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1
Essential Health Services Access Project
Environmental Management Plan
2
/ (International Development Association - IDA)
() / (Environmental Codes of Practices) ()
3
1 ( ) ( ) ( ) / 2 (Rural Health Centres) 3 (Sub Rural Health Centres)
1 2 () () 3 () ()
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(Project Development Objective) (Maternal Newborn and Child Health) -
-
/ (Township Medical Officers) (Station Hospitals) (Rural Health Centres) (Sub-Centres) (Maternal and Child Health Clinics) (Standard Operation Procedures) ( )
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/ /
- - ) (Standard Operation Procedures)
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Universal Health Coverage
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B (Environmental Management Plan)
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- ) () ) () ) () ) () ) () ) () ) () ) () ) () ) () ) () ) () ) () ) () ) ()
(National Health Committee)
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OP/BP . OP/BP .
(Environment, Health and Safety Guidelines)
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Human papilloma virus ( (test kits) ( ) ( ) - ( ) ( ) HIV
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HIV ) (Health Care Waste Management) ) ) ) ( )
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( ) (Enivronmental Codes of Practices - ECoPs) ( ) ECoPs (Project Operation Manual) ( ) -
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HIV HBV HCV HIV HBV HCV (PCI ) (HzHCW)
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/ () (Enivronmental Codes of Practices - ECoPs) ( ) ECoPs / ( )
- (Waste Management Plan) (Waste Management Plan)
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( )
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World Health Organization (WHO)
WHO
( )
WHO
ECoP ( ) /
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( - / ) ( ) ( ) ECoPs ( )
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Environmental Management Plan (EMP) ( ) MOH MOH DOH PowerPoint EMP DOH HCF EMP
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- (Enivronmental Codes of Practices - ECoPs)5
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microwave ( ) ( )
Microwave
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Supplier
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HCW -
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(autoclave microwave)
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Health Facility
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35
- HIV HBV HCV HIV (+) HbsAg (+) Anti HCV (+) ARV HIV HBV HCV HIV HBV HCV HIV ( ) HIV (+) HbsAg (+) Anti HCV (+) HIV HBV HCV Counselling positive HIV HBV HCV HIV(-) HBV(-) HCV(-) HIV HBV HCV HIV HBV HCV ARV HIV HIV HIV negative ARV ARV - HIV HIV (+) HIV (-) HIV (+) HIV positive HIV (-) HIV HIV (+)
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- I.
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NGO
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II. - (MOH) (Social Assessment) (Community Empowerment Planning Framework) (EMP) III. - NGO NGO (WB) IV. ( ) ( ) MOH
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( ( ) ( ( ( Human Development Specialist () V. () - () - MOH (CEPF)
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() / / MOH
/
/
(Penta3 ) NGO
CEPF ( ) MOH
LNGO
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/
(PPP) MOH
NGO
CEPF UHC PPP PPP NGO NGO
M-HSCC NGO
MOH M-HSCC
3MDG Fund Global Fund
NGO TMO NGO
TOR
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- () MNCH
MNCH () ()
UHC
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MNCH UHC
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TMO TMO
MOH
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MOH MOH
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(SOPs)
/ SOP
UNHCR
( ) EMP
MOH
47
/
IDA MOH
MOH
(PHC) MOH PHC PHC UHC
() MOH
48
- WBG - Asbestos () - asbestos Asbestos (Asbestos Containing Materials - ACM) (WBG) Asbestos WBG (General Environmental, Health and Safety Guidelines - EHS) 6 WBG EHS ACM Asbestos ( ) ACM WB WB ACM Asbestos
6http://www.ifc.org/ifcext/enviro.nsf/AttachmentsByTitle/gui_EHSGuidelines2007_GeneralEHS/$ FILE/Final+-
+General+EHS+Guidelines.pdf (pp. 71, 91, 94).
49
Asbestos . Asbestos Asbestos Asbestos 7 , Asbestos ILO 8 Asbestos , WHO 9 Asbestos 10 Chrysotile Asbestos - (A-C) A-C A-C A-C Asbestos A-C Asbestos ( ) Asbestos
7http://www.who.int/occupational_health/publications/draft.WHO.policy.paper.on.asbestos.related.diseases.pdf.
See also Stayner L, et al., Exposure-Response Analysis of Risk of Respiratory Disease Associated with Occupational Exposure to Chrysotile Asbestos. Occupational Environmental Medicine. 54: 646 -652 (1997). 8http://www.ilo.org/wow/Articles/lang--en/WCMS_081341
9http://www.who.int/occupational_health/publications/asbestosrelateddiseases.pdf
10Asbestos defined in Castleman, B. Asbestos: Medical and Legal Aspects 5th Ed. New York: Aspen, 2005, 894 pp.
50
11 - Asbestos Asbestos (IFBWW) Collelgium Ramazzini Asbestos ( ) Chrysotile12 Asbestos ILO sbestos Asbestos Landrigan PJ, Soffritti M. sbestos Collegium Ramazzini m. J. nd. Med. 47: 471-474 (2005). . Asbestos Asbestos http:// ibassecretariat.org./ lka_alpha _asb_ ban_280704.php sbestos , , , , , Item 299, pp. 20/47- 48. - http://www.who.int/occupational_health/publications/asbestosrelateddiseases.pdf . Asbestos Asbestos Asbestosis ( Pleura Peritoneum Mesothelioma
11
ILO Asbestos Convention No. 162, (see http:www.ilo.org/ilolex or http://www.itcilo.it/actrav/osh_es/m%F3dulos/legis/c162.htm) 12
http://www.who.int/occupational_health/publications/asbestosrelateddiseases.pdf. Directive 2003/18/EC of the
European Council and Parliament amending Council Directive 83/477/EEC, and Directive 99/77/EEC
http://www.who.int/occupational_health/publications/asbestosrelateddiseases.pdf
51
) 13 Asbestos Asbestos Mesothelioma Asbestos 14 Asbestos 15 A-C Asbestos Chrysotile Asbestos () Asbestos 16A-C Asbestos Asbstos Asbestos 17 A-C ggressive 18 Asbestos
13
http://www.euro.who.int/document/aiq/6_2_asbestos.pdf 14
Asbestos. World Health Organization IARC Monographs on the Evaluation of Carcinogenic Risks to Humans/ Overall Evaluations of Carcinogenicity: An Updating of IARC Monographs 1 to 42, Suppl. 7. Lyon: International Agency for Research on Cancer, 1987, pp. 106-116. 15
Wagner JC, Berry G, Skidmore JW, Timbrell V. The Effects of the Inhalation of Asbestos in Rats. Br. J. Cancer 29:
252-269 (1974). 16
International Program on Chemical Safety, Conclusions and Recommendations for Protection of Human Health, Chrysotile Asbestos, Environmental Health Criteria 203. Geneva: World Health Organization, 1998, p. 144. 17
http://whqlibdoc.who.int/hq/2000/a68673_guidelines_3.pdf 18
http://whqlibdoc.who.int/hq/2000/a68673_tech_aspects_4.pdf
52
19ACM Asbestos ACM 20 . Asbestos Asbestos 21 Asbestos . (ILO) Asbestos 22 19
Jones, Robert Living in the Shadow of the Asbestos Hi l ls (The Need for Risk Based Cleanup Strategies for Environmental Asbestos Contamination in South Africa). Environmental Exposure, Crisis Preparedness and Risk Communication, Global Asbestos Congress, Tokyo, Japan, November 19 - 21, 2004.
http://park3.wakwak.com/~gac2004/en/index_abstract_e.html. See also Oberta, AF Case Study: An Asbestos Cement Plant in Israel -- Contamination, Clean-up and Dismantling. Hellenic Asbestos Conference, Athens, Greece, October 29 - 31, 2002. http://www.ibas.btinternet.co.uk/Frames/f_lka_hellen_asb_conf_rep.htm 20
Boer, A.M., L.A. Daal, J.L.A. de Groot, J.G. Cuperus The Combination of the Mechanical Separator and the
Extraction Cleaner Can Process the Complete Asbestos -containing Waste-stream and Make it Suitable for Reuse. European Conference on Asbestos Risks and Management, Rome, Italy, December 4 -6, 2006. http://venus.unive.it/fall/menu/Boer.pdf 21
R. Virta, US Geological Survey, 2007. 22
www.ilo.org/ilolex
53
Asbestos (C ) 23 Asbestos ILO Asbestos - ACM . ACM ( WHO ISO ASTM) ( )
23
http://www.ilo.org/ilolex/english/convdisp1.htm
54
- ACM A-C A-C A-C (ASTM E2394 HSG189/21924 ) Asbestos Asbestos Concentration limits have been set by regulations in numerous countries for workers whose duties involve contact with ACM; ACM Asbestos Asbestos ACM ACM 24
55
Asbestos (See EPA NESHAP regulations, EPA NESHAP ) Asbestos ( ) (ESM. )25 Asbestos A-C Asbestos 26Asbestos Asbestos Asbestos Asbestos Asbestos ACM
25
See Basel Convention Secretariat http://www.basel.int/ 26 Asbestos
56
Asbestos . Asbestos ( ) - 27 WHO 28 .. Ployvinyl alcohol (PVA) Ploypropylene cellulose - A-C - Polypropylene-cellulose - A-C Asbestos - A-C // A-C A-C
277. Asbestos - chrysotile asbestos See Harrison PTC, et al. Comparative Hazards of Chrysotile Asbestos and Its Substitutes: A European Perspective. Envir.Health Persp. 107: 607 -611 (1999). http://www.ehponline.org/members/1999/107p607-611harrison/harrison-full.html 28
http://www.who.int/ipcs/assessment/asbestos/en/
57
Asbestos WBG EHS (GIIP)29 WBG EHS WBGs EHS Guidelines30 ACM ACM Asbestos ACM ( ) ACM The plan should be made available to all persons involved in operations and maintenance activities. ACM 31 32 Asbestos Asbestos 29 30
http://www.ifc.org/ifcext/enviro.nsf/AttachmentsByTitle/gui_EHSGuidelines2007_GeneralEHS/$FILE/Final+-
+General+EHS+Guidelines.pdf (pp. 71, 91, 94) 31 (examples of North American training standards are available a t: http://www.osha.gov/SLTC/asbestos/training.html) 32 ASTM International E1368 Asbestos E2356 Asbestos E2394 - Asbestos
58
33 - Asbestos . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
33http://www.ifc.org/ifcext/enviro.nsf/AttachmentsByTitle/gui_EHSGuidelines2007_GeneralEHS/$FILE/Final+-+General+EHS+Guidelines.pdf (pp. 71, 91, 94)
59
. . . . . . . . . . . . . . .
- Asbestos
References
ACM - ACM CM
:
- Asbestos ACM Asbestos
- ( P) KH- ( P) - (
60
P) - TKB Shili (IFC )
- Abestos -
WHO (www.who.org) www.searo.who.int/LinkFiles/Publications_and_Documents_prevention_guidelines.pdf(p. 70) www.searo.who.int/en/Section23/Section1108/Section1835/Section1864_8658.htm (ISO) (www.iso.org) ISO 10312 (1995): -- Asbestos -- [ASTM D6281 ] ISO 13794 (1999): Asbestos Indirect-transfer transmission electron microscopy method ISO/FDIS 16000-7: : Asbestos ISO 8672: -- phase contrast optical microscopy -- (1993) [AIA RTM1 ] (www.basel.int) (www.ilo.org) , ICSC 0014: www.ilo.org/public/english/protection/safework/ cis/products/icsc/dtasht/_icsc00/icsc0014.htm (europa.eu.int/smartapi/cgi/sga_doc?smartapi!celexapi!prod!CELEXnumdoc&lg=EN&numdoc=32003L0018&model=guichett) Asbestos
http://www.who.org/
61
83/477/EEC 2003/18/EC ( ) - Asbestos Asbestos Phase Contrast Microscopy . (8 TWA) ASTM International (www.astm.org) Asbestos - ( ) - Andrw F. Oberta MPH CIH E2356 E2394 E1368 Asbestos Asbestos E2356 ACM ASTM E2356 ACM ACM ( ) Asbestos Asbestos E2394 ( ) Asbestos- E1368 ( ) Asbestos E2308 ()
62
Transmission Electron Microscopy Direct Transfer (TEM) Asbestos D6281 Asbestos Asbestos Phase Contrast Microscopy D7201- Asbestos Phase Contrast Microscopy (Transmission Electron Microscopy ) NIOSH 7400 7402 (www.ascc.gov.au/ascc/AboutUs/Publications/NationalStandards/ListofNationalCodesofPractice.htm) sbestos [NOHSC: 2002 (2005)] Asbestos [NOHSC: 2018 (2005)] (http://www.hse.gov.uk/asbestos/index.htm) Asbestos (http://www.opsi.gov.uk/si/si2006/20062739.htm) Asbestos (http://www.hse.gov.uk/asbestos/essentials/index.htm). - Asbestos INDG289 08/01 C600 Asbestos ( ) MDHS100 Asbestos () Asbestos MDHS100 ACM Asbestos ASTM ACM HSG189/2. Asbestos () Asbestos Asbestos () Asbestos / Asbestos
63
(http://www.nibs.org/pubsasb.html) - Asbestos O & M () Asbestos ACM Abestos - () (http://www.on-norm.at/index_e.html) ONORM M 9406, Asbestos , . ACM Chrysotile (www.chrysotile.com). [ Abestos ] (RTM1) light microscopy ( ) Asbestos Asbestos Phasse Contrast Microscopy (RTM2) Scanning Electron Microscopy Asbestos Phase Contrast Microscopy Asbestos (www.cdc.gov/niosh/topics/asbestos) Asbestos (www.cdc.gov/ niosh/pdfs/0041.pdf) (www.cdc.gov/niosh/topics/ asbestos/#prevention) 7400, PCM Asbestos () m : AIA RTM1 Phase Contrast Microscopy 7402 TEM Asbestos (). m m : Asbestos Transmission Electron Microscopy
64
(www.epa.gov/asbestos) ACM ACBM ( ) - M - Asbestos. 40 CFR Part 61. () ACM ACM ; ; disposal of ACM and waste material in approved landfills ACM 20T-2003 Asbestos - Asbestos () Guidance document (O&M) O&M O&M O&M EPA-600/R-93/116 Asbestos () Asbestos Polarized Light Microscopy Gravimetry X-ray diffraction Transmission Electron Microscopy Asbestos Polarized Light Microscopy Asbestos Asbestos Polarized Light Microscopy Gravimetry X-ray diffraction Transmission Electron Microscopy ( ) (www.osha.gov/SLTC/asbestos) / (www.osha.gov/SLTC/asbestos/standards.html) Asbestos ( ) 29CFR1926.1101. (1994). Regulations for: (
65
) f/cc f/ml PEL work practices for friable and non-friable ACM ACM OSHA 160 Asbestos (). NIOSH 7400 Phase Contrast Microscopy Ontario Ministry of Labour () (www.e-laws.gov.on.ca/DBLaws/Source/Regs/English/2005/R05278_e.htm) 278/05 Asbestos (). - respiratory protection and work procedures Abestos Abestos Asbestos (Phase Contrast Microscopy f/cc) WorkSafe British Columbia () (www2.worksafebc.com/publications/OHSRegulation/Part6.asp) - Asbestos -ACM Asbestos (www.acts.co.za/ohs/index.htm - type asbestos in search box) Asbestos , - Phase Contrast Microscopy TWA f/cc Asbestos Asbestso
66
- Asbestos Asbestos
Asbestos
(polyvinyl alcohol polypropylene) /cellulose ( ) - (Parry) (Harveytile) (Dekra ) uPVC polypropylene polyethylene (Worldroof)
Asbestos- ( )
/cellulose ( ) - gypsum (BHP Gypsum) polystyrene ( ) polystyrene (Alucabond)
Asbestos- - polyethylene plyvinyl chloride () polyester : cellulose- cellulose/PVA - polyester ( )
Asbestos-
Cellulose- polyethylene PVA-cellulose -
Asbestos- cellulose- PVC
67
( ) - Asbestos . . - Asbestos . Asbestos (ACM) Asbestos ACM - ( ) . ACM Asbestos . ACM
68
. . ACM Asbestos ( - ILO ) ACM . . ACM . ACM . .
( ) Asbestos
.
Asbestos ACM
-
69
- - - - ACM - - ACM 34 - ACM CM . 35
Asbestos
34Asbestos EHS http://www.ifc.org/ifcext/sustainability.nsf/AttachmentsByTitle/gui_EHSGuidelines2007_WasteManagement/$FILE/Final+-+Waste+Management+Facilities.pdf 35Asbestos sbestos batement and Management in Buildings: Model Guide Specification
70
. ACM
-