Questions/Answers

The main objective of this initiative is to preserve the environment and public health from hazardous and toxic medical waste. The waste is generated from hospital activities in the form of solid, liquid or gas. If not managed properly, hospital waste become infectious, toxic, and worsen environmental sustainability. A study by University of Indonesia (2013) found that 4,900 health workers in Indonesia were infected with hepatitis B due to needle sticking. The number of hospitalized patients related this accident also increased, in 2015 there were 12,750 patients, in 2016 it rose to 13,896, and in 2017 it rose again to 14,548 patients. To respond the problem, in November 2016 Haji General Hospital of Surabaya made an initiative called Mendulang Mentari (Recycling to Preserve the Environment) that recycling medical waste such as infusion bottles and used hemodialysis jerry cans. The process includes remove the content of hazardous and toxic materials and then handed over to collectors to be recycled into economic value goods but still environmentally friendly. Another objective of this initiative is to push the operation cost of the hospital related to waste management. In 2017, this hospital spent Rp 876,300,000 (USD 58,420) to manage the medical waste.

This initiative inlines with Category 2: Ensuring integrated approaches in the public-sector institutions. This approach is also fit with the creteria of Introduces and operates institutional frameworks that integrate and harmonize policies, strategies and programmes for implementation of the 2030 Agenda. To manage the medical waste, the hospital work closely with private sector and civil society organization. First, nurses conduct the separation of medical waste in a specific shelter and moves it to the waste treatment facility A private contractor then transport the safe material to APDUPI (Association of Indonesian Plastic Recycling Entrepreneurs) as a recycle place

Mendulang Mentari contributes to acheive several SDG's. First, good health and well-being. Waste recycling contributes to the economic turnover of the community. Second, contributes to materialize clean water and sanitation. This initiative prevents contaminating groundwater and air by hospital waste. Lastly, this program is also relevant to the value of Life on Land since this initiative prevent lower soil fertility and reduce air pollution. For example, burying medical waste made from plastic, poisons from plastic particles will kill decomposers and reduces soil fertility and when burned with imperfect temperatures can produce dioxin gas which is very dangerous for health.

Before initiating Mendulang Mentari, the hospital destroy medical waste by incinerating or burning it through a third party (PT. Tenang Jaya Sejahtera) in Karawang. But the longer, increased patient visits has made medical waste multiply in number. Then, the Ministry of Environment and Forestry Regulation No. 56 of 2015 was issued stating that infusion plastic waste bottles and hemodialysis jerry cans produced from hospital can be processed into non-hazardous materials. If burned with improper temperature it will turn into air pollutants as it produces dioxin which is very toxic and carcinogenic (cancer). In addition, the operational costs for burning medical waste made from plastic are far greater than other medical waste. Mendulang Mentari save budget for burning medical waste up to 19%, which is from Rp. 876,300,000 (USD 58,420) in 2016 to Rp. 709,228,000 (USD 47,281) in 2017. The cost continue to decrease to Rp. 559,521,000 (USD 37,301) from January to October 2018. In addition, the number of nosocomial infections (infections caused by germs from hospitals) also decreased. In 2015 the number reached 0.24%, in 2016 it declined to 0.21%, and declined again to 0.13% in 2017.

Haji General Hospital of Surabaya is a province-owned hospital and serves as referral hospitals in Eastern Indonesia. The dynamic number of patients makes the amount of medical waste unpredictable. Meanwhile, the location of this Hospital is located in the second largest city in Indonesia which is densely populated. Regarding the huge negative impact that can be generated from medical waste on the surrounding environment, the innovation of Mendulang Mentari is a solution, both for hospitals and the surrounding environment. Even recycling businesses also get benefit from processing it.

Mendulang Mentari initiative was adapted and modified from Dr. Sardjito Hospital Yogyakarta. The Haji General Hospital of Surabaya conducted a comparative study to Dr. Sardjito Hospital in Yogyakarta, which had previously carried out the processing of recycled waste, namely by establishing a Waste Bank in early 2016. The Haji General Hospital of Surabaya was inspired by several parts of the innovation and modified it into the Mendulang Mentari initiative.

Several hospitals have conducted comparative studies for recycling activities of recycled plastic bottles and plastic jerry cans for hemodialysis, namely Ibnu Sina Gresik Hospital and Surabaya UNAIR Hospital. They want to see of sorting, processing and escorting medical waste until it is delivered to a third party in a safe condition. But in its journey, the one who actually did the replication was the Ibnu Sina Gresik Hospital which implemented it since March 2018.

To run this initiative, the hospital spends about Rp 31,2 million (USD 2,080). The budget was spent to build waste treatment facilities and the purchase of equipment for supporting activities (disinfectant and stationery). As for Human Resources, the Hospital did not create a special team, only maximizing the existing officers.

Although it has only been running since November 2016, the efficiency of the economic value of this program is very pronounced. Apart from the nominal allocation of medical waste treatment which continues to decline, the number of nosocomial infections (infections caused by germs from hospitals) has also declined. In 2015 the number of nosocomial infections reached 0.24 percent, in 2016 it declined to 0.21 percent, and declined again to 0.13 percent in 2017. In addition, recycling activities produced financial additions for recycling workers. And also important, janitors and nurses are more concerned about separating other medical waste so that it can be recycled. In the end, the Hospital also made a Standard Operating Procedure on waste sorting where officers must obey with these standards.

Yes

Internally, Mendulang Mentari is monitored and evaluated by the Head of the Room of each Unit and the Infection Prevention and Control Committee every month. The rules is they made an analysis of the results of monitoring waste sorting carried out, then recapitulated and made a report to be given to the Director of the Hospital. Externally, Mendulang Mentari won the Top 25 award from the Public Service Innovation Competition held by the East Java provincial government in 2017.

The indicators used are the results of the compliance of officers in sorting plastic bottle waste, infusion and hemodialysis jerry cans, and decreasing the cost of waste management in Haji General Hospital of Surabaya.

In 2016 before this innovation was born, the level of obedience of officers in sorting waste plastic bottles, infusion and jerry cans of hemodialysis was only 30%, after this innovation running, the compliance of officers became 80%. In financial terms there is a reduction in waste management costs by 19% from Rp. 876,300,000 (in 2016) to Rp. 709,228,000 (in 2017) and in 2018 (January to October) of Rp. 559,521,000

Both private and government entities works hand in hand to run this initiative. Initially, through a cooperation agreement (MOU) with CV TIMDIS which helped administration activities and transportation to recycling sites. The waste recycling site is a collaboration between CV TIMDIS and the Plastic Waste Recycling Processing Association (APDUPI). This activities are monitoring by the Surabaya City Environmental Agency and the East Java Provincial Health Office periodically, or if the Hospital requires consultation, they will immediately conduct direct assistance. Whereas to treat hazardous and toxic materials that cannot be recycled, such as batteries, lights, used oil, infectious medical waste, cytotoxics, body tissues and expired drugs, Haji General Hospital of Surabaya invites third parties PT. Tenang Jaya Sejahtera and PPLI.

The lesson that can be learned from Mendulang Mentari's initiative is the importance of making innovation in the management of medical waste in hospitals. Especially in referral hospitals such as Haji General Hospital of Surabaya. The number of patients is very dynamic, data on inpatients from 2015 to 2018 continue to increase, meaning that the amount of waste produced also increases. If the Hospital does not immediately replace the method of processing medical plastic waste, and continues to choose the incineration system (burning), it will be very detrimental to nature, and the health of patients and communities around the hospital.