Public Disclosure Authorized Public Disclosure Authorized The World Bank Implementation Status & Results Vietnam Hospital Waste Management Support Project (P119090) Operation Name: Hospital Waste Management Support Project (P119090) Project Stage: Implementation Seq.No: 7 Status: ARCHIVED Archive : 02-Nov-2014 Country: Vietnam Approval FY: 2011 Product Line: IBRD/IDA Region: EAST ASIA AND PACIFIC Lending Instrument: Specific Investment Loan Implementing Agency(ies): MINISTRY OF HEALTH Key s Board Approval 29-Mar-2011 Original Closing 31-Aug-2017 Planned Mid Term Review 31-Aug-2014 Last Archived ISR 05-Apr-2014 Effectiveness 29-Aug-2011 Revised Closing 31-Aug-2017 Actual Mid Term Review 18-Aug-2014 Project Development Objectives Project Development Objective (from Project Appraisal Document) The project development objective is to reduce environmental degradation and potential risks for human health through the improved management of health care waste in Vietnam's hospitals. Has the Project Development Objective been changed since Board Approval of the Project? Yes No Component(s) losure Authorized Public Disclosure Authorized Component Name Component Cost Component 1: Policy and Institutional Environment Strengthening 9.00 Component 2: Hospital Waste Management Improvement Facility 134.00 Component 3: Project Implementation Support and Coordination 7.00 Overall Ratings Previous Rating Current Rating Progress towards achievement of PDO Moderately Unsatisfactory Moderately Unsatisfactory Overall Implementation Progress (IP) Moderately Unsatisfactory Moderately Unsatisfactory Overall Risk Rating Substantial Substantial Implementation Status Overview Under Component One on Policy and Institutional Environment Strengthening, the project has made the following progress in the past few months: (i) Inter-sectoral Executive Committee for Environmental Protection in Health Sector which established in October 10, 2013 held its first meeting in June 2014. (ii) Three Technical Guidelines on application of healthcare wastewater treatment technologies, application of non-burn technologies for healthcare waste treatment and healthcare waste management manual were completed and issued. (iii) A Circular guiding for healthcare waste management and a draft Inter-ministerial Circular guiding for cooperation in environmental governance of health facilities were finalized were drafted, discussed with multiple stakeholders, and uploaded on the MOH s website for information. (iv) The Training program and the training modules for 6 target Page 1 of 10
groups were issued by Administration of Science Technology and Training in July 2014. In parallel, a training pilot was completed in December 2013, and then training courses for 3 selected groups in 5 provinces under Round 1 were undertaken in May-July 2014. The VIHEMA has planned to complete training of trainer (ToT) over the next 12 months.(v) A rapid situation analysis/knowledge assessment is scheduled to take place by end of 2014 and based on the assessment the national communication plan and Information exchange (IEC) materials will be developed. The implementation performance under Component Two to provide grants to beneficiary hospitals and provinces for improving hospital waste management has been mixed. The facilities in the five provinces under Round One and one central hospital have almost completed the construction of the waste water treatment systems, and are undergoing verifications by independent verification institutions. The initial tests of the treated waste water from the three hospitals meet the standards according to government regulations. However, the pipes and collection system to the newly built waste water treatment systems have not been renovated, leading to problems of leaking. The beneficiary hospitals are checking the pipes and collection systems and will need a few more months to fix the problem and make the newly built system run at full capacity. The Feasibility Studies under Round Two need to be improved, based on the lessons and experiences from Round One. In order to improve and ensure the technical quality of the round two FSs and designs, the project management team and the Technical Advisory Group (TAG) need to be strengthened by recruiting qualified technical experts. Locations Country First Administrative Division Location Planned Actual Vietnam Not Entered Tinh Tien Giang Vietnam Not Entered Sa Dec Vietnam Not Entered Tinh Long An Vietnam Not Entered Tinh Kien Giang Vietnam Not Entered Ha Noi Vietnam Not Entered Tinh Dong Thap Vietnam Not Entered Tinh Dong Nai Vietnam Not Entered Cai Lay Vietnam Not Entered Bien Hoa Vietnam Not Entered Tinh Ben Tre Vietnam Not Entered Huyen Ba Tri Vietnam Not Entered Thi Xa Go Cong Vietnam Not Entered Huyen Cai Be Vietnam Not Entered Huyen Thap Muoi Vietnam Not Entered Huyen Hong Ngu Vietnam Not Entered Kien Giang Provincial General Hospital Vietnam Not Entered Hanoi Hospital of Traditional Medicine Page 2 of 10
Country First Administrative Division Location Planned Actual Vietnam Not Entered Kien Giang Hospital of Traditional Medicine Vietnam Not Entered Tien Giang General Hospital Vietnam Not Entered Cai Lay District Hospital Vietnam Not Entered Go Cong District Hospital Vietnam Not Entered General Hospital of Sa Dec Vietnam Not Entered Dong Thap General Hospital Vietnam Not Entered Long An General Hospital Vietnam Not Entered Ben Tre General Hospital Vietnam Not Entered Cu Lao Minh District Hospital Vietnam Not Entered Ba Tri District Hospital Results Project Development Objective Indicators Indicator Name Core Unit of Measure Baseline Current End Target Increased share of hospitals' wastewater Percentage Value 0.00 0.00 40.00 meeting the environmental standards Hospital grants are being prepared. 5 Grants of round 1 are under construction and installation. None is completed. Increased share of properly segregated and Percentage Value 0.00 0.00 40.00 treated infectious health care waste Non is completed so there is no data available. Increased number of health care staff following Percentage Value 0.00 0.00 90.00 correct occupational safety practices, including usage of personal protective equipment Hospital grants are being prepared or implemented, none is completed. Page 3 of 10
Improved perception among communities adjacent to project hospitals about health waste being properly managed Intermediate Results Indicators Percentage Value 0.00 0.00 90.00 Hospital grants are being prepared or implemented, none is completed. Indicator Name Core Unit of Measure Baseline Current End Target Effective CPMU and TAG support to Percentage Value 0.00 0.00 80.00 Component 2 beneficiaries Data is not available because questionnaires are not designed. The delay was caused by CPMU who did not pay attention on this indicator. Effective monitoring Percentage Value 100.00 100.00 CPMU has conducted regular monitoring but they need to do better on following up to ensure the comments was taken into account by effective actions. Number of hospital grants approved Number Value 0.00 62.00 150.00 12 central hospitals and 50 provincial hospitals has got approval either on i) master plans on health care waste management or ii) feasibility reports or iii) feasibility reports and procurement plans Number of Health Care Waste Management Number Value 0.00 36.00 60.00 Plans approved 22 provincial health care waste management plans have been approved. 14 health care waste management plans of Page 4 of 10
Central and provincial hospital receiving scheduled environmental monitoring visits Central Hospitals receiving scheduled environmnetal monitoring visits Improved knowledge and skills of key health personnel in health care waste management standards and practices Number of trainers trained with 80% passing test score Number of leaders of health, DONRE, Environment Police, other agencies trained with 80% passing test score 14 central hospitals has been approved... Percentage Value 0.00 Under VIHEMA's environmental monitoring program, all hospitals are receiving environmental monitoring visits. Percentage Value 0.00 100.00 50.00 23-Jan-2014 Under VIHEMA's environmental monitoring program, all central hospitals are receiving environmental monitoring visits Number Value 0.00 5463.00 Training program was completed and waiting for international consultant s comments Training material was finalized and expected tobe approved in the first quarter of 2014. Training courses will be delivered as soon as training material is approved. Number Value 0.00 0.00 276.00 TOT was not yet conducted due to the delay on recruitment of the international consultant to review training materials. Number Value 0.00 0.00 2545.00 Training module was finalized. Training course for leaders is expected to be Page 5 of 10
Number of HCWM administrators in DOH, health care facilities, preventive health centers trained with 80% passing test score Number of technical staff in environment monitoring agency trained with 80% passing test score Number Number delivered in the first quarter of 2014 after receivingofficial approval. Value 0.00 0.00 2332.00 Training pilot is conducted in Dec., 2013 for 5 provinces under Round 1, including Dong Thap, Ben Tre, Tien Giang, Kien Giang, LongAn -Offical training courses for leaders/managers is expected to be started in the third quarter of 2014 as soon as TOT conducted Value 0.00 0.00 310.00 Training module is under developed. Training course for technical staff in environmental monitoring agency will be delivered in thefirst quarter of 2014. Health personnel receiving training (number) Number Value 0.00 0.00 5463.00 Training module was finalized. TOT training is expecting to be delivered in the first quarter of 2014. Number of hospital grants completed Number Value 0.00 0.00 150.00 None of hospital grants has completed. Expectedly, two health facilities will complete construction and installation in June 2014. Page 6 of 10
Number of hospitals meeting: (a) wastewater Number Value 0.00 0.00 140.00 standards; (b) solid waste standards; (c) HCWM practice standard Hospital grants are being prepared or implemented. None is completed yet. Four scientific institutes/regional reference Number Value 0.00 0.00 4.00 labs and provincial preventive health centers have strengthened capacity for testing of solid and liquid health care waste Technical specification of lab equipment is facing with a big delay. After appraisal, the project need to separate the package intotwo. Mobile lab should be appraised later by December 2013. The rest should go ahead in September. Functional web based software application to Number Value 0.00 0.00 250.00 provide up-to-date and transparent information about the status of HCWM in hospitals The TOR for recruitment of IT company was finalized. It is expected that TOR will be approved in the first quarter of 2014. Health facilities constructed, renovated, and/or Number Value 0.00 0.00 150.00 equipped (number) None of health facilities in round 1 completed construction/renovation yet. Smooth implementation and monitoring of Percentage Value 0.00 100.00 100.00 grant implementation Construction and installation works for 5 sub-grants in Bentre and Tien giang are on going. A systematic approach needs to be strengthening to ensure the system will properly operating when the works completed. Credit resources committed (cumulative) Percentage Value 0.00 9.00 100.00 Page 7 of 10
Credit resources disbursed (cumulative) Percentage no further comments. Value 0.00 11.00 100.00 Actual disbursement up to date. Health facilities constructed, renovated, and/or Number Value 0.00 0.00 100.00 equipped (number) 5 sub grants are under construction and installation. None is completed yet. Credit resources committed (cumulative) Number Value 0.00 9.00 100.00 23-Jan-2014 Actual disbursement is very slow. Fully functional Executive Committee for Number Value 0.00 0.00 10.00 Environmental Protection in the Health Sector having regular inter-sectoral meetings Official approval was issued in October 2013 which regulated the role and responsibility and the list of members. The first consultation workshop will be conducted in the first quarter 2014. the number of new or revised policies, Text Value 0 13 regulatory documents adopted and applied HCWM studies published and disseminated - 08 documents were finalized, in which 02 documents will be issued by MOH in the first quarter 2014. - 02 documents (Circular) aregoing to be developed Number of Policy and administrative Text Value 0 4 documents 23-Jan-2014 Policy and administrative documents were finalized and submit to the authorities for approval. It is expected that Page 8 of 10
Number of Technical regulations Text Number of Technical guidance manuals Text Number of workshops with stakeholders Text these documents will be approved in the first quarter of 2014. Value 0 4 Technical regulations were finalized. Non burn technology guideline is expected to be issues in the first quarter of 2014. Value 0 5 Technical guidance manuals were finalized and it will be reviewed by the international consultant. it is expected that official approval will be provided in the second quarter of 2014. Value 0 13 23-Jan-2014 13 workshops are conducted to discuss on the comments on 07 policies, regulatory documents, and technical guidances. Data on Financial Performance (as of 01-Jul-2014) Financial Agreement(s) Key s Project Ln/Cr/Tf Status Approval Signing Effectiveness Original Closing Revised Closing P119090 IDA-48990 Effective 29-Mar-2011 31-May-2011 29-Aug-2011 31-Aug-2017 31-Aug-2017 Disbursements (in Millions) Project Ln/Cr/Tf Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed P119090 IDA-48990 Effective XDR 96.10 96.10 0.00 9.28 86.82 10.00 Disbursement Graph Page 9 of 10
Key Decisions Regarding Implementation 1. Supervision will be strengthened and corrective action taken on technical design to ensure a quality and sustainability of the waste treatment system. 2. Active participation of beneficiaries should be enforced and contract management will be improved. Restructuring History There has been no restructuring to date. Related Projects There are no related projects. Page 10 of 10