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Dr. Nguyen Thi Lien Huong

Deputy Director, Vietnam Health EnvironmentManagement Agency, MOH

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Presentation contentsI. Situation

II. Manufacture

III. Existing policies

IV. Challenges

V. Future plans

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I. SITUATION1. Vietnam has 11,834 health care facilities (in 2010):

34 facilities at center level

65 facilities at province level

735 facilities at commune level 11000 health-care stations

2. Lacking data on mercury sources in health care

Some mercury-base medical devices are in use

Thermometers Sphygmomanometers

Dental amalgam Esophageal Dilators

Laboratory chemical Cleaning product

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I. SITUATION

Mercury thermometers used in health care 4

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Cleaning products in general hospital, Bac Ninh province (electrolyticprocess of chlor-alkali production relies on mercury electrodes,

resulting in mercury contamination of the cleaning products) 5

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I. SITUATION

Facilities No ofthermometers/

1 hospital

Total No ofthermometers

No ofsphygmomanometers/

1 hospital

Total No ofsphygmomanometers

Provincialgeneral hospital

329(65 hospitals)

21,385 150 12,350

District hospital 160(698 hospitals)

111,680 71 49,558

Inter-communalgeneral clinic

10(37 clinics)

370 5 185

Communalhealth station

10 110,000 5 55,000

Total 243,435

117,093

Only figures of thermometers, sphygmomanometers are

available.

Estimated number of thermometers, sphygmomanometersbasing on a list of medical devices for hospitals/clinics atprovince, district and commune levels (not include central):

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I. SITUATION

A study conducted at 18 hospitals in 2007 in Vietnam byUNDP shows that:

For non-hospitalized patients or clients,

- About 20 to 30 thermometers are used in each facility (of

which 15 to 20 are frequently used).- Among those 2 to 4 are broken/month

MOH regulates each inpatient should use 1 thermometer,but the actual number is lower due to budget.

The majority of thermometers are imported from China dueto their cheap price.

Many patients buy new thermometers to compensate forbroken ones.

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I. SITUTATION

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I. SITUATION

In summary:

- Total number of broken thermometers at the 18facilities is 1,629 per month or 20,304 per year.

- The rate of breakage is 18.88% per month.

- The estimated total number of broken thermometersnationwide is 447,588 per year (extrapolated from the18 facilities, based on the total number of 196,311 bedsin use nationwide).

(Source: UNDP, 2007)

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I. SITUATION

Health-care Facility Grams mercury per bed per year

1500-bed hospital 1.3

1000-bed hospital 1.2

580-bed hospital (pediatric) 1.7

550-bed hospital 1.5

450-bed hospital 1.7

350-bed hospital 1.9

7-bed health station 2,1

5-bed health station 4,4

Average of mercury released from broken thermometers:1.8 grams per bed per year(Source: UNDP, 2007)

Estimated mercury release from broken thermometers

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I. SITUATION

Estimated total annual mercury releases from brokenthermometers and sphygmomanometers per 196,311beds is 550 kg

Estimates are based on 2.8 g mercury per bed per year(for thermometers and sphygmomanometers only).

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I. SITUATION

3. Current handling and disposal techniques:

No facility has a standard procedure for separatingmercury-containing waste for treatment.

Mercury waste is generally collected and incineratedtogether with other health-care waste in hospitalincinerators or central incinerators, or disposed inmunicipal landfills.

Some facilities collect broken thermometers anddispose of them on-site.

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II. MANUFACTURE

In Vietnam, there is not any thermometers and

sphygmomanometers manufacturer. They are imported from China, Japan, France, etc.

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III. EXISTING POLICIES

(to phase out mercury in health care)

Law on Environmental Protection, 2005.

Decrees, decisions that further regulate treatment ofliquid and solid waste from production and trade

facilities, hospitals, hotels and restaurants.

VN ratified the Stockholm Conventionon 22 July2002.

Documents issued by the Ministry of Health: Hospital Regulations (1997) including Waste

Treatment Regulations.

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Health-Care Waste Management Regulations (2007):

Mercury waste is classified as hazardous chemicalwaste and heavy metal containing waste.

Standards for waste container/plastic bag (blackcontainer for chemical waste), symbols and insidetransportation.

Classification, collection, transportation, storage of

solid waste. Transportation of solid medical waste outside the

health care facilities.

III. EXISTING POLICIES(to phase out mercury in health care)

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III. EXISTING POLICIES

Models, technologies for solid waste treatment anddestroying: chemical waste will be treated or destroyedby 4 methods:

Returned to suppliers.

Incinerated in high temperature incinerators.

Destroyed by neutralizing or alkali hydrolysis.

Inertized before being buried

The Master Plan for the Health-Care Waste Managementwill be approved by the Government soon.

No specific policies on mercury in health care.

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IV. CHALLENGES

Hospital waste is an urgent environmental issue inVietnam. Ineffective health-care waste treatment is apublic concern and a challenge for government at alllevels.

Health-care waste treatment needs a large budget.

Estimated investment is 1.160 billion VND.

Awareness about practical waste treatment solutions

is low Legislation is inadequate.

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IV. CHALLENGES

There has not been enough information on mercurysources in health care and mercury productalternatives in Vietnam.

The government lacks the infrastructure to manage

mercury waste. There is a belief that mercury products are accurate

and do not need calibration.

Replacing mercury-based medical devices is oftenexpensive.

For example: Price of mercury-based thermometer isUS$ 0.5; price of digital thermometer is US$ 3

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V. FUTURE PLANSShort-term: Conducting rapid assessments to:

Identify mercury sources

Evaluate mercury product alternatives

Develop guidelines on safe use of mercury-basemedical devices including mercury clean up and wastehandling and storage procedures

Raising awareness & education about occupationalhealth risks and environmental pollution due tomercury release and best management practices

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Medium-term:

Increase efforts to reduce the number of unnecessaryuse of mercury equipment.

More pilot models of mercury waste management areimplemented

Long-term:

Develop policies to substituting mercury-base medicaldevices with safer alternatives.

Support for replacing mercury-based medical devicesfrom Government, international organization, NGOs

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V. FUTURE PLANS

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Project Demonstrating and Promoting BestTechniques and Practices for Reducing Health-Care

Waste to Avoid Environmental Releases of Dioxinsand Mercury

4 years (2008-2012), implemented by UNDP, GEF, WHO,HCWH

Vietnam is one of 8 participating countries

Total budget for Vietnam: US$ 1.040.000

Overall objectives: to demonstrate and promote best

techniques and practices for health-care wastemanagement, thereby minimizing health-care waste andreducing or eliminating releases of dioxins and mercuryinto the environment.

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Project aims: to demonstrate the applicability of global besttechniques and practices, and to lay the groundwork forsustainability and replicability beyond the model facilitiesand the Project countries.

Project major components:

Model facilities: Vietduc University Hospital -Hanoi

(urban model hospital), and general hospital Ninhbinhprovince and 10 district health centers& communal healthstations in Ninhbinh province (model cluster)

Best practices for health-care waste management

including management of mercury wastedemonstrated

Awareness-raising and educational materials relatedto mercury developed and disseminated.

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Model central facility: Technology demonstration inURENCO (responsible for all municipal, hospital andindustrial waste management in Hanoi): investingtwo autoclaves, one additional shredder to promote

non-burn treatment of waste in the central facilityand introducing a first-of-its-kind city-wide sharpsmanagement program

Establish or enhance training programs to build

capacity for implementation of best practices andappropriate technologies beyond the model facilitiesand programs.

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Review relevant policies, seek agreement by relevantauthorities on recommended updates or reformulationsif needed, seek agreement on an implementation plan,and if appropriate, assist in holding a policy review

conference for these purposes.Distribute Project results on best techniques and

practices to relevant stakeholders, disseminate materialsand hold conferences or workshops to encourage

replication.

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