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INDONESIA:COUNTRY STATUS

MERCURY-FREE HEALTH CARE

Yuyun IsmawatiBALIFOKUS

Manila, March 15, 2011

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Indonesia area is 2 millionsq. km, maritime area:7,900,000 sq. km.More than 17,500 islands;

6,000 islands are inhabited;1,000 of which arepermanently settled.Population (July 2009): 240.3million, annual population

growth rate (2009 est.):1.136%, distributed within 33provincesGovernmental system is

based on decentralization

Geographical and Demographical Situations

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NATIONAL REGULATIONS

• Law No. 32 year 2009 regarding Environmental

Management and Protection

• Ministry of Health Decree No. 1204 year 2004regarding Requirement of Hospital EnvironmentalHealth

• Government Regulation No. 74 year 2001 regardingHazardous Substances Management

• Government Regulation No. 18 year 1999 jo No. 85year 1999 regarding Hazardous Waste Management

• Law No. 36 year 2009 regarding Health

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•

To support implementation of medical waste and heavymetal management in health care facilities on the wasteminimization basis

• To support the development of centralized medical wasteand heavy metal management in the region

•To support the alternative of non-incineration technologydevelopment effectively and efficiently

• To develop coordination among related sectors andprograms on building and supervising of medical waste andheavy metal management by establishing a forum at the

central, province and district level, in respond to thedecentralized government system

• To support the private sector role on centralized medicalwaste and heavy metal management and ExtendedProducer Responsibility (EPR)

NATIONAL STRATEGY ON HEALTH-CARE WASTEAND HEAVY METAL MANAGEMENT (2008)

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Mercury DevicesThermometers, Sphygmomanometers,

Dental Amalgams, Reagent

Health Care FacilitiesHealth-Care Facilities  Total 

Hospitals  1,371 Primary Health Cares (PHCs)  7,071 Assisted PHCs  21,587 Mobile PHCs  5,084 Clinical Laboratories  ----------- Doctors  > 97,000 Midwives  > 104,000 

Source: Directorate of Medical Services, 2009 

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• National Mercury Roundtable Forum• Demonstration from the local level towards national

program started in Bali• Each hospital, PHC and clinic use at least 1

thermometer and 1 sphygmomanometer per serviceroom

• Each assisted PHCs, mobile PHCs, doctor and midwifeuse at least 1 thermometer and 1 sphygmo-manometer

• Health-care facilities are distributed in rural and urbanareas, isolated and geographical difficulties to reach

• In the decentralization system, local governments havetheir own authorities to develop local policy and budget

SITUATION ANALYSIS TOWARDS MERCURY-FREE HEALTH CARE SECTOR

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Assessment in Denpasar City Hospitals

Collaboration of BALIFOKUS with

Environmental Agency and Health AgencyDenpasar City

14 hospitals participated in the assessment

(A-E class) 21% have strong commitment to comply with

regulation (supply chain, committee, wastemanagement, towards mercury-free)

21% review their termometer use and purchasing 14% review their sphygmo use and purchasing

3 hospitals acting as services provider for medicalwastes incineration

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Hospital wastes management

Model 1  – On-site management

Non-medicalwastes

Other

wastes

Medicalwastes

Autoclave/

Insinerator

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Hospital-1 

Hospital-2  HOSPITAL

“Z” (Waste generator

and Waste Management)

PrimaryHealth Care-2

Hospital wastes management

Model 2 – Off-site

CityLandfill

PrimaryHealth Care-1

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Hospital wastes management

Model 3  – Off-site management 

Hospital A

Hospital C

Hospital B

Company

“Z” Hold the special wasteManagement permit

from MoE

Ash

Haz WasteFacility

Company X

Company X

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Challenges

•

Changing mind-set andpractices

• Local / city level storage

• Environmental standard and

monitoring

• Local Policy and regulations

• EPR  – waste management,

take-back policies, labelling& information,deposit/refund scheme

• National Policies

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On-going program and follow up

MoUs with 7 hospitals in Denpasar City on phasing-

out mercury devices

Awareness raising - supply chain, consumer, users

Demonstration in Bali and soon in Jakarta andBandung

Capacity building for primary stakeholders

Green certification/labelling through Green Hospitaland PROPER Hospital

Integration into National Action Plan on Mercury andmercury inventory

To be part of the Global Initiatives

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MARAMING SALAMATTHANK YOUTERIMAKASIH

BALIFOKUS

Mandalawangi No.5

Jalan Tukad Tegal Wangi, Sesetan

DENPASAR 80223Ph/Fax +62-361-233520

yuyun@balifokus.asia, balifokus@balifokus.asia

www.balifokus.asia