Hcwh Sea_dohao21 Hospital Compliance Report_25november10

8/8/2019 Hcwh Sea_dohao21 Hospital Compliance Report_25november10

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A Survey Report :

Status of Implementation of DOH

Administrative Order No. 2008-0021

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

Health Care Without HarmLeading the global movement

for environmentally responsiblehealth care.

Health Care Without Harm Southeast Asia

Unit 330 Eagle Court CondominiumMatalino Street, Diliman, Quezon City, [email protected]


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Backgroundo

In January 2006, HCWH conducted the FirstSoutheast Asian Mercury in Health CareConference

o Former DOH Secretary Francisco Duque III

announced at the same conference that anAdministrative Order on the phase-out of mercuryis to be drafted.

Memo on Mercury Spills Management was released to

guide health care facilities on proper clean-up of smallmercury spills.

Rapid Mercury Assessment on several DOH controlledhospitals was conducted to test their mercury levels.

First Quarter of 2008 - Committee to draft AO on

mercury phase-out was formed


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Backgroundo In 2007, HCWH published the list of available

alternatives to mercury containing devices anddistributed to hospitals nationwide.

o HCWH organized and participated in conferences,

forums and workshops promoting mercury-freehealth care

o In July 2008, Secretary Duque signed DOH AO21

o In September 2008, DOH AO21 took effect.

o In September 2009, HCWH conducted a four city(Baguio, General Santos, Pasig, Quezon City)campaign to promote alternatives to mercurycalled I Got Screened


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Backgroundo In 2009, the Philippine Health Insurance

Corporation (PhilHealth) has included in its BenchBook compliance to AO21

o In December 2009, HCWH drafted the survey on

the compliance to AO21.o Between the months of January and August 2010,

the survey on AO21 compliance was conductedthrough 10 regional forums.


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Methodology

o HCWH SEA conducted a simple survey on thestatus of implementation of AO21.

o All questions were formulated based on the

General Provisions as prescribed by AO21, like:o How many of the hospitals have discontinued

the distribution of mercury thermometers intheir facilities.

o

Followed guidelines - formation of MMT, anaudit of existing mercurial devices

o Development of temporary storage for phased-out mercury devices.


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Scope and Limitation

o The total number of hospitals 1,745 was based

on the 2009 Philippine Hospital Association(PHA) list of members (excluding two CHDs)

o Survey was conducted between January andAugust 2010

o HCWH SEA worked in coordination with theCenter for Health Development (CHD) of each

region

o Some CHDs were not included in the surveydue to several reasons presented by the

different offices


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Scope and Limitation

o Survey forms were distributed through the

regional forums conducted, others were mailedto the concerned CHDs and the rest were

faxed or emailed.o CHDs were in charge of distribution, follow-up

and sending of accomplished forms to HCWH,except for regions that have not had regional

forums.


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Copy of Survey Form


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Survey Result

Health Care Without HarmLeading the global movement

for environmentally responsiblehealth care.


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Breakdown of 705 respondents

NCR31 (4%)

CAR

40 (6%) R1-Ilocos

47 (7%)

R2-Cagayan

Valley

28 (4%)

R3-Central

Luzon

92 (13%)

R4A-CALABARZON

101 (14%)R4B-MIMAROPA36 (5%)

R5-Bicol

68 (10%)

R6-Western

Visayas

8 (1%)

R7-Central

Visayas

42 (6%)

R9-Zamboanga

Peninsula

7 (1%)

R10-Northern

Mindanao

62 (9%)

R11-Davao

52 (7%)

R12-SOCCSKSARGEN

84 (12%)

R13-CARAGA7 (1%)


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705 Survey Respondents againstPHA list

0

50

100

150

200

250

(17%)

NCR

(68%)

CAR

(36%)

R1

(34%)

R2

(45%)

R3

(42%)

R4A

(60%)

R4B

(57%)

R5

(9%)

R6

(40%)

R7

(9%)

R9

(56%)

R10

(45%)

R11

(79%)

R12

(12%)

R13

3140 47

28

92101

36

68

8

42

7

6252

84

7

183

59

130

83

206

242

60

120

87

106

76

111 116 106

60

NumberofResp

ondents

Regions

Survey Respodents (total = 705)

Hospitals Listed in PHA (total = 1,745)


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o Total number of submitted forms (by August 2010)were 705 (respondents)

o Out of the 705 respondents, the following were

their breakdown:o 60 respondents have already phased-out even

before a phase-out was ordered by the DOH

o 25 respondents have no verifiable answers

(thus their forms were rendered useless)

o 20 respondents were not implementing AO21

o 600 respondents have implemented AO21

Breakdown of survey respondentsA021 Implementation


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Breakdown of survey respondentsA021 Implementation

Started Mercury

Phase-out

pre-AO 21

60 (8%)

Still not

implementing

AO 21

20 (3%)

No specific

answer

25 (4%)

600 (85%)

complianthospitals


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Breakdown of 600 implementersRegions

PHA List of

Hospitals

Implemented

AO 21Percentage

1. Region 12 106 71 67%

2. CAR 59 34 58%

3. Region 4B 60 32 53%

4. Region 5 120 63 52%

5. Region 10 111 48 43%6. Region 11 116 46 40%

7. Region 3 206 79 38%

8. Region 4A 242 91 38%

9. Region 1 130 41 31%

10. Region 7 106 32 30%

11. Region 2 83 23 28%

12. NCR 183 20 11%

13. Region 13 60 6 10%

14. Region 6 87 8 9%

15. Region 9 76 6 8%

Total 1,745 600

The 600complianthospitals

represent 34%of the totalnumber of

hospitals

(1,745) in thePhilippines.(PHA 2009)


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Regions in LuzonPeriod of Implementation

36

9 10

15 16 16 16 16

24

79

1317

27 27 27

1

8

19

27

3437 37 37 37

0 0

46

8

15

20 20 20

14

9 10

16

37

58

70 70

4

13

22

30

43

59

75 75 75

0 14

6

1114

2729 29

0

6

14

20

25

33

54

62 62

0

10

20

30

40

50

60

70

80

September

2008

4th Qtr

2008

1st Qtr

2009

2nd Qtr

2009

3rd Qtr

2009

4th Qtr

2009

1st Qtr

2010

2nd Qtr

2010

3rd Qtr

2010

NumberofRespond

ents

Period of Implementation

NCR

CAR

R 1

R 2

R 3

R 4A

R 4B

R 5


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12

3

5 5 56

8 8

1

4

7

13

16

20

26 26 26

0

5

10

15

20

25

30

September

2008

4th Qtr

2008

1st Qtr

2009

2nd Qtr

2009

3rd Qtr

2009

4th Qtr

2009

1st Qtr

2010

2nd Qtr

2010

3rd Qtr

2010

NumberofRespondents


R 6

R 7

Regions in VisayasPeriod of Implementation


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0 12 2 3

4 5 5 5

0

4

810

16

24

40

44 44

1 2

7

11

17

32

41 41 41

2

79

14

25

40

55

59 59

0 1 1 1 13

5 5 5

0

10

20

30

40

50

60

70

September

2008

4th Qtr

2008

1st Qtr

2009

2nd Qtr

2009

3rd Qtr

2009

4th Qtr

2009

1st Qtr

2010

2nd Qtr

2010

3rd Qtr

2010

NumberofRespondents


R 9

R 10

R 11

R 12

R 13

Regions in MindanaoPeriod of Implementation


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Mercury Containing Devices

in Storageo The 600 compliant hospitals gave information on

the number of thermometers andsphygmomanometers in storage.

o Fluorescent lamps and bulbs were included in thelist.

o Details were not provided on what type of mercurywastes are in storage.

o Devices in storage are the following:

o Thermometers - 23,731 pcs

o Sphygmomanometers 1,655 pcs.

o

Fluorescent lamps/bulbs

14,327 pcs.


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Mercury Containing DevicesIn Storage

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

NCR CAR R3 R4A R4B R5 R6 R7 R9 R10 R12 R13Thermometer 388 55 558 19,140 186 109 123 63 0 1,054 2055 0

BP Apparatus 314 150 228 281 38 254 91 42 7 160 72 18

Lamps/Bulbs 5,349 436 842 2,384 78 975 95 270 60 2,000 1,823 15

Pieces


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Current Practices in StorageRegion 12


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Current Practices in StorageRegion 4-A


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Current Practices in StorageRegion 1


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Results of the Survey

o Out of the 1,745 hospitals, 600 hospitals or 34%have implemented AO21.

o Region 12 (R12) SOCCSKSARGEN had the

highest number of compliant hospitals.o Majority of the hospitals only started

implementation during the 1st quarter and 2nd

quarter of 2010.

o Lack of information and budgetaryconstraints were raised as issues for thedelayed implementation of AO21.


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Analysis of the Survey Results

o WEAKNESS ON INFORMATION DISSEMINATION

o How was AO21 disseminated from the DOHCentral Office to the CHDs?

o

DOH Central Office being the source of theinformation on AO21 is responsible indisseminating the information to its regional offices(CHDs) for implementation.

o

CHDs as DOH representatives in the regions arethen responsible in disseminating the informationto the concerned regions and local governmentunits (LGUs).


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o WEAKNESS ON INFORMATION DISSEMINATION

o Health Care Facilities/Hospitals are responsible ingetting updates on latest policies, administrativeorders, memos, etc.


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Analysis of the Survey Resultso AVAILABILITY AND ACCURACY OF

ALTERNATIVES

o Research has shown that alternatives areavailable in the country, but very little effort wasmade in studying the alternatives for its efficacy.

o There is also little or no information provided tohospitals on standards pertaining to alternatives

o Budget for the purchase of alternatives could havebeen resolved by the 2nd year of AO21implementation.

o Hospitals failed to maximize as reference the 2007HCWH publication Guide to Alternatives for

Health Care Personnel .


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o GEOGRAPHICAL SETTING IS NOT A HINDRANCE

o Looking at the different geographical settings ofthe top 4 (R12, CAR, R4-B, R5) AO 21 compliantregions, geographical setting is not a hindrance inthe implementation of mercury phase-out

o R12 has a considerable number of hospitals (106hospital total), yet 67% of their hospitals is

implementing AO21.o The support of CHDs in the following regions

played a crucial role in the implementation ofAO21 (R12, CAR, R4-B, R5).


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o COORDINATION OF DOH/CHDS WITH LOCALGOVERNMENT UNITS (LGU)

o There have been several LGU controlled facilitiesthat participated in the survey (but were notreported here) majority replied that AO21 was notrelayed to them.

o A more effective information dissemination formatshould be applied for all DOH-related AO to LGUs

and other pertinent government agencies.


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o STORAGE

o Concerns as to the safety of maintaining an on-site storage for hospitals were raised by thehospitals, yet, except for the guide provided byAO21, there were no efforts in providing guidanceto these hospitals.

o While some of the hospitals have complied inconstructing a separate room for mercurialdevices (both broken and unbroken), problemswere still encountered on proper storage.

o Majority of the hospitals have not divulged the

system in how they store their mercurial devices.


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Recommendations

o For Hospitals

o Must comply to DOH AO21 and PhilHealth BenchBook.

o

Be proactive in sourcing or knowing latest DOHand PhilHealth updates.

o For the Alternatives Distributors

o Know the latest information on accurate, efficient

and affordable alternatives.o Be proactive in disseminating information

pertaining to latest DOH and PhilHealth updates.

o Provide trainings in the use of alternatives.


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Recommendationso

For LGUso Close coordination with DOH CHDs.

o Be proactive in knowing the latest policies.

o Provide support for the phase-out of mercury inhealth care.

o Provide funding for the purchase of alternatives(budget).

o

For the DBMo Immediate release of the 13.2 million allocated

budget for DOH for the purchase of alternatives tomercury (thermometers and

sphygmomanometers)


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Recommendationso For DENR-EMB

o Work on a more centralized system for storingphased-out mercury

o Coordinate and support hospitals on the

construction of on-site intermediate storageo For DOH

o Utilize multi-media platforms to effectivelydisseminate and promote AO21 and other future

AOs, etc.o Work on an Administrative Order that will ensure

that temporary storage inside hospitals are safeand conforms with UNDPs Guidelines on Safe

Storage of Mercury Wastes.


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Recommendations

o Continuous monitoring of compliance toAO21 and other future AOs, etc.

o Periodic reporting on the status and

developments on AO21 and other futureAOs, etc.

o Strengthen collaboration with different

sectors such as civil society organizations,professional organizations, etc.


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Recommendations

o Being the first country in Southeast Asia toenact a policy to phase-out mercury inhealth care, the DOH should always lead

by example.o Implement a Ban on the Importation of

mercury containing devices.


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Health Care Without Harm Southeast Asiawww.noharm.org.ph

Unit 330 Eagle Court Condominium, MatalinoStreet, Diliman, Quezon City, Philippines

T. 2.9287572 / F. 2.9262649

E f @h h
http://www.noharm.org.ph/http://www.noharm.org.ph/

Documents

Hcwh Sea_dohao21 Hospital Compliance Report_25november10