Dr.

Tsetsegsaikhan Batmunkh
Ministry of Health Mongolia

Green Hospitals Asia Conference 2013

Tsetsegsaikhan Batmunkh, PhD Mongolia 15 October, 2013

Brief introduction about Mongolia

Land area: 1564.1

thousand square kilometers

Population:

2,8

million
Population

density: 1,7 people per square km

Administrative units and health care organizations structure

Specialized centers/tertiary hospitals Regional diagnostic and treatment 4 17 12 6 37 16

centers
Aimag general hospitals District general hospitals Rural general hospitals Inter-soum hospitals

Soum hospitals
Family group practices (FGP) Delivery center Private hospitals

274
219 3 171

Key activities on Green Hospitals Initiative

Improving Health Care Waste Management

Evidences for the need to improve HCWM

TCDD-TEQ
Total TEQs 2500
Concentration (pg/g)

2040

2000 1500
1010

1000 500
7.23 0.715 0.169 0.167

0 ESP Fly Ash H/K Cement & Bottom Ash Municipal Metallurgical Children's Hospital Waste Factory Darkhan Sewage Sludge (Power Plant #4) Lime Factory (Power Plant #4) #2 Incin. Location

Source: POPS Project of the Ministry of Nature and Environment, 2005

Evidences for the need to improve HCWM

90 % of the health care facilities burn in small scale, low temperature incinerators without any air filter 10% direct disposal without treatment

Source: Characterization survey of HCW in Ulaanbaatar, 2004-2005

Key activities on improving Health Care Waste Management (HCWM)

Infrastructure towards environmentally sound technologies in secondary level

3 Province (aimag) hospitals - MOH 5 Province (aimag) hospitals - ADB Investment into steam treatment technologies, training

Before

After

Infrastructure towards environmentally sound technologies in primary level

28 primary level rural hospitals - WHO 35 primary level rural hospitals MCA

90 primary level rural hospitals ADB

Investment into steam technologies, training treatment

After Before

Overall shift to non- burning technology Capital city Centralized Treatment Facility 33 % of secondary level 40% of primary level hospital shifted

Awareness raising, training

Seminars, conferences

for stakeholders (multisectoral approach)

Awareness raising, training

Continuous training (3 level training system)

Awareness raising, training

IEC materials (manuals, brochure,

calendar, poster, video)

Mercury Free Health Care Initiatives

Baseline survey for mercury containing devices in health care facilities of Mongolia (2010)
578 departments of 38 government and private health care facilities 38% of mercury containing devices were thermometers and 24% sphygmomanometers Utilization period: 1-3 years

75% of HCF hadnt any regulation for safe handling, storage and disposal of Hg containing devices

Improvement of Legal Environment

The Joint Order #07/27 of the Minister of Health and Director General of the National Emergency Management Agency ,

11 January, 2011

Improvement of Legal Environment

to prohibit purchase of the mercury containing thermometer and sphygmomanometer and dental amalgam starting from 15 Jan, 2011 and take all measures to reduce the usage of the previously obtained ones safety rules for mercury containing devices mercury spill guideline

Survey on mercury contamination of outdoor and indoor air of some health care organizations in Ulaanbaatar (2011) Conducted by the Toxicology laboratory of the National Public Health Center Used methodology Environment Facility developed by UNDP Global

Air samples from 178 units of 16 healthcare organizations Indoor air: exceed of mercury level in air 1.08-215.99 times comparing to minimal risk level of mercury in indoor air estimated from Agency for Toxic Substances & Disease Registry ATSDR, USA (0.2 g/m3) in air Outdoor air: Mercury content in outdoor air in 21 sites nearby hospitals were lower than reference level for Mongolia (2 g/3)

 Mercury free healthcare organization

awardees (2013)
14 tertiary and secondary level hospitals
State Central Hospital No.2 National Center for Infectious Diseases National Traumatology and Orthopedic Research

Center National Center for Maternal and Child Health Maternity hospitals (1st, 2nd, 3rd ) District Hospitals (Bayanzurkh, Bayangol, Chingeltei, Khan-Uul, Songinokhairkhan)

Challenges
Funding

Chemical and other hazardous waste disposal

Monitoring of new equipments

Implementation of guidelines, standards

Engineers, equipment running staff

Futher activities
Fifth Health Sector Development project, ADB

Upgrade of CTF in UB city Improve chemical waste management

Recycle of some waste

Budget: 3.7 mil USD