesses.
Annual reports on recycling programs
Continue to encourage landfills to install and use scales to more accurately measure the amount of waste received and disposed.
Scales installed and in use
Establish mechanisms to track the level of compliance requirements to recyclables separation and collection programs.
Recyclable separation mechanism in place
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Emphasize market-based incentives and market development for recycled products.
Compile and provide access to recyclables market information at a nationwide level.
Market information in place
Work with the Recycling Market Development Board to continue to encourage purchases of recycled-content products by national agencies.
Tons of recyclables purchased
Continue the Sierra Leones Recycled voluntary marketing program for recycled-content products.
Number of items in the recyclable list with corresponding tons
Continue to consider improvements to the composting refund program to provide incentives to development of additional composting operations.
# of composting sites in the program
Educate local and regional entities on how to develop cooperative agreements and programs to enhance markets for recyclables.
Education program in place
Role of Other Entities The LGAs and other regional and local entities should consider establishing cooperative purchasing and market development programs to support markets for recyclable materials and for products made from those materials.
Number of items in the recyclable list with corresponding tons
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Municipalities and districts should comply with statutory requirements to establish programs for the separation and collection of recyclables at government facilities and operations, giving preference in purchasing to products made from recycled materials.
# of products from recyclable materials
10
Continue to implement efficiency improvements in MSW permitting and regulatory processes
Continue to implement efficiency improvements that began with consolidation of some permitting processes and enhancements to public participation and notice procedures.
Reports
Use alternative dispute resolution processes, as well as bifurcated hearings to settle land use concerns. Number of hearings
Continue improvements to permit development guidance and pre-application instructions.
Number of documents prepared
Further encourage applicants to participate in pre-application meetings and discussions with permitting staff early in the process.
Number of pre-application meetings with reports
Role of Other Entities The LGAs should take on a greater role in helping to resolve local issues and concerns before a permit application is submitted to the EHD. As part of this role, the LGs should establish voluntary pre-application review and public participation procedures through their existing solid waste advisory committees, and should actively encourage potential applicants to participate in those processes early in planning for a SWM facility.
Reports on concerns resolved
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Identify areas with less than 10 years of municipal solid waste disposal capacity available either within the region or through facilities in
Continue to assess nationwide and regional disposal capacity, and ensure that regional and local leaders are aware of when the capacity in their area has reached 10 years or less.
Reports
Target outreach and assistance efforts by EHD regional program staff to communities that have less than 10 years of remaining capacity available, to ensure that those communities are planning to meet their needs.
Reports of activities
Role of Other Entities The LGAs in their regional solid waste management plans should assess disposal capacity needs, and
Reports from LGAs
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nearby and adjacent regions, and plan with public and private entities to implement regional and local strategies to develop adequate capacity reserves.
should target local areas with less than 10 years of capacity for development of local plans or technical studies to identify the best approach to meet those local capacity needs. Local governments should consider establishing long-term agreements with private disposal service providers, cooperative agreements with other local governments, or other mechanisms to assure long-term availability of disposal capacity, where those options exist.
Number of agreements
The local governments, and landfill operators should continue to consider integrated waste management options, as well as the use of different landfill designations where appropriate, to ensure the availability of disposal capacity.
Plans in place
12 Involve Private Sector in the MSWM
Private Sector involved in the MSWM
Increase number of contracts between LGA and private sector in waste collection, transportation and disposal
Number of New Service Contracts, a Process Indicator
Assign Private sector specific areas for collection, transportation and disposal
Percentage Service Coverage, a Process Indicator
Empower the private sector in collection of MSW via training, supportive supervision program
Collection Index, a Physical Performance Indicator
Empower the private companies in the data recordkeeping for MSWM activities, financial management practices and full cost accounting
Annual Expenditure per Ton of Waste Collected, a Financial Efficiency Performance indicator
13 Monitoring and Evaluation of MSWM plan
MSWM activities are monitored, evaluated and documented
Monthly operational control reports Monthly reports Mid-term evaluation (end yr 2) Evaluation report Final Evaluation (end yr 5) Evaluation report
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5.2.5 Institutional Arrangements 5.2.5.1 Improvement of the Institutional and Legal Framework The Ministry of Health and Sanitation (MoHS) will be responsible for the improvement of the institutional and legal framework. These activities should be conducted in the first year of the program by the EHD. 5.2.5.2 Training The training activities should be led by the EHD. This structure has competence in MSWM and could be assisted by training institutions in this field. At district levels, management of training activities should be assigned to the District team. Specific training activities will be done in the first two years of the program. 5.2.5.3 Public Awareness The Health Education Unit of the MoHS will lead the activities intended to make the general public aware about MSWM. At the local level, the District team will do the supervision. These activities will take place over a five year period, through district public meetings, radio and television messages, posters, etc.
5.2.5.4 Control and Monitoring of the POA At the local level, the control and monitoring of MSWM plan implementation should be done by the District team which will ensure monthly monitoring, while the yearly follow up will be realized by EH Department.
5.2.5.5 Evaluation and Supervision of the POA The evaluation of the MSWM Plan should be assigned to international consultants (under supervision of EH Department), to ensure objectivity. This evaluation should be done halfway through (at the end of the 2nd year) and at the end of the first phase program (year 5). 5.2.6 Partnership Framework and Funding 5.2.6.1 Potential partners and field of intervention Delivery of essential MSWM services and the fight against vector diseases relies on the involvement of a wide range of actors -- public and private sectors, NGOs, and civil societies. Thus, it is necessary to establish a partnership framework to identify the roles and responsibilities of each category of actor. Table 5.8: Potential field of intervention Actors Potential field of intervention
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Technical services of the Government (MoHS)
• Inform the local authorities • Facilitate co-ordination of MSWM plan activities • Supply technical expertise • Execute control and monitoring activities • Train the Environmental Health Staff • Supervise the training process, monitoring and evaluation • Disseminating information providing education, training and
technical assistance to the public about various components of the integrated municipal solid waste management system
• Drafting the Plan and its amendments and revisions, proposed legislation and regulations, with review comments
• Providing for the periodic review and update, if necessary, of the Plan on a three-year basis.
Local Governments
• Participate in the mobilization of the Sierra Leone population • Assist in the establishment of recycle programs/centers • Administer recycling regulations, including providing technical
assistance and support, as well as enforcement; • Ensure MSW is properly disposed in the landfill • Participate in training, monitoring and evaluation • Overseeing the collection of solid waste, responding to inquiries
and complaints related to collection services • Enforcing solid waste management laws and regulations
Private operators in MSWM
• Invest in MSWM (e.g., collection, transport, treatment, disposal, etc.)
• Operate as contractors • Managing solid waste reduction, recycling, composting,
resource recovery and disposal facilities and programs to implement the integrated solid waste management system
NGOs and CBOs • Inform, educate and make population aware • Participate in/offer training activities
Training Institution
• Provide environmental health staff training
5.2.6.2 Involvement of Public Sector in MSWM
• EHD coordinates public participation in solid waste management planning and provides administrative support and information to the local governments.
• Public Hearings – The district council holds a public hearing on the proposed Integrated Solid Waste Management Plan and any revision thereof. At least ten
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days notice of the hearing is given by publication in a newspaper or newspapers of general circulation.
• Public Information Meetings – LGAs may conduct public meetings for the purpose of informing the public concerning any aspect of requirements, developments, and proposals related to solid waste management and planning.
5.2.7 Environmental and Social Mitigation Measures 5.2.7.1 Measures for Mitigating Negative Environmental Impacts
• Mitigation measures are measures that effectively control, eliminate, or significantly reduce an initiative's adverse environmental effects. Not all the measures identified in this table have to be used - only those which are relevant and contextually pertinent to the initiative and its setting. The chosen mitigation measures can be underlined in the following table. When documenting the chosen mitigation measures, it is pertinent to provide details about how they will be achieved.
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Table 5.9: Major potential adverse environmental effects and associated mitigation measures Major adverse effects Associated mitigation measures Conflicts over existing or planned land uses, activities, and infrastructures (both "legal" and "illegal") may arise.
Ensure community involvement in locating and preparing the initiative's sites and access routes, as well as in developing responsibilities for managing the initiative's operations (including possible collection fees). Design the initiative to provide alternatives for affected individuals (e.g. local employment, alternate livelihoods, and so on).
Nuisances (e.g., noise, foul odors, airborne dust, traffic), health risks (transmission of diseases), and risks of accidents.
Plan site preparation/construction activities and operations according to a schedule compatible with the climate and the population's activities. Locate solid waste management site(s) well away from and downwind of human settlements and vulnerable areas.
See appropriate sectoral tool (rural roads) for more details on access roads.
Promote environmental training, health and safety training, as well as the use of adequate protective clothing and equipment (e.g. masks, overalls, resistant gloves, boots with thick soles, and so on). Prevent access to solid waste management site(s) by unauthorized persons and wildlife (through vigilance, control of incoming and outgoing traffic, warning signs, and security fences). Minimize the handling of waste and quantities of waste to be disposed of; ensure adequate solid waste segregation; and maximize containment. Provide specific and regularly cleaned and maintained enclosed collection vehicles or carts (with tarpaulin covers), and ensure collection is sufficiently frequent (in line with quantities and climate). Provide specific enclosed areas for vehicle unloading and refuse sorting (for recovery/re-use and recycling/composting); ensure good ventilation, dust suppression, ground impermeability, and worker protection, as well as accident and emergency preparedness; and avoid excessive traffic. Ensure adequate composition, aeration, and maintenance of compost. Study disease carriers and monitor disease occurrence and other public health indicators, and take corrective measures as needed. For solid waste landfills: spread and compact adequately sorted incoming refuse, and cover with soil, daily; provide for safe ventilation, recovery, and treatment of decomposition gases (such as methane, which is a product of decomposition and is explosive), and consider their possible use as
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an alternative energy source (biogas). For solid waste incinerators: install appropriate, effective equipment for complete combustion and air pollution control (air filters or scrubbers), while ensuring that only wastes adequate for incineration are burnt (e.g., pressurized containers, halogenated plastics - PVCs, tires, and wastes containing heavy metals are not to be incinerated).
Ecosystem and soil degradation (e.g. erosion, compaction, changes in drainage, and so on) may occur. Soil degradation is particularly a problem where soils are fine or weak, or have complex drainage cycles. Heavy precipitation and steep slopes also present issues.
Ensure training in soil degradation control and implement appropriate erosion control measures during site preparation (e.g. minimize time of exposure of areas cleared or excavated, especially during rainy and windy periods; stabilize and re-vegetate disturbed areas; when stockpiling soil, promote the creation of small mounds; implement buffer zones of vegetation; install adequate surface drainage control measures, and so on). Maintain erosion and drainage control during operations. Minimize vegetation clearing. Avoid inappropriate use of heavy machinery.
Degradation of water quality.
Ensure training in environmental issues, solid waste management, as well as health and safety topics (including site preparation/construction, operations, proper cleanliness and hygiene practices, first-aid measures, protective clothing and equipment, maintenance, waste segregation, collection, storage, transportation, treatment, disposal, accident and emergency response, reporting, as well as proper closure and restoration), and raise community awareness of the importance of waste reduction, recovery/re-use and recycling to reduce waste disposal requirements and extend the life of disposal sites. Promote reduction of wastes at source as well as waste segregation to enable the re-use of certain products, recycling of other products, composting of biodegradable wastes (for example through vermiculture of vegetable food waste) and appropriate collection, storage, transportation, treatment, and disposal of other wastes. Implement pollution prevention or control devices to limit the harmful effects of pollutants (for example, drainage and surface run-off systems), as well as leachate recovery and treatment systems (leachate is the soluble portion of decomposing solid wastes and may be treated through physical, chemical, or biological means, for example, with a sewage treatment facility, recirculation that sprays leachate from the bottom of the landfill onto its surface, evaporation of leachate through
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a series of open ponds or lagoons, and so on). For solid waste landfills: siting where the underlying soils are relatively impermeable and have a high capability for containing contaminants (e.g. clays); siting well above the underground water table and where topography is relatively flat; use a landfill liner/sealer (e.g., clay or geosynthetic) if leachate risks entering groundwater; siting well away and down gradient from surface waters and groundwater recharge areas or sources (according to the distance required to promote the receiving water's capability for dilution and dispersal of potential contamination); install test well(s) at landfill perimeter, and monitor water quality during operations, for early identification and mitigation of emerging adverse effects. Ensure separate collection, storage, transportation, treatment, and disposal of hazardous wastes (e.g. biomedical, heavy metals, tires, oil, batteries, paint, solvents, acidic solutions, and so on).
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5.2.7.2 Environmental Mitigation Measures during Siting, Planning, and Design By addressing such concerns early in the initiative's cycle, they will have better chances of success and long-term sustainability, help to prevent negative outcomes, and avoid rehabilitation costs. The following guiding principles are useful to avoid adverse environmental effects associated with siting, planning, and design:
• Take into account the population density, the characteristics of land occupation and uses (e.g. proximity of residences), the existing solid waste management practices (integrate informal reclamation/re-use and recycling/composting), the socio-economic and technical production capacities of the communities, as well as soil characteristics (stability, texture, drainage, permeability, and so on), proximity to water bodies, topography, climatic conditions when selecting the solid waste management site and designing the system.
• Take into account the nature and quantities of the solid wastes to be managed (by category, such as organic and compostable, hazardous, recyclable, and so on) when designing the solid waste management system, and ensure separate collection, treatment, and disposal of hazardous wastes.
• Avoid siting in areas prone to natural disasters or hazards (flooding, heavy rain, intense storms, earthquakes, landslides, and so on).
• Avoid infringing on vulnerable sites or sites of economic, ecological, cultural, archaeological, or historical importance (e.g. water bodies, waterways, slopes, wooded areas, coastal areas, wetlands, biodiversity hotspots, habitats of endangered species, floodplains, and so on).
• Avoid unacceptable changes in ways of life and cultural characteristics (e.g. for indigenous populations, uncontrolled and unplanned human settlements, and so on).
• Avoid sites that would accentuate social inequalities (e.g. the selection of a solid waste elimination and/or reclamation site in poorer urban marginal areas without the prior consultation and involvement of residents) and/or would lead to unacceptable population displacements (e.g. as a result of the nuisances associated with a solid waste elimination site or the appropriation of this site, migrations, expropriations, eviction of tenants or squatters).
• Integrate environmental conservation and restoration measures (e.g. erosion control; tree planting; restoration of degraded sites; creation of buffer zones; promotion of waste reduction, reclamation/re-use, recycling/composting, and so on).
• Ensure that international and national/local policies, standards, and regulations are respected (e.g., siting, design, and operation of solid waste facilities; hazardous and toxic wastes; land use; protected areas; health and safety standards; water quality standards, and so on).
5.2.7.3 Social and Cultural Considerations
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A successful ISWM program at both the national and community level requires the engagement and contribution of all participants. Since this involves just about everybody as either a waste generator or an active process participant, the cultural and social aspects of the country must be considered. This includes the manner in which individual waste generator practices can be influenced as well as the means for achieving community results through collective efforts. 5.2.7.4 Environmental Considerations/Aspects The effort associated with implementing an MSWM program is justified by the environmental and health benefits that will derived from an effective program. Many current practices such as random dumping or substandard disposal areas that may be in poor locations have a negative environmental impact. Effective ISWM processes take environmental and health impact into consideration in development and design. This is particularly the case in locating and constructing new disposal areas. Environmental considerations of MSWM processes must also be considered in development of community-level programs. Interim disposal areas must also be sited and operated with environmental impact in mind. How to plan follow-up and monitoring of environmental aspects When planning the environmental follow-up and monitoring of an initiative, the following should be addressed. Planning follow-up and monitoring questions:
• Items to be monitored: What items will be monitored? Potentially significant environmental effects, sensitive components of the environment, any uncertainties, and mitigation measures (their implementation and effectiveness) are generally monitored.
• Follow-up/monitoring methods: How, where, and according to what schedule will follow-up/monitoring take place to help identify unforeseen effects and to assess the implementation and effectiveness of the chosen mitigation measures? Sufficient flexibility is required for additional measures when necessary.
• Follow-up/monitoring roles and responsibilities: Who will be responsible for implementing these tasks and ensuring that the results are acted upon?
• Follow-up/monitoring reporting methods: How and when will the results are reported to enable the analysis of lessons learned and their feedback into future initiatives and who will be responsible for these aspects.
5.2.7.5 Technical Considerations
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There are a number of alternative approaches that can be utilized in each of the MSWM processes illustrated in model schematic. Experience throughout the world has shown that some technologies and practices may not be applicable and sustainable in all applications. For example, technologies that may be applicable to solid waste management in a city like Freetown most likely will not be applicable to small population centers and rural areas such as those found in the provinces. The MSWM approach requires that systems and practices be adopted that are effective and sustainable in the area for which they are developed. Appendix A presents a summary of sustainable best practices that may be applicable to solid waste management in Freetown. 5.2.7.6 Legal/ Political Considerations National law and governmental decrees establish the roles and responsibilities of the various levels of government in Sierra Leone. Legally, Sierra Leonean law establishes some of the basis by which effective solid waste management must be practiced. For successful integration, each of the governmental agencies responsible for developing and operating MSWM processes and elements will need to work in a coordinated manner that best achieves the overall desired result. The manner in which they do so is often set in law or legal precedence.
In addition, key elements of the MSWM program will require significant community and political input. For example, the development of new disposal areas is something that everybody clearly recognizes as necessary. However, once specific sites are identified, there is usually opposition to those sites. The NIMBY (Not in My Back Yard) phenomenon is not unique to Sierra Leone and requires political will and consensus building to overcome it. An important element of the implementation of an effective MSWM program is the building of political and public consensus required for achieving MSWM elements (particularly transfer stations and disposal areas).
5.2.8 Action Plan Capacity Building Elements In creating an effective MISWM program, a base line level of understanding is required of all the participants. Experience has shown that there are a number of common subjects where technical capacity is required. This Action Plan attempts to provide a basic level of understanding of key issues so that EHD and its implementing partners can define its solid waste management initiatives and the manner in which capacity building and technical assistance can be provided.
To this end, various MSWM program participants must understand the following in terms of each of the key MSWM processes. These generally provide the basis by which EHD and its implementing partners should seek to provide its assistance to MSWM
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participants at the government and community-level. Key points associated with the principal capacity building element are presented in Figure 5.1.
Figure 5.1: MSWM technical assistance and capacity building elements 5.2.9 The Monitoring Plan 5.2.9.1 Principles and Objectives Municipal solid waste management is a continual task demanding a permanent effort from each and every person in the community. During the baseline survey, the process of MSWM must be investigated and recorded, and upgraded. Once the required level is reached, regular monitoring should ensure that the desired standard is maintained. The monitoring of MSWM is part of the overall quality management system to be undertaken by MoHS through the EHD. To measure the efficiency of the MSWM Plan, as far as the reduction of infections is concerned; activities should be monitored and evaluated, in collaboration with concerned institutions: MoHS, City/Town Councils, NGOs, etc. The indicators shown in the POA and other indicators to be developed shall be used. 5.2.8.2 Methodology for Implementation of M&E
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The HCWM Plan will be executed over 5 years and implementation monitoring will be carried out as follows: Table 5.10: Implementation Plan for M&E Objective Timing/Period Responsible Party Institution and Legal framework
At the beginning of the program (1st year)
EHD/MoHS/OCA/LGA
Planning activities At the beginning of the program
EHD/MoHS/LGAs
Implementation of the LGA plans
Yearly, according to the time table
LGA/EHD/MoHS
Control and follow up of the execution of the MSWM Plan activities
Daily LGA Monthly LGA/EHD, Health
departments in the LGAs Yearly LGA/EHD/MoHS
Training 1st and 2nd years LGA/EHD Awareness 1st and 2nd years EHD/MoHS/LGAs
MSWM Plan Evaluation
Midterm review, half way (end of 2nd year)
EHD/LGAs with support from international consultant
At the end of the 5th year EHD/LGAs with support from international consultant
Supportive supervision Six-monthly EHD/MoHS/LGA 5.2.8.4 Measurable Indicators Evaluating solid waste management conditions that define sound practices involves the investigation of a number of factors, including:
1. Availability of financial resources to implement new or enhanced processes 2. Level of economic development in the area of evaluation including relative cost of
resources (capital, labor, etc.) 3. Level of technological development (availability of local equipment and services,
etc.) 4. Level of human resource development in the municipal solid waste field (trained
and competent technicians, managers, etc.) and in society in general (effective labor, etc.)
5. Physical conditions of collection areas including residences, container, locations, access roads, cleanliness, etc.)
6. Physical conditions of disposal areas such as topography, soil characteristics, hydrogeology and the type/proximity of water bodies.
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7. General climate conditions that may influence system design features (temperature, rainfall, prevailing winds, etc.)
8. Specific environmental sensitivities of the region such as the extent of air pollution or the condition of water bodies near disposal areas, etc.
9. Solid waste characteristics including composition, density, moisture content, combustibility, recyclable content, and the inclusion of hazardous or biomedical waste in the municipal solid waste stream
10. Demographic and geographic characteristics such as size, population density, and infrastructure development, political jurisdictions, waste shed definitions
11. Degree to which solid waste management decisions are constrained by political considerations and the nature of those constraints
12. Existence or effectiveness of regulatory laws and enforcement 13. Policy initiatives that may exist or are under development that will influence the
development of an effective solid waste management system 14. Social and cultural practices 15. Extent of informal practices such as solid waste scavenging in collection systems
and disposal areas 5.2.9 Institutional Framework and Implementation Responsibilities 5.2.9.1 Responsibilities a) Ministry level
• Formulates the Solid Waste Management Plan, revisions of the Plan, and such other revisions or amendments to the Plan as may, from time-to-time, be appropriate.
• Coordinates public participation in solid waste management planning. • Coordinates and recommends to the government the operating budgets and
capital improvements to implement this plan. • Solid waste management planning shall be an ongoing activity conducted by
EHD. • Monitors technical developments and innovations in solid waste management. • Analyzes, reviews, and identifies potential sites for solid waste management
facilities and receives and processes requests for appropriate permits, permit updates, revisions and modifications.
• Reviews and comments on national solid waste refuse disposal permit applications, modifications, revisions and amendments for solid waste facilities.
• Causes facilities and systems to be designed, constructed and placed in operation as these relate to solid waste management to implement the Plan, including the provision of appropriate investigations and studies.
b) District level/Local Government
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• Development of contracts, the selection and supervision of contractors in accordance with appropriate national permits.
5.2.9.2 Institutional Arrangements for Implementation a) Legal and political framework
• Executive Regulations – The Director of EHD, in coordination with the Office of Chief Attorney, prepares Executive Regulations appropriate to implement solid waste programs and policies
• Legislative cognizance – The Director of EHD maintains cognizance of legislation under consideration which is related to solid waste management and provides testimony to legislative committees as may be appropriate.
• Legal Support – The Office of Chief Attorney provides legal advice and assistance in all legal matters related to solid waste management.
• Regulatory Compliance – LGAs work cooperatively to ensure that the citizens comply with all national regulatory requirements relating to the management of solid waste management facilities.
b) Training Training will involve training of trainers (ToT) followed by actual training for EHD staff involved in MSWM, LGA staff working in (MSWM staff, and private company managers involved in MSWM. The focus of this sub-component is to promote the development of training programs for government officials and general members of the community interested on MSWM. The program seeks to provide authorities at the national and district level with methodology and background on solid waste management issues. The program also aims at encouraging individual and collective civil actions that ultimately lead to minimization of the impacts of MSW in the environment and human health in Sierra Leone. It will be performed mainly through the preparation and dissemination of training information and the organization of workshops, seminars, group discussion and public audiences. These activities will be targeted at specific audiences such as public servants, members of the private sector, NGOs, academics, students, professionals, civil organizations, media personnel, civil society and community leaders to encourage exchanges of information and collaborations. c) Population awareness A promotional campaign will be organized to disseminate information on MSWM, as well as to promote the activities of MoHS, EHD, LGAs and the private sector. The objective of the campaign is to raise the level of awareness on the issues of MSWM at a national level. Promotional material for all ages, consistent to that prepared for the training program, will be distributed around the country. A leading role of the EHD is expected. Outreach activities to promote public awareness of MSWM issues within
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Sierra Leone shall be routinely conducted by both public and private sector entities as well as by national and international NGOs. Other Ministries, such as LGA, Science and Technology, Agriculture, Energy, Transport, Home Affairs, and Industry will also participate in promotional activities. d) Strategy for private sector participation The principal reasons for privatizing are to bring in private sector investment and improve operational efficiency. The greatest opportunity to involve the private sector lies in having private firms provide collection service under contract with the local government. It is feasible for local firms with modest financial resources to enter into the business of solid waste collection. Among the various options for private sector participation, contracting for solid waste service holds the greatest promise to developing countries as a way of lowering cost. Even when only a small portion of the city is served under private contract, significant efficiencies may be achieved because of contestability of market principles, wherein the government monopoly over service delivery is contested. There are not enough government revenues available in developing countries to cover their infrastructure needs. Loans from international agencies and donor countries can do little more than support investments in important demonstration projects of new infrastructure concepts. A key objective of involving the private sector is to open up a new source of capital financing. Extra costs of private sector service remain government income. These costs are usually paid by the private sector and not by government, such as: corporate and property income taxes, equipment insurance and registration, company registration, cost of corruption, cost of transactions. Other costs include: Marketing, political manipulation, cost of borrowing for capital investment and to cover cash flow needs when payments are delayed. Other methods for Private Sector Participation that can be used include:
• Contracting • Competition • Contracting for transfer and disposal • Cost recovery • Leasing • Franchise • Informal sector solid waste collection • Recycling and resource recovery • Build, own, operate, and transfer (BOOT) • Build, own, and operate (BOO) • Solid waste recycling concessions
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• Solid waste recycling To achieve successful private sector participation the following actions are recommended:
• Maintain a balance between the private sector and government for optimum contestability.
• Negotiate with labor unions or representatives over restrictive labor practices and redundancy, seeking a phased program of improvements and staff reductions which minimizes adverse social impacts.
• Develop contractual periods that enable economic depreciation of assets and repayment of loans.
• Develop techniques and facility sizes that are appropriate and economic. • Define private sector service zones that are equitable and comparable for
optimum competition. • Achieve economies of scale and optimum spans of management. • Rationalize collection and transfer haul distances to minimize costs. • Seek harmony and competition with private sector partners for win-win
contractual and operational relationships. • Build government capacity to work as an effective partner in contracting and
performance monitoring, as well as a contestable service provider in competitive zones of service.
• Encourage private sector joint ventures that bring in foreign expertise and optimize the use of local knowledge and skills.
e) Baseline survey, need assessment and activity planning The following presents recommended activities and criteria that should be incorporated into a solid waste management needs assessment for local areas. Once this assessment has been completed, improvements can be planned and implemented. It is important that implemented improvements be based on sound practices that are practical and sustainable for the region in which they are to occur. Table 5.11: Needs assessment steps and criteria Step 1: Conduct collection situation analysis 1. Gather background data a. Applicable laws and regulation
b. Demographic c. Physical characteristic d. Land use
2. Conduct inventory and assess existing conditions
a. Waste composition b. Generator storage and handling practices
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c. Collection service d. Diversion methods and programs e. Disposal facilities
3. Obtain input from residents and businesses
4. Waste characterization a. Source b. Types c. Quantities d. Seasonal Variations e. Composition f. Density
5. Generator storage and handling practices
a. Container types used b. Accumulated waste Assessment
6. Environmental, health and safety impacts
7. Impediments to best practices 8. Collection Service
a. Management and administration b. Collection practices c. Operational performance d. Environmental performance e. Financing methods and costs
9. Diversion Methods and Programs
a. Formal: i. Reuse ii. Recycling
b. Informal c. Reuse d. Recycling
10. Disposal Facilities
a. Expected life (years) b. Operational impacts on collection equipment c. Compliance with regulations d. Cost
11. Obtain Input from Residents and Businesses
a. Expectations for the type of service and its frequency. b. Willingness to co-operate in planning and
implementation of improved service. c. Ability and willingness to pay for improved service
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Step 2: Establish program and service goals 1. Collection system planning
guidelines
a. Collection is complex and costly b. There is no one solution c. Must balance service with ability and willingness to pay
2. Typical public goals a. Convenient point of collection b. Service reliability c. Enforcement of applicable laws d. Improved public awareness and behavior e. Adequate and sustainable funding f. Monitoring of the service provider g. Equity of costs and benefits received
Step 3: Identify Options for Improving Collection Service 1. Point of collection 2. Materials to be collected 3. Handling of recyclable
materials
4. Method of collection 5. Collection frequency 6. Service provider Step 4: Evaluate potentially viable collection system options 1. Formulate scenarios for viable
systems
2. Develop preliminary cost estimates for each scenario
3. Evaluate applicability of strategic element options
a. Point of collection b. Materials to be collected c. Method of collection d. Storage container type e. Frequency of collection
4. Evaluation criteria a. Compliance with laws and ordinances b. Cost effectiveness c. Health/Safety d. Environmental compatibility e. Effectiveness f. Public acceptance g. Efficiency
5. Point of collection options a. At the door b. At the building c. Waste pooling sites
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6. Method of collection a. Manual collection b. Semi-automated collection c. Automated collection
7. Materials to be collected
a. Bulky wastes b. Construction and demolition wastes(C&D) c. Yard wastes
8. Storage container type
a. Plastic bags b. Metal or plastic rigid containers c. Rollout carts d. Large metal or plastic bins
9. Collection frequency
a. Twice weekly b. Three times weekly c. Six times weekly d. Daily (seven times weekly)
10. Formulate potentially viable system scenarios
11. Develop preliminary cost estimates for each scenario
12. Use data from operational experience and assessment of existing collection system
Step 5: Select the preferred collection system 1. Solicit stakeholder input 2. Compare cost of each
scenario with ability to pay
3. Make final decisions regarding strategic service elements & service provider
4. Make final strategic decisions a. Point of collection b. Materials to be collected c. Storage container type d. Method of collection e. Frequency of collection f. Service provide
Step 6: Implement the selected program 1. Develop a public awareness
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and communication program
2. Establish the Program Funding Mechanism
a. Decide who will pay for waste collection service b. Decide how the money will be collected
f) Plan Monitoring through data management and reporting
• The EHD gathers solid waste management data from a variety of sources that are used to determine disposal rates, recycling rates, waste reduction activity, and other key measures.
• Certain solid waste data are readily attainable from in-county sources. Tonnages from district facilities should be made available for input into a data management system at the ministry level (for example, the tonnages of MSW processed at the Transfer Station and the tonnages of recyclables handled at the Materials Recovery Facility (MRF) are recorded on-site).
• EHD to prepare data collection tools and distribute to the districts for retrieval on monthly basis.
• Regulations require all licensed private haulers and collectors to report, semiannually, on the amount and disposition of waste collected (i.e. tonnage, by type, and where they took it, including non-district facilities).
• Specialized studies should be used to monitor some minor waste streams not reported by the foregoing means.
• Periodically (e.g. every year) the districts conduct analysis of the composition of the disposed waste stream (“Tip and Sort”) involving statistical sampling of the waste delivered for disposal at the Transfer Station. In addition to providing thorough support for tracking its progress toward achieving its recycling goal and guiding future efforts on that front, these studies also ensure that system benefit charges are properly allocated.
g) Sustainability plan The implementation of an effective MSWM approach requires the active involvement of all stakeholders and participants. Currently, many spatial and infrastructure planning activities in Sierra Leone are being undertaken by donors and NGO’s. Ultimately, the SWM responsibility will fall totally onto the institutions that remain after current donor and NGO programs have lapsed. Accordingly, capacity building elements associated with the institutional considerations of this Action Plan must be aimed at addressing the
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sustainability of the development process by increasing the knowledge and technical capacity of the institutions that will remain in the long-term.
In a general sense, a successful municipal solid waste management practice must be sustainable so that it can continue to exist beyond its initial implementation. There are many cases throughout the world where the availability of new equipment (such as waste collection vehicles) or the installation of new processing facilities (such as compost plants) did not fulfill expectations created at the time that these new systems were put into place.
In addition, insufficient institutional or financial capacity to operate and maintain a new system or equipment can lead to a situation where the new solid waste management asset cannot be operated, maintained, or managed successfully and the improvement fails. This is particularly the case in countries where donor-supplied equipment and facilities are put into place without the proper consideration or allocation of what it takes to keep the systems operable and efficient for their full technical life expectancy. System failures are common when a strong dependency is created on the donor process without establishing the ability to financially and technically support improvements or to implement equipment and facilities required to eventually replace donor systems.
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5.2.9.3 Time Table for Implementation of the Plan Table 5.12: Time table for strategic plan implementation (MSWM)
Y1 Y2 Y3 Y4 Y5 Objective Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
1. Train the EDH staff on MSWM and Mangers of Waste Management Companies
2. Make the general public aware of the risks linked to MSWM
3. Identify areas with inadequate collection, transportation, and/or processing services, and plan for and implement strategies to provide those services by public or private entities.
4. Support local efforts to identify areas with litter and illegal disposal problems, and implement enforcement and other programs to address those problems.
5. Incorporate the of MSW management needs into the environmental partnership programs and other outreach efforts.
6. Clarify the role of local solid waste management plans in permitting processes
7. Complete regional inventories of closed municipal solid waste landfill sites, and establish a process to maintain those inventories.
8. Benchmark and track the effectiveness of national, regional, and local waste reduction efforts.
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9. Emphasize market-based incentives and market development for recycled products.
10. Continue to implement efficiency improvements in MSW permitting and regulatory processes
11. Identify areas with less than 10 years of municipal solid waste disposal capacity available either within the region or through facilities in nearby and adjacent regions, and plan with public and private entities to implement regional and local strategies to develop adequate capacity reserves
12. Involve Private Sector in the MSWM
13. Monitoring and Evaluation of
MSWM plan
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5.2.10 MSWM Plan of Action - Costs The estimated cost of implementing the MSWM POA and initiating this process of proper handling, disposal and management of medical waste is 580,600 430,600 USD. Table 6 below provides more details per component of the POA. Table 5.13: Implementation costs of the MSWM Plan
Objective Strategies Unit QuantityUnit cost
(USD) Total (USD)
Train the EDH staff on MSWM and Mangers of Waste Management Companies
Develop training programs Days 20 200
4,000
Train trainers Days 30 80
2,400
Train all MoHS staff working in MSWM and Company managers
Days
200 50
10,000 Train waste management company managers
Days 60 50
3,000
Evaluate implementation of the training program
Days 60 50
3,000
Train EHD staff to MSc in Environmental Engineering # 3 50,000 150,000
Subtotal
172,400
Make the general public aware of the risks linked to MSWM
Television messages # 30 500
15,000
Radio messages # 150 200
30,000
Posters in health facilities # 5,000 10
50,000
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Public animation sessions # 100 200
20,000
Subtotal
115,000
Identify areas with inadequate collection, transportation, and/or processing services, and plan for and implement strategies to provide those services by public or private entities.
Prepare for national survey Man/day 10 400
4,000 National MSW survey
Man/day 50 400
20,000
Subtotal
24,000 Support local efforts to identify areas with litter and illegal disposal problems, and implement enforcement and other programs to address those problems.
Prepare for national survey Man/day 10 400 4,000 National MSW survey
Man/day 50 400
20,000
Subtotal
24,000
Incorporate the of MSW management needs into the environmental partnership programs and other outreach efforts.
Visit the MSW activities # 20 50
1,000
Prepare action plan for intervention # 20 200
4,000
Subtotal
5,000
Clarify the role of local solid waste management plans in permitting processes.
Stakeholders meeting Days 60 30
1,800
Subtotal
1,800
Complete regional inventories of closed municipal solid waste landfill sites, and establish a process to maintain those inventories.
Prepare for national survey Days
20 400
8,000 National MSW survey Days
100 400
40,000
Subtotal
48,000 Benchmark and track the Prepare for national survey Days 20 400
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effectiveness of national, regional, and local waste reduction efforts.
8,000
National MSW survey Days 100 400
40,000
Subtotal
48,000
Emphasize market-based incentives and market development for recycled products.
Prepare for national survey on market based incentives
Days 20 400
8,000
National MSW survey Days 100 400
40,000
Subtotal
48,000
Identify areas with lack of municipal solid waste disposal capacity
Prepare for national survey on market based incentives
Days 20 400
8,000
National MSW survey Days 100 400
40,000
Subtotal
48,000
Monitoring and Evaluation of MSWM plan
Plan starting activities Days 30 80
2,400
Monitoring at national and local level
Days 250 80
20,000
Mid-term evaluation (end yr 2) Days 30 400
12,000
Final Evaluation (end yr 5) Days 30 400
12,000
Subtotal
46,400
TOTAL:
580,600
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5.3 Plan of Action for Industrial Waste Management
5.3.1 Key Findings in Context This plan answers important questions about the status of industrial waste management in Sierra Leone, and outlines a number of policy goals, objectives, and recommendations, and budgeting to be considered by the Ministry of Health and Sanitation in MoHS and the entities it works with to protect the health of our citizens and the environment. This plan also addresses issues of capacity to manage industrial wastes, and efforts to reduce the amount of waste generated and disposed of in this country. 5.3.1.1Status quo for Industrial Waste Management
• The management of industrial waste in Sierra Leone is poor due to lack of skills and enforcement
• Waste collection services are facing bottlenecks when it leaves the industrial premises due to problems facing the waste management companies
• Sierra Leone continues to be successful in its efforts to minimize the amount of hazardous waste generated relative to manufacturing output. The quantity of industrial nonhazardous waste increased over the last 5 to 10 years as the manufacturing sector experienced substantial growth
• Treatment and/or disposal capacity for hazardous and industrial nonhazardous waste appears to be insufficient to meet Sierra Leone’s needs
• Incineration of industrial waste is not practiced.
5.3.1.2 Waste Management Planning
• Traditionally, waste management was undertaken on an ad hoc basis to meet immediate needs
• The siting of landfills was generally haphazard, without adequate planning and design; the management and operation is poor; and the control of waste types disposed at the dumpsites is inadequate
• The two waste disposal sites are located on previously undeveloped land, without any consideration for the possible expansion of nearby communities. This resulted from a lack of integrated planning and inadequate enforcement of proper buffer zones
• Local authorities had neither sufficient funding, nor adequately trained staff, to effectively plan and execute their waste management functions. Some efforts exist for municipal solid waste and healthcare waste, while industrial waste has not been given attention
• Communities were not involved in the siting of waste disposal sites, and consequently resisted their development, by developing slums and residences very close to the dumpsites.
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• The level of waste management services varies between different industries in the city, many of which have been left without proper waste management services.
• Waste management planning within local authorities is primarily focused on waste disposal only.
• The lack of capacity within all tiers of government, due to insufficient funding, as well as the low priority previously accorded to waste management were the main factors contributing to inadequate waste management planning.
• Planning of landfill sites, proper site location, buffer zones, public participation and proper operating procedures will lead to an improvement in the disposal component of waste management.
• Further change has been initiated by the development of policy document, covering industrial waste management as one of the components. The integrated national waste management policy document has introduced concepts such as ‘cradle-to-grave’ management and the waste management hierarchy, and placed an emphasis on waste minimization.
• Public sector participation is highly encouraged in the integrated national waste management policy document.
5.3.1.3 Industrial Waste Generation
• Annual reporting of industrial waste generation in Sierra Leone is currently not undertaken, although it is a legal requirement.
• Solid waste from the mining industry is mainly disposed of on tailings dams and mine dumps.
• General waste is disposed of at general waste landfills and hazardous waste is disposed of in hazardous waste landfills, which are operated as co-disposal sites. Industrial non-hazardous waste is disposed of together with domestic waste on general waste landfills.
• There is a lack of hazardous waste landfills within Sierra Leone and large quantities of potentially hazardous industrial waste are believed to be disposed of illegally at general waste landfills.
• Illegally dumped industrial waste is frequently observed on undeveloped land, particularly near industrial areas.
5.3.2 Methodology, Focus and Goals for Developing the IWM Plan of Action 5.3.2.1 Methodology As with all of the Action Plans for the INWM, this Action Plan was developed using an approach known as "Logical Framework Analysis" (LFA). This approach entails an analysis of the problems of waste minimization and recycling, the stakeholders, and the risks to the successful implementation of the plan, and identifies the activities, inputs,
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assumptions and means of verification to ensure effective achievement of the objectives and outputs. The functions, roles and responsibilities of implementers and the procedures for evaluating, reviewing and reporting on implementation of this Action Plan are also detailed. 5.3.2.2 Focus Areas
1. Waste management capacity for ensuring the proper management and disposal of industrial solid waste
2. Waste minimization and pollution prevention to achieve continued reductions in the amount of hazardous and industrial nonhazardous waste generated and disposed of in Sierra Leone.
3. Recycling of industrial waste to minimize landfilled waste volume 4. Prevent environmental pollution 5. Maximizing EDH human and financial resources.
5.3.2.3 Motivation and Justification for the Waste Minimization and Recycle Initiative
The waste management hierarchy is an important component for achieving sustainable development. By implementing the hierarchy:
• Industries avoid or minimize waste production at source by reviewing their production processes and substituting environmentally hazardous with less hazardous raw materials.
• The service sector and consumers may reduce waste through the selection of products, the appropriate use of products and the conservation of energy.
• Certain waste products in the production process are recycled to recover raw material for further use in industrial processes.
• Post-consumption products are reused or recycled for resource recovery.
As a result of these preventive and proactive waste management steps, there will be less waste disposed to landfill sites. Natural resources (renewable and non-renewable) will therefore be conserved, landfill space will be minimized, pollution will be avoided and environmental degradation will be reduced.
In addition to its traditional ‘control and direct’ approach, it is necessary for EHD to play an effective role as a facilitator promoting waste minimization and recycling in all sectors of society. This facilitation will involve expediting the co-ordination and dissemination of information regarding existing successful programs, the promotion of awareness-raising initiatives, and the introduction of relevant legislative and policy mechanisms.
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According to the situation analysis, a number of industries have made important strides in waste minimization and recycling. Recycling of certain waste products by industry, particularly the reuse of bottles through the deposit-refund system can be established. Almost all kinds of common recyclable materials are also being recycled, including waste paper, bottles, plastics, cans and drums. In addition, certain industries such as the fishing, textile and metal plating industries have embarked on cleaner production projects. In recognition of their contribution to waste minimization and recycling, measures should be taken by EHD to facilitate and encourage the adoption of additional co-regulatory and self-regulatory initiatives by industry.
Waste separation at source is a precondition for recycling of high quality materials. In addition, recycling has the potential for job creation, by promoting entrepreneurs to establish community collection systems and recycling centers. Recycling is also a viable alternative to informal salvaging at landfills, which is undesirable due to the associated problems of health and safety. Recycling and waste minimization public awareness and education campaigns, which stress the importance of separation of materials at source, are needed to modify current behavior patterns.
5.3.2.4 Objectives of the Action Plan for Industrial Waste Management
1) Forecast demand for commercial hazardous and industrial waste treatment and/or disposal capacity and track the availability of facilities to serve that demand.
2) Maximize EDH permitting resources and continue to make the permitting process more efficient.
3) Encourage innovation and flexibility to increase pollution prevention results through recycling efforts.
4) Target efforts toward industrial wastes that pose the greatest impact to human health and the environment.
5) Develop and implement industry-specific pollution prevention programs targeted to the environmental problems faced by the regions in which those industries are located.
6) Leverage national and other education and information resources 7) Continue to develop voluntary partnerships and promote environmental quality
improvements achieved by industry 8) Use market-based incentives to assist industries to further reduce waste
generation. 9) Maximize recycle of industrial waste.
5.3.3 Problem Analysis
The overriding objective is to identify and implement measures to promote existing and new waste minimization and recycling initiatives in Sierra Leone. An analysis of existing
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initiatives has identified the following problems and priority issues that need to be addressed by government, industry and the public/civil society.
5.3.4.1 Problems facing the Government Efforts
i. Insufficient awareness and understanding of the benefits and methodology of Waste Minimization and Recycling. There is still a predominant emphasis in both the public and the private sectors on "end-of-pipe" waste treatment, rather than preventive strategies
ii. Government is seen to have a predominant focus on "command-and-control" strategies with limited perceived benefits to industry
iii. Inappropriate incentives: government should publicize its support for waste minimization and recycling and should emphasize its commitment to making waste minimization and recycling in Sierra Leone more economically viable
iv. Inadequate regulatory pressure as well as potential conflicts between existing legislation on environmental permits for industrial companies and the promotion of waste minimization and recycling practices
v. Insufficient data available on waste minimization opportunities, existing recycling and the total amount of recyclable materials in the waste stream. Such data is a prerequisite for appropriate new waste minimization and recycling initiatives.
vi. Current legislation does not allocate clear responsibility for waste management planning to the different tiers of government. Waste management planning for both the short and long-term has been inadequate or absent at national and provincial government level.
vii. Although some planning has been carried out by local government, regarding waste collection, transfer stations as well as waste disposal sites, this planning did not focus on integrated waste management and the waste management hierarchy.
viii. Planning was not coordinated with other tiers of government, nor was it consistent between different local authorities. In some instances neighboring local governments were reluctant to co-operate in a regional context. In most instances, the waste management planning that was undertaken was not transparent and plans were prepared by local government, without stakeholder participation.
ix. Planning of treatment and disposal capacity has been inadequate, resulting in critical landfill airspace situations, especially with regard to hazardous waste landfills and environmentally acceptable general waste landfills. Although local government is required to prepare structure (land-use) plans; these plans do not address waste management planning.
x. Limited financial and human resources are major constraints in all tiers of government. Although redeployment of existing staff, reallocation of budgets and more efficient use of existing resources may be adequate to implement IWM
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planning, additional resources will have to be secured for this purpose in many instances.
xi. Where certain functions and responsibilities are reallocated from one national department to another department and/or tier of government, the financial and human resources formerly used in fulfilling those responsibilities may not be similarly reallocated, thus severely constraining the newly-responsible department’s ability to carry out those functions effectively.
xii. In addition, there is reluctance in the provincial environmental departments to accept the responsibility for IWM Planning and other waste management functions, due to the lack of resources and capacity, as well as time constraints for implementation.
5.3.4.2 Problems facing the Industry
i. Insufficient commitment to waste minimization by management. The amount of information targeted at management level should be increased and information on the techniques and benefits associated with waste minimization, recycling and cleaner production should be made available.
ii. The prevalent perception that waste minimization and recycling is a cost factor, rather than an opportunity for savings should be rectified.
iii. The lack of knowledge about the availability of waste minimization and recycling technology and existing case studies must be addressed.
iv. Better training and appropriate courses in waste minimization and recycling should be instituted.
5.3.4.3 Problems inherent to the Public/Civil Society
i. Improving the dissemination of information on industrial waste minimization and recycling would enhance public awareness and increase pressure from civil society that environmentally friendly methodologies be adopted.
ii. Salvaging at landfills is a major problem due to the health and safety risks for the informal salvagers. By increasing source separation of recyclable materials, this practice will be discouraged.
5.3.5 Components of the Strategic Plan for IWM Objective 1: Forecast demand for commercial hazardous and industrial waste treatment and/or disposal capacity and track the availability of facilities to serve that demand. Activities:
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• Continue to conduct an assessment of the need for hazardous waste treatment and disposal capacity every two years, and the need for industrial waste disposal capacity every four years
• Analyze waste management trends that may impact capacity, such as changes to the level of on-site disposal.
• Make information available to new businesses on the availability of various prevention, recycling, treatment and disposal technologies, and continue to make more information accessible electronically.
Objective 2: Maximize EDH permitting resources and continue to make the permitting process more efficient. Activities:
• Continue to prioritize the processing of permit applications for new commercial hazardous waste treatment and disposal facilities based on need
• Continue improvements to increase efficiencies in permit processing, to include efforts to reduce the number of notices of deficiencies and problems with permit applications.
• Continue to implement efficiency improvements beginning with consolidation of some permitting processes and enhancements to public participation and notice procedures
• Continue improvements to permit development guidance and pre-application instructions.
• Applicants for EDH industrial waste management permit need to work closely with the local community and the EDH staff early in the facility planning process.
Objective 3: Encourage innovation and flexibility to increase pollution prevention results through recycling efforts. Activities:
• Continue streamlining waste exemption and variance procedures and educate the regulated community on these procedures
• Work with the EPA to consider regulatory and program changes to allow industry more flexibility under national laws and regulations, particularly changes to remove disincentives to reuse and recycling.
• Compile further examples of where granting regulatory flexibility would provide substantial environmental benefits.
• Regulated industries need to continue to evaluate alternative approaches and to provide the sound scientific evidence to justify flexible alternatives
Objective 4: Target efforts toward industrial wastes that pose the greatest impact to human health and the environment. Activities:
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• Determine those industrial sectors which have the greatest significance to human health and the environment, and allocate resources to address the greatest risks.
• Identify wastes that have the greatest significance to human health and the environment.
• Emphasize source reduction and environmentally-sound recycling. • Industrial facilities and other businesses should evaluate their wastes based on
greatest risk to human health and the environment, and prioritize waste reduction activities accordingly
Objective 5: Develop and implement industry-specific pollution prevention programs targeted to the environmental problems faced by the regions in which those industries are located. Activities:
• Develop pollution prevention strategies tailored to each region, and allocate regional pollution prevention program resources according to those strategies.
• Encourage the use of supplemental environmental projects to address the risks to human health and the environment in the area where an alleged violation occurs
• Local communities and industry, particularly those located in the major industrial areas of the country, should work together to develop partnerships and to recognize the environmental quality improvements that may result from those partnerships
Objective 6: Leverage national and other education and information resources Activities:
• Continue to make available industry-specific information on environmentally-efficient technologies to new businesses.
• Continue to develop web-based training and education resources, as well as make important information available via the Internet.
• Continue on-site assistance activities and training. • Use existing national and other education and outreach resources to inform the
public of the benefits of targeting pollution prevention programs to those wastes with the most significance to human health and the environment.
Objective 7: Continue to develop voluntary partnerships and promote environmental quality improvements achieved by industry Activities:
• Continue to use award and recognition programs as a primary tool in the national voluntary pollution prevention and waste minimization programs
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• Implement a new generation of voluntary partnership programs, and place further emphasis on environmental improvement goals by industry that are supported by and are in concert with the goals of the community
• Develop case studies and program examples targeted to specific industry sectors and present other evidence to industries and local communities of the benefits of working together to prevent pollution and minimize waste
• Share information on capacity and demand and coordinate with pollution prevention efforts
• Local and regional governmental entities, community groups, and industry should continue and increase efforts to develop partnerships which help to address issues of environmental quality, while supporting sound economic development.
Objective 8: Use market-based incentives to assist industries to further reduce waste generation Activities:
• Establish and Operate the Resource Exchange Network for Eliminating Waste (RENEW) to assist industries and businesses to market their surplus materials and by-products to other users.
• Highlight to the public the impact of consumer choices have on manufacturers’ decisions toward waste minimization and pollution prevention.
• Educate the regulated community regarding the applicability of the property tax abatement program for purchases of pollution prevention equipment.
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Table 5.14: Plan of Action for Industrial Waste Management S/N Objective Result Strategies Indicators
1
Forecast demand for commercial hazardous and industrial waste treatment and/or disposal capacity and track the availability of facilities to serve that demand.
Industrial waste Treatment and disposal capacity improved
Continue to conduct an assessment of the need for hazardous waste treatment and disposal capacity every two years, and the need for industrial waste disposal capacity every four years.
Need assessment report
Analyze waste management trends that may impact capacity, such as changes to the level of on-site disposal.
Report on waste disposal capacity
Make information available to new businesses on the availability of various prevention, recycling, treatment and disposal technologies, and continue to make more information accessible electronically.
# of businesses visited by category
2
Maximize EDH permitting resources and continue to make the permitting process more efficient.
Performance of EDH as permitting unit improved
Continue to prioritize the processing of permit applications for new commercial hazardous waste treatment and disposal facilities based on need.
# of permits for industrial waste disposal and treatment
Continue improvements to increase efficiencies in permit processing, to include efforts to reduce the number of notices of deficiencies and problems with permit applications.
Decreasing # of permit violations
Continue to implement efficiency improvements beginning with consolidation of some permitting processes and enhancements to public participation and notice procedures.
# of permitting processes consolidated
Continue improvements to permit development guidance and pre-application instructions.
Guidance and instructions in place
Role of Other Entities Applicants for EDH industrial waste management permit need to work closely with the local community and the EDH staff early in the facility planning process.
Procedure for applicants and LGA involvement in place
3 Encourage innovation and flexibility to increase pollution prevention results through recycling efforts.
Improved Environmental Management programs in industry
Continue streamlining waste exemption and variance procedures and educate the regulated community on these procedures.
Procedures in place
Work with the EPA to consider regulatory and program changes to allow industry more flexibility under national laws and regulations, particularly changes to remove disincentives
# of products from re-used materials having
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to reuse and recycling. no taxes Compile further examples of where granting regulatory flexibility would provide substantial environmental benefits.
# of regulatory flexibility cases
Role of Other Entities Regulated industries need to continue to evaluate alternative approaches and to provide the sound scientific evidence to justify flexible alternatives.
# of industries with revised waste management plans
4 Target efforts toward industrial wastes that pose the greatest impact to human health and the environment.
List of high impact industrial wastes established
Determine those industrial sectors which have the greatest significance to human health and the environment, and allocate resources to address the greatest risks.
Survey report and implementation plan
Identify wastes that have the greatest significance to human health and the environment.
Survey report and action plan
Emphasize source reduction and environmentally-sound recycling.
# of industries with such programs
Role of Other Entities Industrial facilities and other businesses should evaluate their wastes based on greatest risk to human health and the environment, and prioritize waste reduction activities accordingly.
# of reports from industries, LGAs, on high risk wastes
5 Develop and implement industry-specific pollution prevention programs targeted to the environmental problems faced by the regions in which those industries are located.
Develop pollution prevention strategies tailored to each region, and allocate regional pollution prevention program resources according to those strategies.
Resources allocated
Encourage the use of supplemental environmental projects to address the risks to human health and the environment in the area where an alleged violation occurs.
# of projects implemented
Role of Other Entities Local communities and industry, particularly those located in the major industrial areas of the country, should work together to develop partnerships and to recognize the environmental quality improvements that may result from those partnerships
# of partnerships
6 Leverage national and other education and information
Continue to make available industry-specific information on environmentally-efficient technologies to new businesses.
Information bulletin prepared
Continue to develop web-based training and education Web-based
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resources resources, as well as make important information available via the Internet.
training courses in place
Continue on-site assistance activities and training. # of visits/training sessions in industries and communities or businesses
Use existing national and other education and outreach resources to inform the public of the benefits of targeting pollution prevention programs to those wastes with the most significance to human health and the environment.
# of public address programs
7
Continue to develop voluntary partnerships and promote environmental quality improvements achieved by industry
Industries develop voluntary environmental quality improvement programs
Continue to use award and recognition programs as a primary tool in the national voluntary pollution prevention and waste minimization programs.
# of awards granted to industries
Implement a new generation of voluntary partnership programs, and place further emphasis on environmental improvement goals by industry that are supported by and are in concert with the goals of the community.
#of voluntary partnerships developed
Develop case studies and program examples targeted to specific industry sectors and present other evidence to industries and local communities of the benefits of working together to prevent pollution and minimize waste.
# of case studies and examples developed
Share information on capacity and demand and coordinate with pollution prevention efforts.
# of information bulletins on pollution prevention
Role of Other Entities Local and regional governmental entities, community groups, and industry should continue and increase efforts to develop partnerships which help to address issues of environmental quality, while supporting sound economic development.
Documented partnerships
8
Use market-based incentives to assist industries to further reduce waste generation
Incentives for waste minimization implemented
Establish and Operate the Resource Exchange Network for Eliminating Waste (RENEW) to assist industries and businesses to market their surplus materials and by-products to other users.
# of RENEW networks in place
Highlight to the public the impact of consumer choices have on Public awareness
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manufacturers’ decisions toward waste minimization and pollution prevention.
programs developed
Educate the regulated community regarding the applicability of the property tax abatement program for purchases of pollution prevention equipment.
# of operators exempted
9 Monitoring and Evaluation of MSWM plan
MSWM activities are monitored, evaluated and documented
Monthly operational control reports Monthly reports Mid-term evaluation (end yr 2) Evaluation report Final Evaluation (end yr 5) Evaluation report
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5.3.6 Institutional Arrangements and Allocation of Responsibilities
To ensure that the principles of the waste management hierarchy are implemented, the following issues will be addressed in the short-term Action Plan for IWM:
1) Local government has traditionally been responsible for the management (collection and disposal) of urban domestic and commercial waste, and industry has been responsible for its own waste. Most general waste landfill sites were established, developed and operated by local authorities, while hazardous waste landfill sites were generally established and operated by private companies, although in some cases, provision was made for co-disposal of hazardous waste at regional landfills.
2) EDH shall be responsible for issuing permits for landfill sites and enforcing compliance therewith.
3) Recycling initiatives in Sierra Leone are currently restricted to a number of commercially viable projects that are not supported or regulated by legislation. Private recycling companies and individuals currently initiate and drive recycling projects.
4) There are currently deficiencies and a lack of integration in the allocation of functions and responsibilities for integrated waste management.
5) Organizational and planning initiatives: In consultation with stakeholders, EHD will implement this Action Plan, including the development of a list of priority pollutants and waste streams. These identified wastes will form the basis for setting legislated waste minimization targets for specific substances and materials across specific industrial sectors and other waste generators, including the public sector.
6) As part of this Action Plan, the potential for increased recycling in different sectors will be analyzed and specific recycling initiatives will be promoted
7) In addition, EHD will enter into discussions with the mining and power generation industry, to develop action plans to investigate, promote and extend recycling of wastes generated by these industries.
8) The introduction of incentives for waste minimization and recycling, including the development of appropriate pricing strategies for waste and resources, and providing high profile national and provincial awards for achievement in this sphere.
9) Legal and policy framework: For waste generators to be given sufficient inducement to recycle and minimize waste, it is essential that there should be an appropriate legal and policy framework comprising both legal sanctions and financial incentives.
10) Information, Education and Demonstration Projects: 11) Government will encourage the inclusion within secondary and tertiary education
curricula of principles relating to integrated environmental management;
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12) The Action Plan will include waste minimization and recycling demonstration projects.
13) Effective networking structures (such as waste minimization and recycling clubs) will be established, and co-operation with research institutes will be promoted to develop and implement effective waste minimization and recycling technologies.
14) Public-Private and Private Sector initiatives: It is essential that there is active participation of the private sector, not only as the principal generators of waste, but also in acknowledgement of their specific technical and entrepreneurial capacity.
5.3.7 Stakeholders Analysis, Partnerships and Funding
There are a number of key stakeholders that have been involved in the IWM process and that need to be involved in the further development of this Action Plan.
5.3.7.1 Government Departments
• Department of Minerals and Energy (DME): will be involved initiatives relating to minimization and recycling of mining, coal combustion and radioactive wastes. In addition, the DME will be involved in integrating energy efficiency measures with the NWMS initiatives, as part of the development of a national strategy for cleaner production.
• Department of Trade and Industry (DTI): will participate in an inter-departmental working team which will investigate the feasibility of introducing economic instruments to promote waste minimization and recycling and will assist in identifying any existing barriers to waste minimization and recycling. The DTI will also participate in the development and implementation of certain demonstration projects, and may serve as a source of funding for co-operative waste minimization initiatives. In addition, the DTI will have an important role to play in technology transfer initiatives, and will be involved in investigating the desirability of a National Waste Minimization and Recycling Centre.
• Department of Transport: may be involved in ensuring that statutory controls relating to the transportation of certain industrial wastes do not hinder legitimate efforts to divert material from the waste streams for recovery and re-use.
• Department of Finance: will participate in the investigation into appropriate funding mechanisms for and financing of Waste Minimization and Recycling, and will make the final decision regarding the possible introduction of economic instruments to promote waste minimization and recycling.
• Provincial Environmental Departments: will be responsible for integrated waste management planning including waste minimization and recycling; it will also play a role in the promotion and implementation of a number of the Action
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Plan initiatives and may be involved in the government waste minimization demonstration project.
• Local Governments: will be responsible for general waste management planning including waste minimization and recycling and have a key role to play in establishing structures at local level to promote increased recycling, including, for example, providing recycling centers and promoting partnerships with local entrepreneurs and small scale recyclers; it will be involved in the promotion of initiatives such as waste minimization clubs, and will be active in the collection of data required for the regional waste information system. A conflict of interest could arise since waste disposal charges are an important source of revenue for local governments and these financial interests may counteract activities which encourage the public to minimize and recycle their waste, rather than dispose of it.
5.3.7.2 Other Stakeholder Groups
These groups include:
• Community-based organizations (CBOs), which should mobilize assistance and support from communities to give input on the development of integrated waste management planning and also assist with the implementation of public awareness campaigns
• Non-governmental organizations (NGOs), which should give input on the development of integrated waste management options and plans and assist with the implementation of public awareness campaigns. NGOs may assist in research, training, technology transfer and the implementation of awareness campaigns
• Organized labor and the trade unions can contribute to the identification and development of waste minimization practices and serve as important players in achieving recycling targets
• Scavengers or salvagers at landfills should become involved in community-based recycling initiatives so that jobs can be created through source separation and collection systems and dangerous salvaging activities can be phased out
• As the principal generator of waste, industry is a crucial stakeholder in the effective implementation of the waste minimization and recycling initiatives; individual industries and sectoral organizations will be directly affected and involved in most of the Action Plan initiatives, and will be encouraged to participate in co-operative initiatives with government
• The private recycling sector has a significant role to play not only in directly recycling material, but also in coordinating the collection of recyclable material through local agents. Although many of these private sector organizations are of
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the opinion that recycling is currently taking place wherever it is economically viable and that additional legislative initiatives are thus not needed (or welcomed), they have nevertheless expressed a willingness to contribute to the development of initiatives arising from this Action Plan.
5.3.8 Risk Analysis for the Plan of Action
Successful implementation of this Action Plan depends on a number of factors, which are outside the control of the implementer and that constitute risks for the project. Risk factors relevant to implementation of this Action Plan are outlined below. The following risks have been identified as being critical to the implementation of the Industrial Waste management Action Plan:
5.3.8.1 Risks posed by Government
• Insufficient political commitment by any sphere of government will have a direct effect on the planning and implementation process.
• The failure to complete the capacity building programs in time will impact on the availability of suitably qualified government personnel.
• Budget constraints may lead to an inability of various spheres of government (national, provincial and local) to allocate the necessary resources (human and financial) to implement the Action Plans.
• The high priority accorded to waste management issues by the Government and other stakeholders may not be reflected in the financial and other resources allocated to waste management.
• Insufficient regulatory and financial incentives will impede greater adoption of recycling and waste minimization.
• Inconsistent enforcement of legislation will impede adoption of recycling and waste minimization strategies/initiatives.
• Inadequate co-operation between government and industry. • Inconsistent application and implementation of the polluter-pays principle. • Insufficient data on the amount of recyclable waste. • Lack of capacity (expertise) in all or certain tiers of government. If the provincial
environmental departments accept the proposed allocated functions, capacity within existing and new personnel will have to be developed.
• Capacity building programs, necessary to develop personnel are not completed timely.
5.3.8.2 Risks posed by the Industry
• The relatively low cost of water, energy and raw materials may lead to less interest in waste minimization and recycling
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• Low waste and effluent disposal charges may lead to less interest in pollution abatement through waste minimization and recycling
• A general resistance to change may impede the adoption of waste minimization and recycling programs
• Insufficient information on the advantages and techniques associated with waste minimization and recycling
• Inadequate commitment by industry to implement waste minimization and recycling
• Industries may lack capacity and therefore be unable to draft integrated waste management plans within the proposed time frames.
• Low market demand for recycled products.
5.3.8.3 Risks posed by Public/Civil Society
• A delay in the implementation of public awareness campaigns for integrated waste management could retard the participation by civil society in initiatives to separate recyclable waste at source and minimize waste
• Insufficient consumer and shareholder pressure by civil society on industry and business to adopt waste minimization and recycling initiatives
• Unwillingness to accept different packaging standards and types of packaging, if such materials are targeted for waste minimization
• Unwillingness to purchase recycled products. • Awareness of waste management issues in civil society may not be timely
promoted, with the result that civil society cannot participate effectively in IWM planning.
• Key stakeholders may not co-operate during the various stages of the planning process.
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5.3.9 Plan of Action Implementation Time Table for IWM
Table 5.15; Time Table for implementation of IWM
Y1 Y2 Y3 Y4 Y5 Objectives Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 1. Forecast demand for
commercial hazardous and industrial waste treatment and/or disposal capacity and track the availability of facilities to serve that demand.
2. Maximize EDH permitting resources and continue to make the permitting process more efficient.
3. Encourage innovation and flexibility to increase pollution prevention results through recycling efforts.
4. Target efforts toward industrial wastes that pose the greatest impact to human health and the environment.
5. Develop and
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implement industry-specific pollution prevention programs targeted to the environmental problems faced by the regions in which those industries are located.
6. Leverage national and other education and information resources
7. Continue to develop voluntary partnerships and promote environmental quality improvements achieved by industry
8. Use market-based incentives to assist industries to further reduce waste generation.
9. Monitoring and evaluation
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5.3.10 IWM Plan of Action - Costs The estimated cost of implementing the IWM POA and initiating this process of proper handling, disposal and management of industrial waste is 420,700 USD. Table 6 below provides more details per component of the POA. Table 5.16: Implementation costs of the MSWM Plan
Objective Strategies Unit QuantityUnit cost
(USD) Total
(USD)
1. Train the EDH staff on MSWM and Mangers of Waste Management Companies
Develop training programs Days 20 200
4,000
Train trainers Days 30 80
2,400
Train all MoHS staff working in IWM and Company managers
Days 200 50
10,000
Train waste management company managers dealing with IWM
Days 60 50
3,000
Evaluate implementation of the training program
Days 30 50
1,500
Train EHD staff to MSc in Environmental Engineering (Industrial Waste Management) # 3 50,000 150,000
Subtotal
170,900
2. Maximize EDH permitting resources and continue to make the permitting process more efficient.
Prepare permit guidance Days 60 80
4,800
Review permitting process Days 50 200
10,000
Prepare procedure for LGA involvement Days 60 80
4,800
Discussion meetings with LGA, Stakeholders and Industry # 10 300
3,000
Subtotal
22,600
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3. Encourage innovation and flexibility to increase pollution prevention results through recycling efforts.
Prepare procedure for waste exemption Days 60 80
4,800 National survey for products from re-used materials with/without tax Days 50 80
4,000
Assess industries with revised waste management plans Days 60 80
4,800
Subtotal
13,600
4. Target efforts toward industrial wastes that pose the greatest impact to human health and the environment.
National survey on critical hazardous waste Days 60 200 12,000 National survey on critical industrial sectors Days 60 200 12,000Survey on industries with source reduction programs
Days 50 100
10,000
Subtotal
34,000 5. Develop and implement industry-
specific pollution prevention programs targeted to the environmental problems faced by the regions in which those industries are located.
Develop pollution prevention strategies Days 20 80
1,600
Subtotal
1,600
6. Leverage national and other education and information Resources on industrial waste management
Prepare industry specific information bulletins
# 20 500
10,000
Prepare web-based courses # 10 3000
30,000
Train industry staff on IWM Sessions 10 5000 50,000Public address programs Messages 20 500 10,000
Subtotal
100,000
7. Continue to develop voluntary partnerships and promote environmental quality improvements achieved by industry
Prepare information bulletins #
10 1000
10,000 National case-study survey Days 60 200 12,000
Subtotal
22,000 8. Use market-based incentives to assist
industries to further reduce waste Public address programs
Messages
20 500 10,000
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generation Subtotal 10,000
9. Monitoring and Evaluation of MSWM plan
Plan starting activities Days 30 80
2,400
Monitoring at national and local level Days 250 80
20,000
Mid-term evaluation (end yr 2) Days 30 400
12,000
Final Evaluation (end yr 5) Days 30 400
12,000
Subtotal
46,400
TOTAL:
420,700
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CHAPTER SIX
6.0 MONITORING AND EVALUATION SYSTEM FOR INWMSP IMPLEMENTATION
6.1 Introduction
The MoHS has about 1028 health facilities and 12 district level local governments. The INWMSP is expected to cover all health facilities and local governments at all levels. To be effective, it has to be integrated within the existing ministerial structure. Hence, there is a need for a well established organization structure, integrated supportive supervision (ISS), and monitoring and evaluation (M&E).
The INWMSP has been developed in the context of the Millennium Development Goals. As such, the monitoring framework is also developed to ensure achievement of the MDGs and goals of the PRSP. In the same manner, INWMSP indicators and targets have been set in line with global and national indicators and targets as well as estimated availability of resources (financial and human). The monitoring framework will thus be inclusive and participatory, using joint reporting, monitoring and evaluation mechanisms, and utilizing information from all levels of governance.
The monitoring plan for INWMSP will draw significant lessons from the previous experiences, which suffered from insufficient and poor quality of information for planning, monitoring and evaluation purposes. In order to improve M&E, the monitoring and evaluation system is designed as part of the Policy, process of which will be implemented at all levels of the health system. A single results-based framework with a small number of indicators to make the monitoring and evaluation process effective and efficient will be agreed for the national level M&E system.
Monitoring and evaluation should begin at the commencement of a program. An increase in HIV, HBV and HCV transmission in workplaces may indicate a problem. Monitoring should be executed by all institutions which have an interest (stakeholders) in the program.
Purpose of Monitoring and Evaluation: The purpose of Monitoring and Evaluation is to assess services and operations, improve HIV, HBV and HCV prevention practices and procedures at the workplace with the objective of enhancing quality and maximising resource utilisation. Therefore, all health and social welfare facilities should establish systems or mechanisms to ensure that the HIV and AIDS WPI Programme is closely monitored and continuously evaluated.
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Indicators for monitoring and evaluation: It is important that indicators chosen should be useful, realistic and appropriate for the workplace programme. These indicators should focus on the progress in the implementation; identifying problems, test changes and measuring program achievements. For instance, the increase in accidental exposure to HIV and other blood borne infection rates among health and social welfare workers should be monitored over time for immediate intervention. Monitoring and Evaluation Tools: The tools should be developed according to indicators which will provide quantitative and qualitative data. 6.2 Indicators for IWMSP Implementation
The performance during implementation of the INWMSP will be monitored using a set of agreed indicators whose selection takes cognizance of indicators contained in the implementation framework of the MDGs. The national level indicators have been maintained, but a few new indicators have been added to incorporate current dynamics in the waste management and sanitation. Due consideration has been given to ensuring regular (preferably annually) availability of data for these indicators. The national level indicators for IWM are shown in Table 8. In addition to the national level indicators, municipal, industrial, district and hospital level indicators will be developed to facilitate regular performance assessment at the various levels and to provide an opportunity for comparing entities at these levels. 6.3 Sources of Information for Monitoring the INWMSP
HMIS is the major tool for collecting information for monitoring the INWMSP. In this regard, strategies have been employed to strengthen HMIS to enable it to play its role effectively in monitoring of the INWMSP. In addition, information from other sources will be used, including:
1. Surveys commissioned by the MoHS, which may be carried out directly by the EH department within the MoHS or contracted out. They are planned to include:
a. Mapping/population survey to determine geographical access to environmental health services, including functional coverage of the INWMSP
b. Use of burden of disease or other appropriate methodology like comprehensive sentinel surveillance sites for communicable diseases.
2. Surveys in other institutions, including national household surveys, demographic and health surveys, and national service delivery surveys;
3. Studies in the health sector which will be commissioned to address appropriate issues
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4. Support supervision reports for the different levels of governance. 6.4 Evaluating Progress
Regular reports using HMIS and other sources of data will be used to assess progress against agreed indicators and targets and will include:
1. Quarterly reports 2. Integrated supportive supervision 3. Annual performance reports 4. Mid-term review and end-term evaluation
6.4.1 Quarterly reports These will be produced by the different levels and used both for self assessment and by supervisors to determine progress or lack of it. 6.4.2 Annual environmental health performance reports The Environmental Health Performance Report (AEHPR) will be institutionalized during implementation of INWMSP to highlight areas of progress and challenges in the environmental health. The review process will include all levels and all environmental health policy areas nationwide. Review reports will be used by all levels to assess performance, following which they will be submitted to the EH Department for compilation of the AEHPR by the end of March each year. AEHPR will be part of the NHSSP performance report for use by all stakeholders. This cycle will form an integral part of the national coordination mechanism for the implementation of the NHSSP. 6.4.3 Mid-term Review and End-term Evaluation A mid-term review of the AEHPR will be conducted after two and a half years of implementation (second half of 2014) and the report validated and launched in the same manner as the AEHPR in 2014. An end-term evaluation of NHSSP will be carried out within the financial year 2016, one year after evaluation for the MDGs. 6.4.4 Integrated Supportive Supervision (ISS) and Inspection Integrated Supportive Supervision is a process of guiding, helping, training, and encouraging environmental health staff to improve their performance in the provision of high-quality health services. It emphasizes the use of integrated tools for all priority programs and empowering of health service providers at all levels. The cornerstone of supportive supervision is working with workers to establish goals, monitor performance, identify and correct problems, and proactively improve the quality of service.
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The following should be the major components of supportive supervision for INWMSP: 1) Integrating the INWM Guidelines into the supervision guidelines, currently
existing and assessing whether they allow for supportive supervision 2) Finding out who does the supervision and the other responsibilities of these
supervisors, and also how much time they have to commit to supportive supervision of the INWMSP
3) Incorporating INWMSP activities into Medium Term Expenditure Framework (MTEF) when budgeting
4) Making supervision part of the training process 5) Working with other supervisors to plan and conduct supportive supervision 6) Identifying gaps and solving problems in positive ways 7) Providing support and strengthen capacity of health and social welfare workers to
meet performance goals. Supportive supervision will be institutionalized as part of the M&E framework to include:
1) National guidelines on comprehensive support supervision developed and implemented in all districts by 2013
2) Skills development program in comprehensive supportive supervision that is time-bound and with costs indicated by end 2014.
Table 6.1: Checklist for improving supportive supervision of INWMSP in health facilities Part A: Health Facility Focal Persons 1) Discuss with your supervisor ways in which supervision can be made
more effective. ______
2) Solicit input from health facility workers about how the supervisory system can be changed to improve overall performance in healthcare waste management.
______
3) Develop guidelines with your supervisor for introducing a team supervision approach.
______
4) Create a team supervisory system that functions between supervisory visits.
______
5) Decide with healthcare workers and supervisor what educational and training programs are necessary to improve healthcare waste management skills.
______
6) Discuss problems with your staff and work with them to find solutions. ______Part B: INWMSP Focal person 1) Develop a supervisory system that focuses on supervising health
facility activities and achievement of INWMSP objectives, rather than on day-to-day individual performance.
______
2) Discuss and agree on an approach to supervision that involves the ______
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Focal person and healthcare workers as part of the supervisory team. 3) Be an advocate for the health facility waste management and
healthcare workers to ensure that they can take advantage of educational and training opportunities.
______
4) Be well prepared for a supervisory visit by reviewing previous recommendations and actions you have taken to support the INWMSP activities.
______
5) At the end of each supervisory visit, prepare a list of actions with the program manager and staff that you all agree to implement before the next supervisory visit.
______
6) Be committed to providing timely and regular feedback to health facility.
______
Checklist for improving supportive supervision of INWMSP in Local Governments 1) Discuss with your supervisor ways in which supervision can be
made more effective. ______
2) Solicit input from health facility workers about how the supervisory system can be changed to improve overall performance in healthcare waste management.
______
3) Develop guidelines with your supervisor for introducing a team supervision approach.
______
4) Create a team supervisory system that functions between supervisory visits.
______
5) Decide with healthcare workers and supervisor what educational and training programs are necessary to improve healthcare waste management skills.
______
6) Discuss problems with your staff and work with them to find solutions.
______
7) Develop a supervisory system that focuses on supervising health facility activities and achievement of INWMSP objectives, rather than on day-to-day individual performance.
______
8) Discuss and agree on an approach to supervision that involves the Focal person and healthcare workers as part of the supervisory team.
______
9) Be an advocate for the health facility waste management and healthcare workers to ensure that they can take advantage of educational and training opportunities.
______
10) Be well prepared for a supervisory visit by reviewing previous recommendations and actions you have taken to support the INWMSP activities.
______
11) At the end of each supervisory visit, prepare a list of actions with the ______
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program manager and staff that you all agree to implement before the next supervisory visit.
12) Be committed to providing timely and regular feedback to health facility.
______
6.5 Reporting Mechanism
For information to be adequately used it should be shared with other stakeholders or users. The other stake holders can also use this information for their management decisions and they can help those collecting information to draw meaning and use it for management purposes. In order to be able to use information to make program management decisions, the data should be managed (collected, stored, analyzed, utilized and disseminated) appropriately at all levels including the health facility level and all levels of local governance.
Reports should be made in writing as written reports provide reliable information for management purposes and can be cross-checked over time with other information to ascertain accuracy. Verbal reports should be avoided, since it is very difficult to keep and retrieve for further use. The information collected verbally is also not likely to be consistent especially in cases where past information is needed.
While patient cards and registers are designed to capture all patient-related data, reports will be based on the environmental health indicators that have been jointly agreed and endorsed by the Government and DPs. Commensurate resources will be allocated to put in place the human resources, tools and equipment needed for the proper documentation, compilation, analysis, use and timely reporting of routine facility data as per the standard. All stakeholders operating in the health sector should support and use the monitoring tools for monitoring INWMSP implementation.
Each health facility and administrative level (Ministry, local government, etc.) will put in place the necessary institutional mechanisms (HMIS technician, or team) as per the standard indicated in the new design of HMIS. Data from client-patient records will be collected from health facilities. The data will be aggregated and analyzed to compare performance versus plans for the facility’s own consumption. Facilities will supply data to the relevant administrative levels through the routine reporting mechanism as per the HMIS reporting calendar. Validation of the data is done through performance monitoring, Integrated Supportive Supervision (ISS), surveys and regular inspections.
6.6 Performance Monitoring and Quality Improvement
The Quality Improvement Process (QIP) is a performance monitoring activity in which health facilities (hospitals, health centers and health posts) use locally available data
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generated during health service provision for a continuous process of measurement, reflection and improvement. The Performance Monitoring and Quality Improvement Standard Operating Procedure should be endorsed as part of the Policy planning, monitoring and evaluation Process. 6.7 Evaluation/operational Research
Evaluation: Program evaluations usually focus on process issues, e.g., examining the appropriate execution of program components, or on outcome issues, e.g., examining the worth of implementing an intervention or any of its components. Operational research: It is technically impossible to obtain all environmental health-related data needed for adequate decision making exclusively through the HMIS. Hence, regular demand side and supply side surveys will be conducted to capture selected sets of data and triangulate various sources for improving the accuracy of information about the outcomes and impacts of health interventions. The major principles that underpin this activity are:
1) The data sets need to be mutually agreed between the Government and DPs 2) The surveys should be conducted by/under the leadership of Government in
defined and logical frequency 3) Timing of the surveys should align with the Government calendar 4) DPs should provide adequate resources (financial and technical) 5) Manuals and tools produced for evaluation/operational research should be used
during the implementation of INWMSP.