GROUP DISCUSSION 1

1. GROUP DISCUSSION 1

2. Overview HCW Activity 2 Output 1.1.1: Database on generators and treatment facilities Output 1.1.2: HCRW Generation Rates & treatment capacities Output 1.2.1: HCW Policy (Draft Available) Output 1.2.2-3: HCW Strategy & Action Plan (Internal Outline Prepared) Output 1.2.4: HCW Guidelines (Internal Outline Prepared and Principal agreement with SABS) Output 1.2.5-6: HCW Specifications and Tender Material (Internal Outline Prepared) Output 1.3.1: Waste Information System Needs Output 1.4.1-2: Capacity Building and Awareness Output 1.4.3: NEMA and Basel Convention Requirements Output 1.4.4: Legislation & Institutional Aspects Output 1.4.5: Funding Mechanism Output 1.4.6: Pilot Projects Output 1.4.7: Dissemination and Sustainability TORBENS PRESETNATION ON ACTIVITY 1.2TORBENS PRESETNATION ON ACTIVITY 1.2

3. Vision of the HCWM Policy Integrated, environmentally, socially, and economically sustainable and occupationally safe health care waste management system is established in South Africa and that this is done within the framework and principles of the National Waste Management Strategy, using the assignment of responsibilities as defined by the Health Services Act, the Occupational Health and Safety Act and the National Environmental Management Act, covering the full health care risk waste stream over the full life cycle of the waste. TORBENS PRESETNATION ON ACTIVITY 1.2 TORBENS PRESETNATION ON ACTIVITY 1.2

4. Strategy & Action Plan Executive Summery Introduction Institutional and legal Framework for HCW Management The Strategy Formulation Process Identified Problems and Shortcomings Strategic Targets Activities Action plans and Responsibilities for HCWM Required inputs Assessment of the Impact of the Strategy Monitoring and Evaluating the Impact of Strategy Summary and Conclusions ANNEXURES: TORBENS PRESETNATION ON ACTIVITY 1.2 TORBENS PRESETNATION ON ACTIVITY 1.2

5. Technical Specs & Tender Docs Summary and Introduction to Procurement of HCW Management Services Description of Applicable Procurement Policies for HCW Management Procurement of Receptacles and other Equipment (Durable and Disposable) Procurement of Treatment Technologies Procurement of Services and Choice of Tender Process South African Market Situation and Availability of Goods and Service providers Summary and Recommendations for Procurement of HCW Services and Development of HCW Management Tenders Contract Monitoring ANNEXURE 1: Technical Tool Box ANNEXURE 2: Generic Tender Document for HCRW Services ANNEXURE 3: Tender Evaluation Report ANNEXURE 4: Technical performance monitoring sheet ANNEXURE 5: Cost control and waste generation sheet ANNEXURE 6: Decision making tool for direct haul versus transfer of HCRW TORBENS PRESETNATION ON ACTIVITY 1.2 TORBENS PRESETNATION ON ACTIVITY 1.2

6. Revised SABS (SANS) Guidelines The 2004 SANS 10248 is proposed to be revised and replaced by: SANS10248, Vol I: HCWM for Major Generators (incl. Radioactive Waste) SANS10248, Vol II: HCWM for Rural and Minor Generators SANS10248, Vol III: Green Procurement Practises for Health Care Settings TORBENS PRESETNATION ON ACTIVITY 1.2 TORBENS PRESETNATION ON ACTIVITY 1.2

7. Proposed Outline for Rural and Minor Generator Guidelines (Vol II) Introduction to the Guideline Definitions Typical Problems being experienced in management of HCW by Small Scale Generators Technical Options for Containerisation, Storage, On-site Treatment and Transfer for central Treatment Good Practices for Management of HCW On-site Treatment and Pre-treatment Particular Roles for Local Governments TORBENS PRESETNATION ON ACTIVITY 1.2 TORBENS PRESETNATION ON ACTIVITY 1.2

8. Proposed Outline Green Procurement Guidelines (Vol III) Introduction to Green Procurement and Good Procurement Practises Focus Areas for Green Procurement Best Practices for PVC Best Practices for Heavy Metal Reduction Best Practices for Use of Batteries Best Practices for Mercury Containing Equipment Best Practices for Packaging Best Practices for Use of Chemicals TORBENS PRESETNATION ON ACTIVITY 1.2 TORBENS PRESETNATION ON ACTIVITY 1.2

10. GROUP DISCUSSION 2

11. Proposed Draft Health Care Waste Management Policy for South Africa National Waste Management Strategy Implementation Dept of Environmental Affairs and Tourism & Department of Health THIS IS TORBENS PRESENTATION OF THE POLICYTHIS IS TORBENS PRESENTATION OF THE POLICY

12. What are the overall problems? Awareness and Training Segregation Internal HCW management Equipment Tendering and Contracting Safety and Health Storage Transportation Record-keeping and Reporting Treatment Facilities Disposal of Residues Enforcement, Permitting and Monitoring Inadequate capacity of public agencies THIS IS TORBENS PRESENTATION OF THE POLICY THIS IS TORBENS PRESENTATION OF THE POLICY

13. Specific Problems to be Addressed The current legal requirements for HCRW treatment plants are outdated.There is a large number of poorly performing incinerators that needs to be upgraded or replaced with acceptable technologies. In many instances, especially in rural and remote areas, there is no acceptable or even sub-standard treatment capacity available. This results in the use of unacceptable disposal methods such as open pit burning, indiscriminate dumping, disposal with municipal waste, use of placenta pits etc. There is widespread mis-segregation of HCW resulting in people being put at risk of exposure and resulting in excessive costs of treatment. There is limited availability of affordable and safe receptacles of international standards for containerisation of HCRW There is no or insufficient planning and budgeting for management of HCRW, including poor management of procurement processes and insufficient contract management There is no or insufficient training of HCW Officers for the monitoring, planning and improvement of the management of HCW in South Africa There is lack of national regulations, guidance and policies for acceptable management of HCW in South Africa THIS IS TORBENS PRESENTATION OF THE POLICY THIS IS TORBENS PRESENTATION OF THE POLICY

14. Vision of the HCWM Policy Integrated, environmentally, socially, and economically sustainable and occupationally safe health care waste management system is established in South Africa and that this is done within the framework and principles of the National Waste Management Strategy, using the assignment of responsibilities as defined by the Health Services Act, the Occupational Health and Safety Act and the National Environmental Management Act, covering the full health care risk waste stream over the full life cycle of the waste. THIS IS TORBENS PRESENTATION OF THE POLICY THIS IS TORBENS PRESENTATION OF THE POLICY

15. Strategic Goals and Objectives Avoid and minimise quantities and hazards associated with wastes produced at health care facilities by design and use of activities and equipment that reduce quantities of HCRW and reduce hazards associated with collection, storage, transport, treatment and disposal of waste HCRW must be segregated from HCGW efficiently at source into categories suitable for economic and safe disposal. HCRW must be collected in safety containers that are designed to acceptable safety standards HCRW must be stored, and transported separately from general waste. All health care facilities should keep records, monitor performance and make improvements that demonstrate management of the risks associated with HCRW Treatment, storage, transport and disposal facilities for HCRW must be operated in accordance with regulatory standards and guidelines for the environmental health and safety All generators of HCRW in South Africa must have adequate access to HCRW receptacles, collection, disposal and treatment services Operators of health care facilities as well as service providers managing HCRW must ensure that all personnel are adequately trained and aware of the hazards and costs associated with HCW Local, Provincial and National Government Dept of Health and Environment must provide necessary guidance, regulations, enforcement, planning and support to ensure compliance with the policy for HCRW Management THIS IS TORBENS PRESENTATION OF THE POLICY THIS IS TORBENS PRESENTATION OF THE POLICY

16. Cradle to Grave Procurement of products Generation Source separation Collection for reuse, recycling, treatment or residual waste disposal Storage on-site Transport to suitable facility Processing at facility Disposal of residues THIS IS TORBENS PRESENTATION OF THE POLICY THIS IS TORBENS PRESENTATION OF THE POLICY

17. Proposed Regional Approach THIS IS TORBENS PRESENTATION OF THE POLICY THIS IS TORBENS PRESENTATION OF THE POLICY

18. Minimum Requirements for HCWM Policy for the use of treatment technologies Environmental Protection Waste Incineration Treatment efficiencies Emissions to the atmosphere Monitoring Disposal of bottom ash and air pollution control residues Disinfection/ microbial inactivation methods Emissions to the atmosphere Treatment efficiencies / Microbial inactivation Verification Monitoring Disposal of Residues Occupational Health and Safety Requirements for Receptacles, Internal Transport, External Transport and Storage Requirements for assigning of responsibilities and management liability Requirements for advance planning, budgeting and management if health care waste services including Contract Management THIS IS TORBENS PRESENTATION OF THE POLICY THIS IS TORBENS PRESENTATION OF THE POLICY

19. Min Reg: Incineration THIS IS TORBENS PRESENTATION OF THE POLICY THIS IS TORBENS PRESENTATION OF THE POLICY

20. Min Reg: Disinfection Plants THIS IS TORBENS PRESENTATION OF THE POLICY THIS IS TORBENS PRESENTATION OF THE POLICY

21. Min Reg: General Handling THIS IS TORBENS PRESENTATION OF THE POLICY THIS IS TORBENS PRESENTATION OF THE POLICY

22. Min Reg: Responsibilities THIS IS TORBENS PRESENTATION OF THE POLICY THIS IS TORBENS PRESENTATION OF THE POLICY