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  3. mardi 10 avril 2001
Post00334 GAVI DONATIONS - INJECTION WASTE DISPOSAL 10 April 2001 CONTENTS 1. GAVI DONATIONS - INJECTION WASTE DISPOSAL ISSUES 2. NEW CONTACT DETAILS - THE COLLABORATIVE CENTRE FOR COLD CHAIN MANAGEMENT 1. GAVI DONATIONS - INJECTION WASTE DISPOSAL ISSUES The GAVI/CVP supported addition of new vaccines and immunization system strengthening in national immunization programs add to the absolute volume of injection waste. Data from many countries indicate that the management of immunization and other injection waste is inadequate and dangerous to health workers and to the public. John Lloyd, PATH/CVP, Ticky Raubenheimer, CCCCM/SA/CSIRO, and Anthony Battersby, FBA Analysts, have kindly copied this interesting discussion to Technet Forum in January. The key issue is that in the next year or so 7,661 cubic meters of immunization injection waste is being added to health systems where the current management of health care waste in inadequate to non-existent. * Solutions....? Actions....? Opinion, comments and additions please: [][/email] or use your reply button ___________________________________________________________________________ From: Ticky Raubenheimer To: John Lloyd Sent: 09 January 2001 04:27 Subject: GAVI donations to poor countries - Waste disposal issues Dear John, We would like to start getting our thinking caps on and come forward with meaningful contributions and proposals on how we can assist GAVI to enable the poor countries receiving vaccine bundles to prepare for and handle the resultant medical waste - as was discussed in Pretoria. We know that the timing is becoming critical and that we need to get the proposals to you as a matter of urgency. To help us accelerate this process, can you please provide me with some clarity on; 1. Which countries, in priority sequence, will need to be assisted 2. What time frames for stock delivery are applicable to these countries and what volumes of stock is expected in each. 3. What language preferences are applicable to these countries 3. Broad outline of priority objectives for the assistance to be given 4. What technical expertise should be included in the team. 5. What time frames for medical waste management implementation in each country would you like to see I fully support your view that the team involved should be as small as possible and very dedicated to medical waste management, without getting involved in other areas of vaccine logistics and injection practices. Due to time constraints, such a team will have to be extremely mobile and focussed on rapid implementation of basic requirements. Group facilitation will also be very important skills in the team to make the process in a country as inclusive and empowering as possible in a very short period of time. We would like to strengthen the south-south collaboration through your assistance and guidance as soon as possible and could even get our SADC Health Protocol desk to assist with advocacy in those countries that fall within SADC. Best regards Ticky H.T.Raubenheimer Tel: +27 12 807 5982 Fax: +27 12 807 5982 Mobile: +27 82 575 2222 --- From: "John Lloyd" To: "Ticky Raubenheimer" Subject: Syringe disposal systems for Africa Date: Wed, 24 Jan 2001 Dear Ticky, Congratulations on your move to CSIR The theme of our discussions with you in Pretoria was that the African countries who are expected to receive assistance from GAVI, either in new vaccines or in immunization infrastructure support, will be in transition to auto-disable syringes for routine immunization. They will all (probably all) require a new or improved system of syringe disposal, otherwise referred to by WHO as infectious waste management, at the level of the health unit and the district. I have attached a list of the countries for you together with a guess at the number of syringes needed per annum for all immunization based on 6 injections per live birth (inc. 1 TT for the mum) and 100% coverage of live births. I have also calculated the volume of waste which that represents, about equivalent to a 2km high cube! (I am sure Anthony will correct this). The further up the list they are, the shorter time we have to get a solution implemented! Quite simply, the sooner these countries can be visited by an expert team to conduct an investigation of the problem and come up with a plan both for software and hardware for syringe disposal, the better! As the institution with the most experience in laboratory and field testing of small scale incinerator systems, CCCCM/CSIR are well placed to assist in this process and WHO has already firm ideas on what should be the method of these investigations. To proceed, you will need WHOs assistance in coming up with precise terms of reference and their assistance to obtain government clearance in each of the countries. You will also need funding. Funding for implementation of the plan generated by the visiting team and the government should be generated locally, either using GAVI Immunization Service funds or through the national ICC. Funding for the country investigations will need to be generated by the global partners of GAVI. I cannot guarantee that CVP will be able to provide funds for this purpose, but I do think that there is a strong possibility that the necessary funds will be mobilised from one or more GAVI partners as safety is high on the GAVI principles and as the process of change to auto-disable from sterilizable is concurrent with and stimulated by the GAVI process. A comprehensive and convincing proposal is needed to mobilise these funds. Regards, John Lloyd Resident Adviser PATH-CVP Centre d'Aumard 55 Avenue Voltaire 01210 Ferney Voltaire France Tel: (33) 450 28 06 09 Fax: (33) 450 28 04 07 --- Date: Thu, 25 Jan 2001 From: Anthony Battersby Subject: Syringe disposal systems for Africa To: Ticky Raubenheimer Dear Ticky, What you are proposing is really, really, important and maybe is what should drive the pace of change. Is it ethical to add to a country's hazardous waste burden when it is known that there are no acceptable disposal/destruction/final containment systems in place? (especially now that the latest theory for an origin of HIV is the reuse of syringes) Remember ALL used syringes generated have to be destroyed not just the immunisation ones (immunisation does not exist in a vacuum). So John you are right I will correct you, your column total should be 10 times higher! Just one example of what happens if a comprehensive approach is not taken. One Central Asian country has been supplied by UNICEF with enough sharps boxes to meet immunization needs, but the people in charge of immunisation know that if the sharps boxes are issued they will get filled up with both immunisation syringes and non immunisation syringes. There are 4-5 times as many non-immunisation syringes generated at the clinics where immunisations are given so they know they will quickly run out of sharps boxes. So what to do? Solution: Staff are told to bring the used syringes back to the store where they collect the vaccines and there they can put them into an IMMUNISATION ONLY sharps box - Problem solved, immunization sharps safely contained. Only snag, the staff have to recap the syringes, put them somewhere, like the drawer of their desk until they go to the store in a month's time, and then carry them on the bus to get to the store. Oh and the 4-5 times quantity of other syringes still get "chucked out of the window". Cater for all sharps Anthony ___________________________________________________________________________ This table was prepared by John Lloyd, PATH/CVP The data is presented in 4 columns: Countries/GAVI funding approved/anticipated Live births x 1000 in 2001 No. syringes to dispose Volume disposal per annum M3 Reformatted to ASCII plain text from an excel spreadsheet. ___________________________________________________________________________ JULY 2000 Country births syringes M3 Ghana 708 4,471,579 156.5 Kenya 1231 7,774,737 272.1 Madagascar 628 3,966,316 138.8 Malawi 540 3,410,526 119.4 Mali 532 3,360,000 117.6 Mozambique 711 4,490,526 157.2 Rwanda 346 2,185,263 76.5 Tanzania 1252 7,907,368 276.8 Sub total 5948 37,566,316 1,314.8 _________________________________________________ OCTOBER 2000 Country births syringes M3 Cote d'Ivoire 697 4,402,105 154.1 Liberia 140 884,211 30.9 Rwanda 346 2,185,263 76.5 Uganda 1071 6,764,211 236.7 Sub total 2254 77,122,105 2,699.3 _________________________________________________ JANUARY 2001 Country births syringes M3 Benin 257 1,623,158 56.8 Burkina Faso 471 2,974,737 104.1 Cameroon 532 3,360,000 117.6 Chad 273 1,724,211 60.3 Mauritania 89 562,105 19.7 Niger 472 2,981,053 104.3 Senegal 350 2,210,526 77.4 Sierra Leone 216 1,364,211 47.7 Zimbabwe 423 2,671,579 93.5 Sub total 3083 103,357,895 3,617.5 _________________________________________________ APRIL 2001 Country births syringes M3 Angola 555 3,505,263 122.7 Burundi 283 1,787,368 62.6 Congo DRC 2035 12,852,632 449.8 Djibouti 0 0.0 Eritrea 147 928,421 32.5 Ethiopia 2597 16,402,105 574.1 Gambia 47 296,842 10.4 Guinea 331 2,090,526 73.2 Guinea Bissau 45 284,211 9.9 Lesotho 74 467,368 16.4 Nigeria 4915 31,042,105 1,086.5 Togo 180 1,136,842 39.8 Sub total 11209 70,793,684 2,478 _________________________________________________ OCTOBER 2001 Country births syringes M3 Cen Afr Republ 135 852,632 29.8 _________________________________________________ Grand total 11420 218,898,947 7,661.5 ___________________________________________________________________________ ____________________________________*______________________________________ 2. NEW CONTACT DETAILS - THE COLLABORATIVE CENTRE FOR COLD CHAIN MANAGEMENT Update your records ___________________________________________________________________________ From: "Ticky Raubenheimer" Subject: New contact details - CCCCM Date: Fri, 12 Jan 2001 THE COLLABORATIVE CENTRE FOR COLD CHAIN MANAGEMENT Another major advance in our progress - new office The CCCCM has moved into their new permanent office with a full time secretariat at the CSIR campus in Pretoria. This infrastructure has been made possible by a generous grant from the CSIR. The locality of the office also enhances the networking of the CCCCM with its collaborators and networking partners. The office includes an IT and library support service which will make it possible to deliver a superior advisory and networking service for cold chain management both nationally and internationally. This occasion is also celebrated with the launch of the new CCCCM website which will be expanded substantially in content and practical usefulness during 2001. new website address: Our contact details are: Telephone: +27 12 841 4401 Fax: +27 12 841 4907 e-mail: [][/email] (the old one, [][/email] will continue in order not to loose any info) Physical address: (Please consult our new website : for a detailed map for geographical location of the office. Enter through the North Gate and report to the visitors reception, who will give clear instructions to Building 14 F). Building 14 F CSIR Campus Meiring Naudè ’oad Brummeria Pretoria 0001 South Africa. Postal address: Suite 210 Private Bag X025 Lynnwood Ridge Pretoria 0040 South Africa Please amend your records accordingly. H.T.Raubenheimer Mobile: +27 82 575 2222 ____________________________________*______________________________________

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