INDONESIA: COUNTRY STATUS MERCURY-FREE HEALTH CARE

Manila, March 15, 2011

Yuyun Ismawati BALIFOKUS

Geographical and Demographical Situations

Indonesia area is 2 million sq. km, maritime area: 7,900,000 sq. km. More than 17,500 islands; 6,000 islands are inhabited; 1,000 of which are permanently settled. Population (July 2009): 240.3 million, annual population growth rate (2009 est.): 1.136%, distributed within 33 provinces Governmental system is based on decentralization

NATIONAL REGULATIONS

Law No. 32 year 2009 regarding Environmental Management and Protection

Law No. 36 year 2009 regarding Health Government Regulation No. 18 year 1999 jo No. 85 year 1999 regarding Hazardous Waste Management

Government Regulation No. 74 year 2001 regarding Hazardous Substances Management

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

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

To support implementation of medical waste and heavy metal management in health care facilities on the waste minimization basis To support the development of centralized medical waste and heavy metal management in the region To support the alternative of non-incineration technology development effectively and efficiently To develop coordination among related sectors and programs on building and supervising of medical waste and heavy metal management by establishing a forum at the central, province and district level, in respond to the decentralized government system To support the private sector role on centralized medical waste and heavy metal management and Extended Producer Responsibility (EPR)

Mercury Devices
Thermometers, Sphygmomanometers, Dental Amalgams, Reagent

Health Care Facilities

Health-Care Facilities Total

Hospitals Primary Health Cares (PHCs) Assisted PHCs Mobile PHCs Clinical Laboratories Doctors Midwives
Source: Directorate of Medical Services, 2009

1,371 7,071 21,587 5,084 ----------> 97,000 > 104,000

SITUATION ANALYSIS TOWARDS MERCURYFREE HEALTH CARE SECTOR

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 service room Each assisted PHCs, mobile PHCs, doctor and midwife use at least 1 thermometer and 1 sphygmo-manometer Health-care facilities are distributed in rural and urban areas, isolated and geographical difficulties to reach In the decentralization system, local governments have their own authorities to develop local policy and budget

Assessment in Denpasar City Hospitals

Collaboration of BALIFOKUS with Environmental Agency and Health Agency Denpasar City 14 hospitals participated in the assessment (A-E class)
21% have strong commitment to comply with

regulation (supply chain, committee, waste management, towards mercury-free) 21% review their termometer use and purchasing 14% review their sphygmo use and purchasing 3 hospitals acting as services provider for medical wastes incineration

Hospital wastes management Model 1 On-site management

Non-medical wastes

Other wastes

Medical wastes

Autoclave/ Insinerator

Hospital wastes management Model 2 Off-site

Hospital-1

City Landfill

Hospital-2

Primary Health Care-1

(Waste generator and Waste Management)

HOSPITAL Z

Primary Health Care-2

Hospital wastes management Model 3 Off-site management

Hospital A

Company X

Hospital B

Hold the special waste Management permit from MoE

Company Z

Haz Waste Facility

Hospital C

Company X

Ash

Challenges
Changing mind-set and

practices 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

On-going program and follow up

MoUs with 7 hospitals in Denpasar City on phasingout mercury devices Awareness raising - supply chain, consumer, users Demonstration in Bali and soon in Jakarta and Bandung Capacity building for primary stakeholders Green certification/labelling through Green Hospital and PROPER Hospital Integration into National Action Plan on Mercury and mercury inventory To be part of the Global Initiatives

BALIFOKUS Mandalawangi No.5 Jalan Tukad Tegal Wangi, Sesetan DENPASAR 80223 Ph/Fax +62-361-233520 yuyun@balifokus.asia, balifokus@balifokus.asia www.balifokus.asia

MARAMING SALAMAT THANK YOU TERIMAKASIH