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    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 () ()

  • 4

    (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) ( )

  • 5

    / /

    - - ) (Standard Operation Procedures)

  • 6

    Universal Health Coverage

    ( ) () ( ) ( ) () () ()

  • 7

    B (Environmental Management Plan)

    () (- - ) ( )

  • 8

    - ) () ) () ) () ) () ) () ) () ) () ) () ) () ) () ) () ) () ) () ) () ) ()

    (National Health Committee)

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    / () (,) (,) () (Basic Health Staff) -- - -

    OP/BP . OP/BP .

    (Environment, Health and Safety Guidelines)

  • 10

    ( )

    ( ) ( )

    ( )

  • 11

    /

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    / - () ( ) () () () () ( )

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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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    4

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    ( )

    4 HFC .// HzHCW . HzHCW/ - HzHCW/

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    HIV HBV HCV HIV HBV HCV (PCI ) (HzHCW)

  • 18

    / () (Enivronmental Codes of Practices - ECoPs) ( ) ECoPs / ( )

    - (Waste Management Plan) (Waste Management Plan)

  • 19

    ( )

  • 20

    World Health Organization (WHO)

    WHO

    ( )

    WHO

    ECoP ( ) /

  • 21

    ( - / ) ( ) ( ) ECoPs ( )

  • 22

    Environmental Management Plan (EMP) ( ) MOH MOH DOH PowerPoint EMP DOH HCF EMP

  • 23

    () ( ) () () ( ) () () () () () () () () () () () () ()

  • 24

    () ()

  • 25

    - (Enivronmental Codes of Practices - ECoPs)5

    /

    - HCF

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    - ( )

    -

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    - ( )

    -

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    5

  • 26

    - / ( )

    -

    - Asbestos

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    - ( )

    -

    -

  • 27

    - () -

    ( . . .)

    -

    - -HCF - ( ) - ( ) PE PP (PVC ) , , / " " / " " / "`"

  • 28

    ( )

    ( )

    ( ) -

    ( )

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    - () -

    ( . . .)

    -

    - - HCF / - HCF HCF " " / " " - - - - -

  • 30

    . -

    microwave ( ) ( )

    Microwave

    -

    -

    -

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    Supplier

  • 31

    HCW -

    - -

    -

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    - -

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    - -

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    (autoclave microwave)

    - - (Shredder) - -

    - -

  • 32

    -

    -

    Chamber

    - -

    - cytotoxics - - - operator -

  • 33

    . - () -

    ( . . .)

    -

    - - - HCF - ( X )

    Health Facility

    Health Facility

    Microwave

  • 34

    - () -

    ( . . .)

    -

    - - HCF - Occupation and Environmental Health Counselling Anti-retroviral drug - HIV HBV HCV anti-retrovirus - - - (Dakin Javel / 0)

  • 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 (+)

  • 36

    -

    .

    .

    .

    .

    .

    .

    HCF

    .

    .

    . HCF

    . HCF

    . HCF

  • 37

    . HCF

    .

    .

    . ()

    .

    .

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    /

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    . (

  • 38

    )

    .

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  • 39

  • 40

    - I.

    : :

    NGO

    : :

    NGO

    : :

    NGO

    II. - (MOH) (Social Assessment) (Community Empowerment Planning Framework) (EMP) III. - NGO NGO (WB) IV. ( ) ( ) MOH

  • 41

    ( ( ) ( ( ( Human Development Specialist () V. () - () - MOH (CEPF)

  • 42

    () / / MOH

    /

    /

    (Penta3 ) NGO

    CEPF ( ) MOH

    LNGO

  • 43

    /

    (PPP) MOH

    NGO

    CEPF UHC PPP PPP NGO NGO

    M-HSCC NGO

    MOH M-HSCC

    3MDG Fund Global Fund

    NGO TMO NGO

    TOR

  • 44

    /

    - () MNCH

    MNCH () ()

    UHC

    IDA

    MNCH UHC

    UHC

    TA TA

  • 45

    /

    TMO TMO

    MOH

    DOH

    (CEPF

    )

    SOP WB

    (USAID )

    ( )

    WB

    DHS DHP

  • 46

    /

    MOH MOH

    CEPF

    TMO

    (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

    -