This document outlines an environmental mitigation and monitoring plan for improving water and sanitation at healthcare clinics in Liberia. It discusses strategies for providing clean water such as installing new boreholes, repairing existing boreholes, and exploring rainwater catchment alternatives. It also addresses sanitation needs like installing latrines and waste water treatment ponds. The document details best practices for healthcare waste management, including segregating different types of waste and appropriate disposal methods like incineration. It provides guidance on setting up waste management zones with dedicated pits and bins for different waste streams to protect the environment and public health.

1. Environmental Mitigation & Monitoring Plan HCW_Water & Sanitation Improvements for RBHS Healthcare Clinics [email_address] RBHS

3. Direct contact Blood borne disease Ex: Hep A, Hep B, AIDS through needle stick injuries Vector borne disease Ex: malaria, yellow fever, sleeping sickness Water borne disease Ex: Typhoid, Colera, HepA Air borne disease Ex: TB

5. MOVING WATER

6. Design of a typical shallow borehole and handpump

8. Design of a dug well with handpump

9. Sand filter rainwater to drinking water

10. Biosand filters Biosand filters; Diffuser plate Scum Sand Sand Sand Coarse sand Gravel

11. Almost one third of the healthcare facilities reported not always having a water supply. Rainwater is free and relatively good water quality. Catching rain “free-falling” is usually better than from a roof yet there is no one right way, only what works best for your clinic at this time. Rainwater Catchment

12. Simply roll out a sheet of plastic - cleaner surface area than most roofs !

13. Improvised water storage bin - constructed from local materials

15. Water Disease Triangle Source: WHO/UNICEF, 20005

16. Ahh the many choices ! for more information visit www. hesperian.org Latrines

18. Waste water treatment pond with reeds filtering and cleaning the water. Provides viable habitat for wildlife and esthetic view for people. Brocks Hill Visitor Center

21. The MSF Segregation Plan – works well for them!

22. Global and local air pollution Incineration

23. DRUM BURNER – not effective but common

25. INCINERATION for disposal of highly hazardous waste is not the best “environmentally friendly” technology, but is appropriate for Liberia at this time. Use of functional, high-temperature structures is recommended by the MoH EPI.

28. Typical Percentages of Healthcare Waste

33. SUMMARY

34. Crushing glass

36. Red metal glass crusher and cardboard box of glass ampoules - waiting to be destroyed.

37. Wheintown dump

38. Example of a Sanitary Pit, unlined for large amounts of general waste - leaching into ground and decomposition will occur. For small amounts of general waste without plastics, a composting bin can be used. A lined sanitary pit would be with thick plastic, or bricks on bottom & sides of pit, for hazardous waste if incinerator is not available. Additions of lime or ash will inhibit decomposition.

40. Manufactured plastic compost bins Wooden pallet composting bin Rat deterring compost bin

42. Recipe: Cement 1 part Lime 1 part Sand 4 parts Water 1/3 to ½ full Encapsulation in a 55 –gallon drum of ashes, needles from incinerator and crushed glass. --------- ¾ full of treated h.h. waste

44. Expired Pharmaceuticals at JFK Hospital – one of four containers. Note: NDS receives all expired drugs.

45. Sanitary Waste Pit Organic Pit Incinerator Glass & Ash Pit - x - x – x – x – x – x – x – x – x – x – x – x – x – x – x – x – x – x – x – x – x – x – x – x – x – x – x - Xx-x-x-x x-x-x-x- Waste zone w/fence Highly Hazardous Waste General Waste Hazardous Waste Glass Green Bin Red Bin Yellow Bin Black Bin