The Phase-Out of Mercury Containing Devices in Philippine Hospitals

Faye V. Ferrer Programme Officer Mercury-Free Health Care Health Care Without Harm Southeast Asia
Leading the global movement for environmentally responsible health care.

Mercury Use by Philippine Health Care Facilities

o Based on the PHAs 2009 list, there are 99,708 bed capacity provided by 1,851 hospitals in the country. o Hospitals have a policy of giving out one mercury thermometer per patient admission or discharge kit. o Most of the thermometers either break during their stay or are taken home never knowing their fate. o Breakages are common occurrences that never gets reported inside or outside of the hospital. o Disposal is done either through dumpsites, landfill or incinerators.

Dangers of Mercury Introduced in the Philippines

o

In January 2006, HCWH conducted the First Southeast Asian Mercury in Health Care Conference.

Former DOH Secretary Francisco Duque III announced an Administrative Order on the phaseout of mercury is to be drafted.
Health Care Facilities have pledged to move for a phase-out of mercury in their facilities.

HCWH continued to educate and call on the phase-out of mercury

o

In 2007, HCWH published the list of available alternatives to mercury containing devices and distributed to hospitals nationwide.

HCWH organized and participated in conferences, forums and workshops promoting mercury-free health care.
Became part of the drafting group for the phaseout of mercury in health care

Health Care Facilities made their move

Manila Adventist Medical Center, Pasay City

Philippine Heart Center, Quezon City Saint Louis University Hospital of Sacred Heart, Baguio City

Sisters of St. Paul of Chartres, Health Care Ministry

Notre Dame de Chartres Hospital, Baguio City St. Paul Hospital, Tuguegarao City St. Paul Hospital, Dasmarinas, Cavite DLSU Medical Center, Dasmarinas, Cavite

Memo on Mercury Spills Management was released to guide health care facilities on proper clean-up of small mercury spills. Rapid Mercury Assessment on several DOH controlled hospitals was conducted to test their mercury levels. First Quarter of 2008 - Committee to draft AO on mercury phase-out was formed.

In July 2008, Secretary Duque signed DOH AO21. In September 2008, DOH AO21 took effect.

DOH Administrative Order 2008-0021

Gradual Phase-out of Mercury in all Philippine Health Care Facilities and Institutions

A two-year phase-out on the use of mercury containing thermometers and sphygmomanometers.

Hospitals are to form Mercury Management Team as part of the Health Care Waste Management Committee Inventory of existing mercury containing devices. Inform vendors of preference to use alternatives Patient, and patient companion education on the dangers of mercury.

Php13.2 million was allocated in the 2009 General Appropriations Act for the purchase of non-mercury thermometers in the government controlled hospitals. This, however, awaits to be released.
The Philippine Health Insurance Corporation (PhilHealth), on the other hand, has included in its Benchbook compliance to AO21. In December 2010, the Department of Interior and Local Government released Memorandum Circular 2010-140 on mercury reduction program for health care facilities controlled by the local government units (LGUs).

In March 2010, Province of Rizal Governor Jun Ynares III announced that the province will phase-out mercury containing devices in their 5 government hospitals. He issued a directive to the provincial health office (PHO) to include the procurement of non-mercurial apparatus to replace the mercurial devices. In November 2010, Cebu Provincial Board Member Arleigh Sitoy upon seeing the low mercury phase-out compliance in the province said that he will author a resolution and an ordinance to fast track mercury phase-out and address the storage issue in Cebu. In the same month, General Santos City Councilor Marius Oco said that he will author a similar ordinance for the City.
The provinces of Cavite and Northern Samar have likewise expressed support for mercury phase-out in their respective areas. In a forum in Cebu, Provincial Board Member Sitoy said that he will include the mercury phase-out issue in the next budget deliberation and push it in the next meeting of the League of Municipal Mayors.

Information and Education Sustained

More hospitals are Phasing-out Mercury in their Facilities

o University of Perpetual Help o De Ocampo Memorial Medical Center o Manila Doctors Hospital o Sto. Tomas University Hospital o Ospital ng Muntinpula o Asian Hospital and Medical Center o Rizal Medical Center o The Medical City o AFP Medical Center o Capitol Medical Center o FEU Medical Center o Lung Center of the Philippines o National Kidney and Transplant Institute o Philippine Orthopedic Center o St. Lukes Medical Center o World Citi Medical Center o Cardinal Santos Medical Center o Fatima Medical Center o St. Paul Hospital Zamboanga o Central Luzon Doctors Hospital

Status of Implementation of DOH Administrative Order No. 2008-0021

(Gradual Phase-out of Mercury in All Philippine Health Care Facilities and Institutions)

There were 984 compliant hospitals representing 53% of the total number of hospitals (1,851) in the Philippines. (PHA 2009)

Breakdown of 984 per region

Regions Region 4B Region 8 Region 1 Region 12 CAR Region 4A Region 10 Region 5 Region 13 Region 3 Region 2 ARMM Region 11 Region 7 NCR Region 9 Region 6 PHA List of Hospitals 63 75 130 106 59 242 111 120 60 206 83 28 116 106 183 76 87 Implemented AO 21 56 62 101 82 40 162 69 72 31 103 41 13 46 33 51 14 8 Percentage 89% 83% 78% 77% 68% 67% 62% 60% 52% 50% 49% 46% 40% 31% 28% 18% 9%

Total

1,851

984

Challenges Encountered
STORAGE
o

Proper storage are not implemented by some facilities, some do not know how to implement one. Concerns on the safety of maintaining on-site storage were raised Some facilities practiced recovery and placing all elemental mercury in one container. Others, before implementation of AO21 gave out all mercury containing devices to patients to avoid storage.

Current Practices in Storage

Current Practices in Storage

Current Practices in Storage

Challenges Encountered
ACCURACY
o

While many hospitals have phased-out mercury, others are still skeptical specially with digital BP Apparatus. There are no standards in terms of evaluating the alternatives. Sale of mercury containing thermometers, specially sphygmomanometers are prevalent.

Recommendations
o

Continuous monitoring of compliance to AO21 and other future AOs, etc. Periodic reporting on the status and developments on AO21 and other future AOs, etc. Strengthen collaboration with different sectors such as civil society organizations, professional organizations, etc. Implement a Ban on the Importation of mercury containing devices.

MARAMING SALAMAT PO! Thank you!