Environmental & Social Review Summary
Project Number
9586
Company Name
Bell Medical Centers Limited
Date ESRS Disclosed
Feb 5, 2010
Country
Zimbabwe
Region
Africa
Last Updated Date
Jan 2, 2017
Environmental Category
B - Limited
Status
Completed
Previous Events
Approved : Jun 30, 1999
Signed : May 5, 2000
Invested : Aug 2, 2000
Sector
Hospitals and Clinics
Industry
Health, Education and Life Sciences
Department
Regional Industry - MAS Africa
Project Description
ENVIRONMENTAL REVIEW SUMMARY
Project Name: AEF/ZIMBABWE: Bell Medical Centres (Pvt.) Ltd.
Region: Sub-Saharan Africa
Sector: Health care
Project No: 009586
1. This project, which is to be financed through the Africa Enterprise Fund (AEF), involves the expansion of the Torwood Hospital and Redcliff Medical Centre in Kwekwe, in the midland province of Zimbabwe. The two centers are owned by Bell Medical Centers (BMC), whose main office is in Harare. Until recently, the Zimbabwe Iron and Steel Company (ZISCO), a parastatal, owned both medical facilities: Torwood Hospital directly and Redcliff Medical Centre through its in-house medical benefits scheme. Both were originally established as in-house medical facilities for the company. In 1998, ZISCO decided to shed the medical facilities and concentrate on its core business of steel making. During the period leading up to the sale, both centers had been neglected. Since taking over, BMC has upgraded the appearance of both medical centers to make them more attractive to patients. Apart from physical changes like painting buildings and obtaining new linen, curtains, and equipment, the standard of patient care has been upgraded by providing more professional staff and giving greater attention to patient service. To enable BMC to provide more services and handle the anticipated increase in the number of patients, there is need to expand the centers by adding an outpatient unit at both facilities. BMC also intends to install new, modern equipment, an in-house pharmacy, a laboratory, and a radiology department, and to upgrade operating theatres and kitchens.
2. This is a Category B project according to IFC''s environmental review procedure because specific impacts may result which can be avoided or mitigated by adhering to generally recognized performance standards, guidelines, or design criteria. Key environmental health and safety issues that were analyzed are as follows:
• handling and disposal of medical materials;
• disposal of medical and bio-hazardous wastes;
• disposal of solid and liquid wastes including sewage;
• power and water supply including fuel storage if applicable;
• hygiene and implementation of good hospital management practices;
• CFC-free air conditioning and cold storage equipment;
• employee health and safety training and medical monitoring; and
• fire protection and safety in both the existing facilities and expansion phases.
3. IFC has reviewed BMC’s environmental policy, housekeeping and good management practices, and employee health and training manuals. Key elements of this information are described below.
4. Handling and disposal of medical materials: BMC has based its methods for handling and disposing of all types of wastes on policies and procedures in use in the US. Radioactive materials used in x-rays and other diagnostic equipment are kept in a separate room and locked at all times. Used radiographic films are stored separately and collected the supplier for reprocessing. Developing fluids are also collected and recycled. Soiled linen and uniforms are bagged, labeled and sent to the hospital''s laundry for laundering at high temperatures in disinfectant detergents. Heavily soiled linen and equipment are autoclaved on the premises.
5. Disposal of medical and bio-hazardous wastes: Waste materials such as gauze and swabs which may be contaminated with blood or other body fluids are collected in lined pedal bins, prior to disposal by incineration. Each of Bell’s two facilities has a high temperature incinerator that reaches a maximum temperature of 1200° C. and is licensed by the Ministry of Health for disposal of medical materials and wastes. Contaminated sharps (needles, blades) are collected in specially sealed and labeled containers, and the entire container is then incinerated. Laboratory wastes including cultures, organic reagents, and blood, urine, fecal cultures are collected in lined disposal units and incinerated. Bedpans, vomit bowls and other such equipment are sterilized.
6. Disposal of solid and liquid wastes including sewage: Leftover food from the kitchens and patient rooms is collected in lined, sealed refuse bins and held in a secure area until it is collected daily by a designated unit of the municipal refuse authority. Wastewater from patient and staff ablution areas is discharged to the municipal sewerage system. The increase in sewage volumes as a result of the new outpatient units will be negligible. Waste paper from hospital offices is disposed of in covered refuse bins and collected by the municipal authority for disposal at a nearby landfill.
7. Power and water supply including fuel storage if applicable: Power for both hospitals is obtained from the Zimbabwe Electricity Supply Authority (ZESA), the national provider. Each facility also has a back-up diesel generator, for use in the event of an interruption in the power supply. No fuel is stored on the premises. Diesel fuel for the generators is stored at nearby ZISCO facilities, and ZISCO staff refuel the generators as needed. The generators are currently housed in separate structures, which may have to be relocated when the outpatient units are constructed. At IFC’s request, the sponsors have agreed to retrofit the existing structures or equip any structures with concrete flooring and secondary containment bunds capable of holding the entire contents of the generators in the event of a spill or breach. these structures will be equipped with cement bunds capable of containing the entire contents of the generator and fuel tanks in the event of a breach or spill. Water is sourced from the municipal water supply. It is of potable quality and does not need additional treatment on site.
8. Hygiene and implementation of good hospital management practices: BMC has established a code of conduct and good management practices based on the principle of “universal precautions,” which assumes that all blood and body fluids are infected. All activities in its hospitals are conducted on this premise, and appropriate precautions must be taken at all times. Floors, toilets baths and sinks are cleaned and disinfected several times daily. All other surfaces (lockers, beds, and furniture) are damp-mopped with disinfectants regularly. Disinfectant cleaners and hand soaps are used by housekeeping staff at all times. All patients with known infectious conditions are isolated from other patients and treated by specialized nursing staff. Only designated staff are permitted to enter the kitchen, to minimize the risk of infection. Floors and kitchen utensils are disinfected daily. Cleaning materials for the kitchen are stored separately from cleaning materials for the rest of the facility. All kitchen staff are required to wear hair restraints, to be clean shaven, and to keep their fingernails short and clean. Supervisory staff conduct regular inspections to ensure that these requirements are adhered to.
9. CFC-free air conditioning and cold storage equipment: BMC does not have air conditioning systems in its facilities, and has confirmed that its cold storage units utilize non-CFC refrigerants, in accordance with the provisions of the 1987 Montreal Protocol on Substances that Deplete the Ozone Layer.
10. Employee health and safety training and medical monitoring: All employees must undergo a pre-employment medical examination, as well as a follow-up exam every six months. All new staff must undergo an induction training program which outlines the hospitals’ infection control program, as well as other key polices and procedures. The training emphasizes the need to take appropriate precautions and utilize appropriate protective clothing at all times. Medical and support staff are provided with protective clothing including aprons, gowns, rubber gloves, masks, goggles and gumboots, as designated for their particular tasks and for specific areas of the hospital. All staff toilets and rest areas are supplied with disinfectant hand soaps and signs are posted to remind employees that the use of these products is required at all times. The Matron for both facilities gives regular on-the-job instruction and “refresher” courses to all employees, both medical personnel and support staff. Any spillage is mopped immediately to avoid a hazardous situation.
11. Fire protection and safety in both the existing facilities and expansion phases: For both health and safety reasons, no smoking is permitted in the hospital. BMC has contracted with a private licensed supplier to supply, fit and service all fire safety equipment to comply with relevant Government of Zimbabwe regulations. The kitchens at both facilities are fitted with both foam and dry powder extinguishers in the event of a grease fire. The rest of the facility is equipped with extinguishers and fire reels in accordance with Government regulations. BMC conducts fire drills periodically, in conjunction with the local fire brigade. Fire prevention and response training is included as part of the induction course for all new employees. The new outpatient clinics will be fitted with necessary extinguishers and fire reels to ensure compliance with relevant regulations. At IFC’s request, BMC will install a centralized alarm system at each of the hospitals, which covers both existing and new structures. BMC will also install heat and smoke detection devices, and these will also be connected to the central alarm system. Also at IFC’s request, BMC will contract with a fire safety expert to conduct an on-site inspection of the existing facility to determine if additional improvements are needed to comply with IFC guidelines. Work will be completed to codes applicable in the Republic of South Africa (RSA) and certified for occupation as though the building were located in the RSA. Should IFC Guidelines (NFPA 101) require the installation of an automatic sprinkler system for a part or the whole of the new or rehabilitated works, then these will be incorporated as needed. Completion of the fire safety audit must be done within six months of investment approval, and agreement to implement any remedial measures recommended in the audit report will be made a covenant of the Investment Agreement.
12. Based on its review of available information regarding potential environmental impacts and proposed mitigation measures, IFC concludes that the proposed project is being designed and will be operated to meet pertinent Government of Zimbabwe requirements and all relevant World Bank policies and environmental, health and safety guidelines.
13. IFC will monitor ongoing compliance with World Bank Group policies and guidelines during the life of the project by reviewing and evaluating the Environmental and Social Monitoring Reports (AMRs) to be submitted annually to IFC by the sponsor, and by conducting periodic site visits during project supervision.
Environmental and Social Mitigation Measures
Broad Community Support
Related SII
