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International Development Jobs and Consulting Opportunities |
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Environmental Assessment Study of Central Medical Stores and
Identified Kabul Hospitals
Request for Proposals Capacity Building and Access to Medicines (CBAM) Afghanistan Location: Kabul, Afghanistan
The goal of the Capacity Building and Access to Medicines (CBAM) project is to support the Ministry of Public Health (MoPH) of Afghanistan to effectively ensure greater and more equitable access to priority pharmaceuticals and medical supplies for all Afghans with a specific emphasis on women and children. It is essential that environmental issues are considered throughout the implementation of the CBAM project, therefore Health Partners International of Canada (HPIC), as the implementing partner of the CBAM project, has agreed to conduct an Environmental Assessment Study (EAS) of the MoPH Central Medical Stores (CMS) and identified public hospitals in Kabul. The goal of the study is to identify current environmental procedures, methods to improve environmental systems and encourage environmental best-practices for the handling, distribution and disposal of pharmaceutical products. CURRENTLY HPIC IS CONDUCTING A PROJECT TO BUILD NATIONAL HEALTH SECTOR CAPACITIES IN AFGHANISTAN AND IS SEEKING A CONSULTANT TO SUBMIT A FULL PROPOSAL TO CONDUCT AN ENVIRONMENTAL ASSESSMENT STUDY OF THE CMS AND IDENTIFIED PARTNER HOSPITALS TO BE PART OF THE CAPACITY BUILDING AND ACCESS TO MEDICINE (CBAM) PROJECT. Details follow: The CMS, operating under the MoPH General Directorate of Administrative Affairs (GDAA), is an integral part of the pharmaceutical distribution system in Afghanistan as the national warehouse that stores and manages pharmaceuticals and medical supplies for public health facilities. The CMS is a complex storage and distribution facility that must function under certain standards to appropriately manage the national stocks of pharmaceutical and medical supplies in conjunction with the public hospitals of Afghanistan. Storing and distributing pharmaceuticals and medical supplies can be challenging, especially in Afghanistan as the CMS and hospitals have been neglected and are daily faced with the realities of limited resources and complex management systems. In addition, the CMS has become a receptacle for unwanted, returned, unused, damaged and expired medical supplies and pharmaceuticals (hereafter referred to as waste products); many of which are returned from MoPH health facilities, including public hospitals. Therefore, the CMS was identified as a critical component of pharmaceutical management and as such environmental considerations and concerns take priority. A second component of the EAS will include working with CBAM project partner hospitals in Kabul to increase their awareness of environmental issues to reduce and properly manage waste pharmaceuticals and supplies handled at the hospitals and filtered through the CMS. The goal of working with identified public hospitals is part of wider efforts to improve environmental considerations and provide environmental awareness consultations and training in waste management at the hospital level. As a result of the EAS, environmental issues can be addressed with the goal of improving waste management throughout MoPH facilities directly involved with the management and disposal of pharmaceutical products. There will be a special focus on the disposal of waste pharmaceuticals and medical supplies at the CMS, since it has become a storage place for waste products. Recommendations for standard operating procedures (SOPs) dealing specifically with disposal will be essential. The goal is for the SOP recommendations stemming from the environmental assessment to be of internationally acceptable standards in order to improve the overall functioning standards of the facility. The study will also require close collaboration with the CMS management and staff, as well as representatives of various branches of the MoPH. The entire EAS is to begin in October 2010 and be concluded by December 2010, which includes preparation, in country assessment, interpretation of results, presentation of preliminary findings to CMS, drafting a final report and presenting the findings to HPIC. B. QUALIFICATIONS OF CONSULTANTS - Education: Master’s degree or higher - Work Experience: 10 years or more - Expertise: International experience in environmental standards for pharmaceutical warehouses and hospitals pharmacies C. DELIVERABLES The deliverables of the assignment shall include: a. Assessment framework and tools b. Presentation to stakeholders of preliminary findings of assessment c. Preliminary report to HPIC d. Final Environment Assessment Study Report i. Recommendations for environmental SOPs ii. Recommendations for trainings and equipment to aid in implementation of environmental best practices both at the CMS and identified public hospitals in Kabul.
D. DEADLINES Due dates for various activity components: a. PROPOSAL MUST BE SUBMITTED TO HPIC BY SEPTEMBER 15, 2010 BY 5:00PM EST at knicholson@hpicafghanistan.ca. Only complete proposals based on this RFP will be evaluated. b. Preparation, including assessment framework and tools, to be complete by October 31, 2010 c. Field-based information gathering to be complete by November 30, 2010 d. Meeting to present preliminary findings to stakeholders to be complete by November 30, 2010 e. Final assessment report including recommendations to be complete by December 22, 2010
E. TIMEFRAMES Gathering information for the assessment study will begin in October 2010 and be completed by November 2010. The stakeholders meeting to present preliminary findings of the study will be held once all data has been collected. The final assessment report is to be submitted no later than December 22, 2010. F. RATIONALE FOR ASSIGNMENT Due to decades of war, the environment in Afghanistan has been severely neglected. There has been drought, desertification and contamination of water and soil throughout the country. These environmental issues only exacerbate the already poor health conditions that people face in Afghanistan. Although many improvements have been made to give people access to better health care, all of that can be undermined through environmental issues, contamination and disasters. According to a 2009 United Nation’s Environmental Program (UNEP) report “medical waste…is a serious threat”[1] to the health of the Afghan population as it can make its way into water supplies and contaminate soil. The Government of Afghanistan (GoA) and particularly the MoPH are responsible for a large amount of pharmaceuticals that enter the country and how these items travel through the supply chain to the patients or, when necessary, to disposal. The CMS and hospitals are a crucial step in the pharmaceutical supply chain and thus contribute to the way that medical and pharmaceutical waste are dealt with in the country. The years of war have caused serious damage to infrastructure and have reduced the capacities of many facilities. The CMS is no exception. Although it is still a functional facility, there are challenges with proper electricity, storage and temperature control, among others. With the current rebuilding efforts in Afghanistan it is essential to establish proper controls for pharmaceutical waste management at the CMS in order to move forward towards building international environmental standards in pharmaceutical management. Therefore, the CMS requires solutions to address the above mentioned problems that may include recommendations for proper pharmaceutical disposal and environmental best practices, new equipment and supplies, trainings, etc. It is expected that the solutions required will be included in the final report of the environmental assessment study. In addition, the hospitals will require recommendations for SOPs as well as training on internationally recognized best practices and environment and waste management in a hospital setting which will also be the output of the commissioned study. Anticipated Activities of the Environmental Assessment Study The nature of handling pharmaceutical products requires all materials to be handled in an environmentally safe manner to protect the employees that work in hospitals and the CMS, as well as to protect Afghanistan’s environment from becoming contaminated by pharmaceutical products and wastes. The assessment study will require special emphasis on waste management at the CMS and hospitals and disposal methods that are suitable to Afghanistan and existing facilities within the country. Methods to be explored can include, but are not limited to: - Incineration of waste pharmaceuticals and medical supplies, including open container, medium temperature and high temperature incineration - Recycling of supplies and equipment - Landfills, including highly engineered sanitary landfills, engineered landfills and open uncontrolled non-engineered dumps - Waste immobilization, including encapsulation and inertization - Water drainage disposal methods - Chemical decomposition - Others Currently, landfills and incineration are common methods for disposing medical waste in Afghanistan. However, incineration is often done in the open air which creates a major public air quality health concern for communities in the area. Considering this, alternate and innovative disposal methods will be explored as part of the assessment study. Furthermore, a cost effectiveness analysis will be conducted to compare the appropriateness of various methods of waste disposal for the CMS. Currently many of the waste pharmaceuticals, supplies and equipment remain at the CMS and it is necessary to find economical and environmentally conscientious methods of disposal so that space can be better utilized and that the work environment can be sanitary and safe. Further, the assessment study will also examine environmental practices at the CMS and provide recommendations for standard operating procedures (SOPs), specifically targeting environmentally safe handling, storing and distributing. Recommendations for SOPs dealing specifically with disposal will be essential. The goal is for the SOP recommendations stemming from the environmental assessment to be of internationally acceptable standards in order to improve the overall functioning standards of the facility. In working with the hospitals, environmental best practices will be encouraged to reduce waste that is returned to the CMS and build their capacity to manage pharmaceuticals in an environmentally conscientious manner. Involvement at identified hospitals will also include recommendations for trainings and development of SOPs that can have an immediate impact at the hospital level. The goal is for involvement at the identified hospitals to be complementary to the study’s involvement and activities at the CMS, thereby affecting a larger impact on components of pharmaceutical waste management. The assessment study report will identify trainings for the CMS staff and directors as well as the hospital staff and management to increase their knowledge of environmental issues in supply chain logistics, warehouse management, pharmacy management and hospital best practices. This will contribute to the sustainability of environmental SOPs that are being implemented and ultimately will contribute to the sustainability of environmental consciousness at the CMS and hospitals. Finally, the assessment study will include the review of current dumping sites and incineration fields that surround Kabul considering major public health concerns of the residing populations. The study requires close collaboration with the CMS management and staff, as well as representatives of various branches of the MoPH. Their participation is important in determining viable and sustainable solutions to waste management issues. The result of their input will be recommendations for SOPs that can be effectively implemented at the CMS and consultations at the hospitals to guide them towards best practices. The study will also require the consultant to interact with hospital pharmacy staff and directors at two or three identified hospitals to provide consultation on internationally recognized environmental best practices in a hospital setting. G. GOAL AND OBJECTIVES Goal: The goal of the CMS and hospital EAS is to identify feasible areas of intervention to increase the use of environmental best practices and to identify waste management procedures to be implemented at the CMS and identified partner hospitals in Kabul. There will be a special emphasis on appropriate disposal of waste pharmaceuticals and medical supplies that are relevant and can be integrated into the management of the CMS and hospitals. The consultant will be required to observe daily activities and examine current operations and manuals, in comparison to international standards. The assessment will determine the steps that can be taken to have the greatest impact in hospitals and at the CMS based on the needs of the staff, management and the MoPH to build their capacity to conduct activities in an environmentally conscientious manner. Objectives: 1. Conduct review of relevant documents, research and other sources of information pertaining to the CMS and hospitals. This will also include relevant regional information, international guidelines and pertinent literature on environmental warehouse management and logistics as well as environmental best practices in a hospital setting. A summary of this literature review will be included in the final report. Conduct a thorough environmental assessment study of the CMS and a minor assessment of two or three identified public hospitals in Kabul, including the following (others to be identified through the assessment process): a. A physical assessment of current CMS facilities and identified hospitals b. An assessment of current operating procedures at the CMS and identified public hospitals that pertain to the environment, including pharmaceutical and medical supply waste management c. Visit and examine local waste disposal facilities for appropriateness of disposing pharmaceutical waste products d. Identify regional expertise (if possible) e. Identify relevant and feasible strategies for pharmaceutical waste disposal for the CMS and identified hospitals f. Determine training and equipment needs for CMS and hospital staff as it relates to environmental issues 2. Compile data into a report to demonstrate how the CMS can improve their environmental practices through SOPs, trainings, equipment and waste management policies and how the hospitals can improve their SOPs and environmental practices.
H. APPROACH AND METHODOLOGY 1. Parties Involved: During the assignment, work and collaboration will occur between the following: a. Evaluation Team: HPIC anticipates engaging a core team of approximately 2 international expert consultants along with up to 2 local expert consultants (given time and space constraints and considerations). The team should include individuals with expertise covering at least the following areas: i. Pharmaceutical waste management in developing countries (or middle and low income countries) or resource limited regions ii. Warehouse and logistics operations iii. Environmental Specialist in international development familiar with warehouse operations and hospital management iv. Experience in hospital environmental management.
b. Stakeholders Team: individuals and organizations who will participate in the assessment as participants, informants and contacts: i. The Afghan MoPH (specifically the General Directorate of Administrative Affairs and General Directorate of Health Services Delivery) will have a participatory role and will be involved in providing insight, contacts and guidance for the assessment study ii. The CMS and identified public hospitals management will have a participatory role and will be involved in providing insight, access to necessary documents, employees and facilities iii. The CMS employees will participate by providing insight into daily operations and will be involved in providing access to necessary documents and facilities iv. The hospital employees, specifically those in the pharmacies, will participate by providing insight into daily operations and will be involved in providing access to necessary documents and facilities v. NGOs currently working in Kabul in pharmaceutical management who can provide input on current situation vi. Other representatives as identified and required as the assessment study progresses.
2. Meetings: Before, during, and after the assignment, the following meetings, phone calls, communications and contact between the commissioning organization are planned: a. The assessment team will meet regularly to facilitate communication and to ensure assessment information is being shared in an appropriate and transparent manner. The purpose of the meetings is to facilitate sharing of all research data collected and new contacts, updating the team on assessment findings and ensuring the assessment study is on time and on track to achieve the projected goals and outcomes. b. The assessment team will meet twice monthly with the HPIC staff to maintain open communication and to ensure all deadlines will be met and that all data is being collected and collated in an appropriate manner. c. All stakeholders, in addition to HPIC and assessment team, will meet on an as needed basis to maintain open communication, to ensure all deadlines will be met and to share appropriate information. d. At the end of the assessment, a meeting of all stakeholders will be held to discuss the outcomes of the assessment and to work together to identify the next steps in the process.
3. Methods: During the assignment, methods such as interviews, focus groups, a desk review, field visits, etc. will be carried out. Assessment methods include, but are not limited to: a. A thorough literature review to assess all research on the CMS, public hospitals and pharmaceutical waste management in Afghanistan; looking at both present and past formal and informal research as well as pertinent regional studies. A summary of this research will be included in the final report. b. Interviews and/or discussion groups with key CMS and hospital staff, CMS and hospital management, MoPH officials (General Directorate of Administrative Affairs, General Directorate of Pharmaceutical Affairs and General Directorate of Health Services Delivery), regional and international environmental waste management and warehouse/logistics experts, local and/or international non-governmental organizations and other organizations as deemed necessary. c. Field visits to the CMS, identified public hospitals, waste disposal sites, other pharmaceutical warehouses in Afghanistan and other relevant establishments as necessary.
4. Resources Available: During the assignment, the evaluation team will have access to the following resources as required: a. Access to HPIC staff b. Access to CMS and Identified Public Hospitals c. Current literature on CMS and hospital activities d. Transportation, lodging and insurance while in Afghanistan e. Office space while in Kabul (including use of a computer and printer)
I. SPECIFIC TASKS Tasks: a. Preparation i. Literature review of existing information/documents ii. Develop assessment framework and tools iii. Harmonize and finalize assessment tools
b. Conducting the assessment i. Identify key informants and contacts ii. Key informant interviews and group discussions iii. Conduct facility visits iv. Share preliminary findings with stakeholders
c. Post assessment i. Compile data ii. Analyze data iii. Prepare preliminary report and recommendations
d. Presentation and finalization i. Share preliminary report and recommendations with HPIC ii. Prepare final report and submit to HPIC
[1] United Nations Environment Programme (2009). UNEP in Afghanistan: Laying the foundations for Sustainable Development. http://www.unep.org/pdf/UNEP_in_Afghanistan.pdf
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