Dr.

Nguyen Thi Lien Huong Deputy Director, Vietnam Health Environment Management Agency, MOH

Presentation contents
I.
II. III.

IV.
V.

Situation Manufacture Existing policies Challenges Future plans

I. SITUATION
1. Vietnam has 11,834 health care facilities (in 2010):
34 facilities at center level 65 facilities at province level 735 facilities at commune level 11000 health-care stations

2. Lacking data on mercury sources in health care Some mercury-base medical devices are in use
Thermometers Dental amalgam Laboratory chemical Sphygmomanometers Esophageal Dilators Cleaning product
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I. SITUATION

Mercury thermometers used in health care

Cleaning products in general hospital, Bac Ninh province (electrolytic process of chlor-alkali production relies on mercury electrodes, resulting in mercury contamination of the cleaning products)
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I. SITUATION
Only figures of thermometers, sphygmomanometers are available. Estimated number of thermometers, sphygmomanometers basing on a list of medical devices for hospitals/clinics at province, district and commune levels (not include central):
Facilities No of thermometers/ 1 hospital 329 (65 hospitals) Total No of thermometers 21,385 No of sphygmomanometers/ 1 hospital 150 Total No of sphygmomanometers 12,350

Provincial general hospital

District hospital
Inter-communal general clinic Communal health station Total

160 (698 hospitals)

10 (37 clinics) 10

111,680
370 110,000 243,435

71
5 5 117,093

49,558
185 55,000
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I. SITUATION
A study conducted at 18 hospitals in 2007 in Vietnam by

UNDP shows that:

For non-hospitalized patients or clients,

- About 20 to 30 thermometers are used in each facility (of which 15 to 20 are frequently used). - Among those 2 to 4 are broken/month MOH regulates each inpatient should use 1 thermometer, but the actual number is lower due to budget. The majority of thermometers are imported from China due to their cheap price. Many patients buy new thermometers to compensate for broken ones.
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I. SITUTATION

I. SITUATION
In summary: - Total number of broken thermometers at the 18 facilities is 1,629 per month or 20,304 per year. - The rate of breakage is 18.88% per month. - The estimated total number of broken thermometers nationwide is 447,588 per year (extrapolated from the 18 facilities, based on the total number of 196,311 beds in use nationwide).
(Source: UNDP, 2007)

I. SITUATION
Estimated mercury release from broken thermometers
Health-care Facility Grams mercury per bed per year

1500-bed hospital
1000-bed hospital 580-bed hospital (pediatric)

1.3
1.2 1.7

550-bed hospital
450-bed hospital 350-bed hospital 7-bed health station 5-bed health station

1.5
1.7 1.9 2,1 4,4

Average of mercury released from broken thermometers: 1.8 grams per bed per year
(Source: UNDP, 2007)
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I. SITUATION

Estimated total annual mercury releases from broken thermometers and sphygmomanometers per 196,311 beds is 550 kg Estimates are based on 2.8 g mercury per bed per year (for thermometers and sphygmomanometers only).

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I. SITUATION
3. Current handling and disposal techniques:

No facility has a standard procedure for separating mercury-containing waste for treatment. Mercury waste is generally collected and incinerated together with other health-care waste in hospital incinerators or central incinerators, or disposed in municipal landfills. Some facilities collect broken thermometers and dispose of them on-site.

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II. MANUFACTURE
In Vietnam, there is not any thermometers and

sphygmomanometers manufacturer.
They are imported from China, Japan, France, etc.

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III. EXISTING POLICIES

(to phase out mercury in health care)
Law on Environmental Protection, 2005. Decrees, decisions that further regulate treatment of

liquid and solid waste from production and trade facilities, hospitals, hotels and restaurants. VN ratified the Stockholm Convention on 22 July 2002. Documents issued by the Ministry of Health: Hospital Regulations (1997) including Waste Treatment Regulations.

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(to phase out mercury in health care)

Health-Care Waste Management Regulations (2007):
Mercury waste is classified as hazardous chemical

III. EXISTING POLICIES

waste and heavy metal containing waste. Standards for waste container/plastic bag (black container for chemical waste), symbols and inside transportation. Classification, collection, transportation, storage of solid waste. Transportation of solid medical waste outside the health care facilities.
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III. EXISTING POLICIES

Models, technologies for solid waste treatment and

destroying: chemical waste will be treated or destroyed by 4 methods: Returned to suppliers. Incinerated in high temperature incinerators. Destroyed by neutralizing or alkali hydrolysis. Inertized before being buried The Master Plan for the Health-Care Waste Management will be approved by the Government soon. No specific policies on mercury in health care.

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IV. CHALLENGES
Hospital waste is an urgent environmental issue in

Vietnam. Ineffective health-care waste treatment is a public concern and a challenge for government at all levels. Health-care waste treatment needs a large budget. Estimated investment is 1.160 billion VND. Awareness about practical waste treatment solutions is low Legislation is inadequate.

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IV. CHALLENGES
There has not been enough information on mercury

sources in health care and mercury product alternatives in Vietnam. The government lacks the infrastructure to manage mercury waste. There is a belief that mercury products are accurate and do not need calibration. Replacing mercury-based medical devices is often expensive. For example: Price of mercury-based thermometer is US$ 0.5; price of digital thermometer is US$ 3
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V. FUTURE PLANS
Short-term: Conducting rapid assessments to: Identify mercury sources Evaluate mercury product alternatives Develop guidelines on safe use of mercury-base medical devices including mercury clean up and waste handling and storage procedures Raising awareness & education about occupational health risks and environmental pollution due to mercury release and best management practices
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V. FUTURE PLANS
Medium-term: Increase efforts to reduce the number of unnecessary use of mercury equipment. More pilot models of mercury waste management are implemented Long-term: Develop policies to substituting mercury-base medical devices with safer alternatives. Support for replacing mercury-based medical devices from Government, international organization, NGOs
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Project Demonstrating and Promoting Best Techniques and Practices for Reducing Health-Care Waste to Avoid Environmental Releases of Dioxins and Mercury 4 years (2008-2012), implemented by UNDP, GEF, WHO, HCWH Vietnam is one of 8 participating countries Total budget for Vietnam: US$ 1.040.000 Overall objectives: to demonstrate and promote best techniques and practices for health-care waste management, thereby minimizing health-care waste and reducing or eliminating releases of dioxins and mercury into the environment.
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 Project aims: to demonstrate the applicability of global best

techniques and practices, and to lay the groundwork for sustainability and replicability beyond the model facilities and the Project countries. Project major components: Model facilities: Vietduc University Hospital -Hanoi (urban model hospital), and general hospital Ninhbinh province and 10 district health centers& communal health stations in Ninhbinh province (model cluster) Best practices for health-care waste management including management of mercury waste demonstrated Awareness-raising and educational materials related to mercury developed and disseminated.
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 Model central facility: Technology demonstration in

URENCO (responsible for all municipal, hospital and industrial waste management in Hanoi): investing two autoclaves, one additional shredder to promote non-burn treatment of waste in the central facility and introducing a first-of-its-kind city-wide sharps management program Establish or enhance training programs to build capacity for implementation of best practices and appropriate technologies beyond the model facilities and programs.

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 Review relevant policies, seek agreement by relevant

authorities on recommended updates or reformulations if needed, seek agreement on an implementation plan, and if appropriate, assist in holding a policy review conference for these purposes. Distribute Project results on best techniques and practices to relevant stakeholders, disseminate materials and hold conferences or workshops to encourage replication.

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