Technical Assistance Project in Serbia comes to Close
30/06/09
Scott Crossett ended his two year contract as team leader on the EC Delegation funded project Technical Assistance for Healthcare Waste Management. Scott was sub contracted to the Danish consulting firm Grontmij CarlBro who led the consortium involving ET Log from Germany and Euro Healthcare also from Denmark. The project beneficiary was the Ministry of Health and the project was given an overall 'A' grade by the EU Activity Based Monitoring programme.
It was an excellent project and it has made a radical difference to the way that healthcare waste is managed in Serbia. The grading received by the EU Monitoring programme reflects the efforts of all the project team and the outstanding support offered by the Ministry of Health.
The specific objectives are:
1. Support to the Ministry of Health and Ministry for Environmental Protection & Spacial Planning to harmonize hazardous healthcare waste management regulation with the EU legislation;
Expected Result
Legal framework governing medical waste management, updated and harmonized with EU legislative framework where applicable;
Actual Outcome
The project has contributed to the recently published primary legislation on waste management and has co-authored a MOH sub law on hazardous healthcare waste management within healthcare facilities. This was in response to the Ministry of Health's obligations from the primary legislation on solid waste management developed by the MOEP & SP. This legislative programme brings Serbia's waste management legislation into line with EU norms.
2. Draft a comprehensive management strategy for collection and treatment of medical waste in accordance with the requirements of legislation and the relevant EU- directives;
Expected Result
National plan defined for medical waste management in accordance with the National Waste Management Strategy, new draft Law on Waste Management, and draft National Environmental Strategy in accordance with EU directives and legislation;
Actual Outcome
The project has written a national guideline on the 'Safe Management of Healthcare Waste'. This guideline is referenced in the above sub law legislation and has been produced in consultation with a working group of key Serbian experts established for this purpose.
The project has also developed the following five key technical manuals to support the main National Guideline document.
1. Transport of healthcare waste;
2. Treatment of healthcare waste;
3. Development of healthcare waste management plans;
4. Financial reporting in healthcare waste management;
5. Monitoring requirements of a healthcare waste management system
The guideline and associated manuals have formed the basis of the new healthcare waste management system which has been introduced into all state healthcare facilities in Serbia a total of almost 400 participating healthcare institutions in 25 administrative districts
The project has developed an MOH approved treatment network and published a list of public sector treatment centres known as central and local treatment points. These CTP's/LTP's are located in all 25 administrative districts in Serbia guaranteeing treatment of potentially infectious healthcare waste in the primary secondary and tertiary healthcare sectors.
In addition the project is facilitating the implementation of this new system in the State Veterinary Sector, comprising 12 veterinary institutes and the veterinary faculty in Belgrade, through provision of awareness raising events at the 12 veterinary institutes and the faculty to around 300 veterinarians, production of a draft national guideline and lastly training at the faculty of 50 animal healthcare waste technicians.
3. Support the health facilities in the preparation of their waste management plans including collection and storing of medical wastes plan for health facilities;
Expected Result
Efficient and effective implementation waste management including separate collection, storage, transport, treatment and disposal of medical waste (waste management);
Actual Outcome
The project has provided training to 1600 healthcare professionals in relation to the development and production of institutional based healthcare waste management plans. As a consequence each healthcare facility in Serbia from the Primary, Secondary and Tertiary sector has produced a healthcare waste management plan outlining their methodology for healthcare waste management within their institution.
In order to validate and measure the performance of the implementation of and operation of the new healthcare waste management system the project developed and electronic monitoring tools to facilitate this process for both internal and external monitors.
The tool was developed and tested using results from an internal monitoring programme of monitoring visits to 110 healthcare institutions across Serbia. The results will be published at the Final Conference. The monitoring tools can be used by both internal stakeholders and MOH inspectors to assess the performance of the institution in relation to the requirements of the new healthcare waste management system.
In addition the project have written the environment section for the new MOH accreditation body's performance standards and have ensured that there is a synergy between the approach of the accreditation programme and the national guideline document.
4. Support the effective and efficient implementation of the waste disposal equipment (such as autoclaves and shredding machines) within the hospital, through capacity building measures;
Expected Result
1. Successful awareness campaign organized and implemented on medical waste management for medical/pharmaceutical/non-medical staff and the Ministry of Health;
2. Knowledge, skills and capacities transferred to relevant staff in the Ministry of Health and hospital staff trained for medical waste management;
Actual Outcome
1.The project has supervised the installation and commissioning of 78 Autoclaves and 78 Shredders in 69 healthcare facilities across Serbia. This means that Serbia is now treating approximately 10 tonnes of potentially infectious healthcare waste from the state healthcare sector every 8 hour day or 50 tonnes in every 5 day week.
2. The project has introduced a number of new posts to the healthcare sector which are being filled by incumbent staff members. These roles have been formalised by the MOH and each role is accompanied by a comprehensive training package delivered at institutional level over a three day period per role.
The project has developed an MOH approved training programme for each of the new posts created within the new healthcare waste management system. The project has also trained the following numbers of healthcare professionals in the new roles outlines below:
900 Healthcare Waste Technicians in 25 administrative Districts representing about 400 healthcare facilities across Serbia; 210 Healthcare Waste Officers in 25 administrative Districts representing about 400 healthcare facilities across Serbia; 64 Healthcare Waste Managers who will manage the healthcare waste management function in each of the 25 administrative districts in Serbia; 200 Healthcare Waste Carriers (Drivers) in 25 administrative Districts representing about 30 healthcare facilities across Serbia; 200 Healthcare Waste Treatment Plant Operators to operate the autoclave waste treatment technology in the Central and Local Treatment Points
In relation to the animal healthcare sector the project has trained 50 Animal Healthcare Waste Technicians from Torlak, the veterinary faculty, Belgrade and the state veterinary institutes.
In addition to the above the project has developed an electronic vocational training candidate management programme which it has developed with the National Institute of Public Health, "Dr Milan Jovanovic Batut" and this contains all resources for the delivery of the newly developed training programmes for each of the above posts in the human healthcare sector. The programme is able to allocate candidates with a unique candidate reference number and to track their progress through the training process including on successful completion printing off the required certificate.
In addition the project have introduced to the programme and to the healthcare waste management sector the concept of continuous professional development and in this regard they have held four CPD events in Belgrade for healthcare waste management professionals and the Batut training team.
5. Support an information and awareness programme for the professional community, on the health-, safety-, and environmental issues relating to medical waste.
Actual Outcome
The system implementation programme is being supported by a comprehensive healthcare waste awareness programme which has so far interfaced with 4,000 healthcare professionals.
In addition the project has produced an electronic cyber vehicle for the dissemination of information, the Serbian Healthcare Environment Forum, www.shcef.org. The site has received over 500,000 hits over the project duration.
The project has made three educational films to educate healthcare professionals in the primary, secondary and tertiary healthcare sectors on the importance of healthcare waste management and in respect of the veterinary sector.
1. Primary Sector Film: The Journey of Healthcare Waste - Poor Practice Produces Patients (Infectious Waste - Treat it responsibly)
2. Secondary & Tertiary Sector Film: New System New Dawn
3. Veterinary Sector Film:
The project has produced a number of promotional products to promote the core message of the project and its activities these have included coffee sets, calendars, mugs, key-rings and pens.
The project has carried out a National Ministerial Workshop for 450 participants in the Sava Centre, Belgrade. It has also carried out 25 regional workshops in the form of awareness raising events and has conducted 3 sector workshops for the Ministry of Environmental Protection & Spacial Planning, the Ministry of Health, Sanitary Inspectorate, the launch of the 6 Pilot Phase Districts and the has held numerous Financial Sector workshops in various districts across Serbia.
In total the project provided awareness raising events to qround 5,000 healthcare professionals across Serbia.
The final conference was held in Belgrade and the Minister of Health was so impressed by the event and the attendance that he insisted that all future conferences should be in line with the model of the project. Julie Crosset organised the healthcare exhibition at the final conference and this was an excellent opportunity for the minister and other VIP's to meet the staff at the frontline in healthcare waste management.