Pakistan - FATA Temporarily Displaced Persons Emergency Recovery Project : Environmental Assessment : Environmental and Social Management Plan

The objective of the FATA Temporarily Displaced Persons Emergency Recovery Project is to support the early recovery of families affected by the militancy crisis, promote child health, and enhance citizen-centered service delivery in the tribal districts of KP Province. Some of the negative impacts and mitigation measures include: cold chain management, in accordance to the National Expanded Program on Immunization (EPI) Policy and Strategic Guidelines has to be ensured at all levels. Vaccines shall be stored at standard temperatures in official EPI store only. They should not be stored for more than a period of six months at federal level, three months at the provincial level, one month at the district and fifteen days at the facility level. Standard stock ledger with name of the vaccine, quantity in doses, vial size, manufacturer, expiry date, batch and lot number, date of receive and supply to be maintained at all level and updated regularly. Reconstituted vaccine must be discarded six hours after reconstitution or at the end of immunization session, whichever comes first; the risk of infection associated with sharps and syringes can be greatly reduced by ensuring use of WHO pre-qualified Auto-Disable (AD) syringes for conducting vaccination, Personal Protective Equipment (PPE) while handling sharps, provision of information posters at needle exchange places indicating safe handling, and collecting the sharp waste generated during the immunization in dedicated safety boxes for safe disposal; and immunization waste is required to be managed in accordance to the legal framework of Pakistan, specified under the Hospitals Waste Management Rules 2005. Auto disable (AD) syringes are recommended by WHO to be used for immunization purposes, and the EPI only procures the AD syringes for its fixed and outreach activities. Safe disposal of these syringes is necessary from a public health and environmental point of view. Once used, these syringes must be disposed into customized Safety Boxes, as per National EPI Policy as well as WHO recommendations. Current immunization activities are being carried out in accordance to the WHO recommendations, and AD syringes and Safety Boxes are being used. Waste disposal will be carried out by using pit burial method within the Basic Health Unit (BHU) and Rural Health Center (RHC) facilities. The unused reconstituted vaccines are also disposed in the same manner.