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Transcript of AsiaHgConference Report 15March11
8/3/2019 AsiaHgConference Report 15March11
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CONFERENCE
REPORTMarch 15, 2011, Manila, Philippines
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This report has been documented and prepared by Desiree M. Lopez for Health Care
Without Harm (HCWH), World Health Organization (WHO) and the United Nations
Development Programme- Global Environment Facility (UNDP-GEF) Global Health Care
Waste Project.
Health Care Without Harm would like to acknowledge f inancial support for the confer-
ence and this document from the Swedish International Development Agency (SIDA)
with the assistance provided by the Swedish Chemicals Agency (KemI). The document
does not necessarily reflect the official positions of Sida or KemI.
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CONTENTs
I. ExECuTIvE summaRy
II. ThE CONFERENCE
III. CONFERENCE ORgaNIzERs
Iv. CONFERENCE PROgRam
v. CONFERENCE OuTCOmE
St U t th 7 Sts f Mcu-F Hath Ca
vI. IssuEs aNd ChallENgEs
vII. ThE way ahEad
aPPENdIx
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The Asia Regional Conference on Mercury-Free
Health Care: Phasing-out mercury-containing fe-
ver thermometers and sphygmomanometers, was
organized by Health Care Without Harm (HCWH),
the World Health Organizaon (WHO), and the
United Naons Development Programme-Global
Environment Facilit (UNDP-GEF) Global Health
Care Waste project.
In 2006, the Southeast Asia Conference on
Mercury in Health Care held in the Philippines
prompted acon in the Philippines on the use of
mercury devices in the health care sector and its
subsequent consequences to global health and
environment condions. In 2008, the WHO and
HCWH launched the Global Iniave to Substute
Mercur-Based Medical Devices with safer, af -
fordable and accurate alternaves.
The Asia Regional Conference came several years
aer the rst Mercur-Free Conference iniaveand was designed to learn from the success that
the Philippine health sector has had in substut-
ing mercury-based medical measuring devices
with safe, accurate and aordable alternaves,
while also looking into challenges such as man-
agement of mercury waste and guidelines for
procurement of sustainable alternaves.
Parcipants included more than 100 representa-
ves of ministries of health and environment,
health professional organizaons, hospitals and
other health sector organizaons from 10 Asiancountries.
It focused on various iniaves from around the
world to phase-out mercury measuring devices in
health care, the progress made among ten Asian
countries and experiences toward mercury-free
health care from several Philippine health care
facilies. It delved into the accurac of mercur-
free thermometers and sphygmomanometers
and the guidelines on on-site storage for phased-
out mercury-containing measuring devices.
Countr presentaons from China, India, Indo-
nesia, Mongolia, Nepal, Philippines, South Korea,
Thailand and Vietnam gave a picture of how
mercur substuon has evolved in the dierent
countries and how the connuing challenges will
shape the course of the iniave in the long run.
An ehibit featuring alternaves to mercur
thermometers and sphygmomanometers was
mounted along with special demonstraons on
the maintenance and calibraon of thesealternave equipments.
The Manila Declaraon on Mercur-Free Health
Care 2011 is a signicant conference output
encouraging mul-sectoral involvement in the
mercur-free health care iniave. It outlines
recommendaons on local and internaonal
government polic-making, acve civil societ
involvement and business and private sector sup-
port in the mercury-free campaign.
ExECuTIvE summaRy
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The Asia Regional Conference on Mercury-Free
Health Care: Phasing-out mercury-containing
fever thermometers and sphygmomanometers
gathered ocials from Ministries of Health and
Environment, hospital managers and repre-
sentaves of naonal health care professional
associaons from across Asia including China,
India, Indonesia, Korea, Mongolia, Nepal, Philip-
pines, Thailand, Vietnam and Saudi Arabia to
discuss eorts made at substung mercur-
based medical measuring devices with safe,
accurate, aordable alternaves throughout the
region. Technical and policy experts from other
countries including South Africa and the United
States were also present.
Over 100 delegates aended the conference,
including Nepal’s Secretar of Health Dr. Praveen
Mishra and Director Rebecca Peñael of the
Philippine Department of Health-- Naonal
Center for Health Facilies Development.
The Asia Regional Conference on Mercury-Free
Health Care: Phasing-out mercury-containing
fever thermometers and sphygmomanometers,
was organized by Health Care Without Harm,
the World Health Organizaon, and the UNDP-
GEF Global Health Care Waste project.
Countr presentaons gave a picture of how
mercur substuon has evolved in the dier-
ent countries and how the connuing challenges
will shape the course of the iniave in the longrun.
The Philippines shared it experience at various
levels of advocac-- from a naonal polic on
mercury thermometer and sphygmomanometer
phase out to actual eperiences of 1st Do No
Harm awardees for mercury phase-out in health
care.
The St. Paul Hospital of Tuguegarao (Philippines)
shared its experience of total phase out of mer-
cury thermometers and sphygmomanometers
while the whole St. Paul network of hospitals
shared their praccal soluons toward achiev-
ing greener hospitals all over the country. The
San Lazaro Hospital (Philippines) presented
its Mercury Management Team’s advances in
the phase-out of mercury thermometers and
sphgmomanometers and best pracces for
on-site management and storage of phased-out
mercury measuring devices.
An ehibit on digital alternaves was mountedto give the parcipants an overview of the wide
range of opons in the market toda. Dr. Jorge
Emmanuel of the UNDP GEF conducted etra
sessions on calibrang digital thermometers and
sphygmomanometers.
A visit to the San Lazaro Hospital was part of the
second da’s inerar to allow the delegates
an eperience of how mercur-free pracces
both in the medical secons of the hospital are
operaonal.
ThE CONFERENCE
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Health Care Without Harm (www.noharm.org) is an internaonal coalion with over
483 member organizaons in 53 countries, working to transform the health care sec-
tor worldwide, without compromising paent safet or care, so that it is ecologicall
sustainable and no longer a source of harm to public and the environment. HCWH’s
campaign is supporng the health care industr to beer appl its ethical commitment
to “First, Do No Harm” to the environmental and occupaonal impacts of the technolo -
gies and materials used in health care.
The UNDP-GEF Project (hp://www.gefmedwaste.org) is a global demonstraon pro-
ject on healthcare waste. Its goal is to protect public health and the global environment
from the impacts of dioin and mercur releases. It accomplishes this b demonstrang
pracces and technologies that limit the amount of healthcare waste generated, elimi-
nate the burning of healthcare waste, and reduce the quant of broken mercur-con-
taining devices that are improperly handled, discarded or burned. The project involves
seven strategicall selected countries: Argenna, India, Latvia, Lebanon, the Philip-
pines, Senegal and Vietnam. An addional component aimed at developing aordable,
non-burn healthcare waste treatment technologies is taking place in Tanzania. The pro-
ject is implemented b the United Naons Development Programme (UNDP) funded
b the Global Environment Facilit (GEF) in keeping with the Stockholm Convenon on
reducing persistent organic pollutants (POPs).
The World Health Organizaon (www.who.int) is the direcng and coordinang author-
it for health within the United Naons sstem. It is responsible for providing leader-
ship on global health maers, shaping the health research agenda, seng norms and
standards, arculang evidence-based polic opons, providing technical support to
countries and monitoring and assessing health trends.
WHO believes that in the 21st centur, health is a shared responsibilit, involving equi-
table access to essenal care and collecve defence against transnaonal threats.
CONFERENCE ORgaNIzERs
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WelCoMe AddreSS
Arch. Rebecca Peñael
Director III, Naonal Center for Health Facilies
Development, Department of Health (Philippines)
Dr. Praveen Mishra
Secretary of Health,
Ministr of Health and Populaon (Nepal)
opening reMArkS
Dr. Jorge Emmanuel
Chief Technical Advisor,
UNDP-GEF Global Healthcare Waste Project
Dr. Hisashi Ogawa
Regional Adviser,
World Health Organizaon Western
Pacic Region (WPRO)
Merci Ferrer
Eecuve Director, Health Care Without Harm-
Southeast Asia
SeSSion 1
GLOBAL INITIATIVES TO PHASEOUT MERCURy
MEASURING DEVICES IN HEALTH CARE
Joshua Karliner
HCWH Internaonal Team Coordinator
SeSSion 2
MERCURy IN HEALTH CARE PHASEOUT OF
MEASURING DEVICES: THE PHILIPPINE ExPERIENCE
Faye V. Ferrer
Program Ocer, HCWH-SEA
SeSSion 3COUNTRy PRESENTATIONS ON MERCURy PHASEOUT
OF MERCURyCONTAINING FEVER THERMOMETERS AND
SPHyGMOMANOMETERS
CONFERENCE
PROgRamCHinA -- Th uct, us, a atats
f mcu thmmts a
shmmamts ChaDr. Z. Cao, Instute for Environmental Health
and Relave Products Safet, Chinese Center
for Disease Control and Prevenon
indiA -- Mcu-F Hath Ca iaDr. S. Kulshresta
Directorate General of Health Services
Ministry of Health & Family Welfare
indoneSiA -- Mcu-F Hath Cayuun Ismawa, Balifokus, Denpasar
MongoliA -- Mcu-F Hath Ca
itats MaDr. B. Tsetsegsaikhan, Ministr of Health
nepAl -- Mcu-F Hath Ca itats na
Dr. Praveen Mishra, Secretar of Health,Ministr of Health and Populaon
Mr. Mahesh Nakarmi
Director, Health Care Foundaon
Dr. Pramita Suwal
Asst. Prof., BP Koirala Instute of Health Sciences
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SeSSion 4
ToWArdS MerCUry-Free HeAlTH CAreRichael T. Batang, Housekeeping Supervisor,
Saint Paul Hospital, Tuguegarao City, Cagayan, Philippines
ACCUrACy oF MerCUry-Free deviCeS
in HeAlTH CAreDr. Peter Orris
Chief of Occupaonal and Environmental Medicine,
University of Illinois
SeSSion 5
STorAge oF pHASed-oUT MerCUry
ConTAining deviCeSDr. Karen Abejar-Arago
Program Manager, Health Care Waste Management,
Mercury Management Team, San Lazaro Hospital, Philippines
gUidelineS For inTeriM on-SiTe STorAge oF
pHASed-oUT MerCUry ConTAining deviCeS
FroM HeAlTH CAreDr. Jorge Emmanuel
Chief Technical Advisor,
UNDP-GEF Global Healthcare Waste Project
CloSing reMArkS
A. Juan Miguel Cuna
Director, Environmental Management Bureau,
Department of Environment and Natural Resources
(Philippines)
SoUTH koreADr. Dong Chun Shin
Chair, Internaonal Commiee,
Korean Medical Associaon
As of the present, there has yet been no organ-
ized eort in South Korea on mercur-free
health care. Most health professionals believe
that at some level, there already has been a
stop to the use of mercury-containing measur-
ing devices in the country, except for cardio-
vascular equipment. However, beyond the
consequences of broken thermometers, South
Korea would tend to put more pressure on the
queson of the environmental impact of mer-
cury use. On the average, Koreans are exposed
to 4 mcg of mercury; however, this becomes
signicant when such accumulate in the envi-
ronment and impacts on the net generaons.
South Korea tends to move toward the
advocac for green hospitals. Since 2008, it has
eplored possibilies of working with the World
Medical Associaon for some acon on naonal
networking for green hospitals.
THAilAnd -- phas-ut f Mcu-Cta
F Thmmt a
ShmmamtDr. Twisuk Punpeng
Department of Health
vieTnAM -- Stuat f mcu-f
hath ca vtamDr. Nguen Thi Lien Huong
Deput Director, Vietnam Health
Environment Management Agency
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CONFERENCE OuTCOmE
St U t th 7 Sts f Mcu-F Hath CaTh s sts t mcu f hath ca was ut th WHo-HCWH ga itat Mcu-F
Hath Ca as a ss f actts, t cssa a s sc squc, twa th mcu
f cama th hath ca sct. patcat cuts th Asa ra Cfc ha ma
ss th fw was:
edUCATion And TrAining
All countries in the region have embarked on a multude of educaon and training acvies on
the health impact of mercur for healthcare professionals, paents and the general public. Train-
ing programs and print materials and guidelines on proper clean-up, storage and disposal of mer-
cury measuring devices are being made and disseminated to a wide variety of audiences.
Nepal’s educaon program targets a wide range of audiences and does not limit educaon to
the health care workers onl. Educaon and training directed to the health care sector includes
mercur waste handling and disposal as well as general informaon about mercur toicit. The
program also targeted students and the general public with basic mercur safet informaon to
ensure that the health care sector’s precauonar pracces are beer understood and supported
by the populace. It also tries to maximize the use of posters and signage to educate people who
are not health workers but who frequent health care facilies.
1
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repliCATion in oTHer HoSpiTAlS
Properl documented eperiences of mercur-free pracces allow for replicaon b other health care facilies.
In China, the experience of two general hospitals in Beijing inspired two other hospitals in the Northern and
Eastern parts of the countr to start their own mercur-free wards and health care facilies.
MegA-CiTy/provinCiAl poliCieS
Municipal and provincial policies on mercur-free health care serve as eamples for replicaon in other regions.
A polic issued b the Delhi Department of Health and Famil Welfare in 2007 has urged all 73 government-run
hospitals in the cit to stop new purchases of mercur thermometers. Over 2,200 health care facilies in the Na-onal Capital Territor of Delhi have since graduall been replacing mercur measuring devices with alternaves.
4
3
piloT HoSpiTAlS
Whether mandatory or voluntary, pilot hospitals carrying the mercury-free line had been launched in the
region and are serving as models of sound environmental and toxic-wastes management to others.In the Philippines, inial pilot hospitals were on a voluntar basis. The eventual release of a naonal polic of
a two-year phase-out of mercury thermometers and sphygmomanometers turned in high rates of success for
the campaign.
In Thailand, voluntar pilot facilies are beginning to inuence and inspire other hospitals and health care
units to opt for mercur-free alternaves to thermometers and sphgmomanometers.
Nepal’s dnamic pilot at the Naonal Kidne Center drew a lot of interest for its zealous and broad-based
acvies, as well as its “out-of the-bo“approach to the mercur issue.
2
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ModelS For repliCATion in regionS
Documented eperiences in various scales and proporons serve as models to be emulated b health
care facilies operang at dierent levels in a localit, province, region or countr.
Vietnam’s involvement in a UNDP GEF -WHO-HCWH project allowed for the idencaon of an urban
hospital, a provincial hospital and a cluster of rural health facilies who shall begin with the substuon
of mercur-based measuring devices as part of a broad sustainable health care waste management eort.
In Indonesia, seven pilot hospitals were engaged for the mercur-free campaign in Despansar.
Models in Bali, Jakarta and Bandung have followed suit.
ConTribUTing To globAl poliCy
Experiences and movements in various parts of the world all lead toward an intensifying campaign on
mercury-free health care among various sectors of society around the world.
The conference parcipants came out with the Manila Declaraon of 2011 which gives out recommenda -
ons for governments, civil sociees, WHO and United Naons and private sector towards the realizaon
of mercury-free healthcare. (Appendix)
6
7
nATionAl poliCieS
Country policies help speed-up the process of the campaign and facilitate compliance on a large-scale.
The Philippines came out with Administrave Order 2008-021 calling for a two-ear phase of out of
mercur thermometers and sphgmomanometers in Jul 2008. Similar policies are underwa in India.
In Mongolia, the Joint Order #07/27 of the Minister of Health and Director General of the Naonal
Emergenc Management Agenc was promulgated prohibing the purchase of the mercur-containing
thermometers and sphygmomanometers and dental amalgam.
5
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What follows are issues and realizaons discussed in the course of the presentaons, fora and conference sessions.
knoWledge, edUCATion, popUlArizATion-
THe TASk oF CHAnging Mind SeTS
Eecng change in the mindsets of health care professionals and the public remains a big task in the mercur
-free health care campaign. The shi to alternaves becomes a dicult choice where there is running be-
lief about the superior accurac of mercur measuring devices as well as the prohibive cost of alternaves.
Eperiences across the region point to the need for connuing research and advocac and the producon and
popularizaon of knowledge and educaon products that shall make audiences see beond tradion and simplecost accounng in the mercur issue. There was also menon of how perspecves ought to be directed toward
environmental cost accounng, that is, the bigger picture.
AlTernATiveS
AccurAcy- The main issue posed to advocates of substuon is whether alternaves to mercur measuring
devices will be at par with mercur devices. Mercur has alwas been the tradional “Gold Standard” for meas-
urement of fever and blood pressure and digital alternaves are deemed less reliable especiall in cardiologi-
cal condions that rel on the supposed accurac of mercur sphgmomanometer readings. Half the work is in
breaking the mth of mercur’s unquesoned accurac and reliabilit among medical praconers.
AffordAbility-The issue of cost-eecveness of alternaves was also put to the fore. In China, Thailand,
India, Mongolia, and Vietnam and most other countries, the cost of non-mercur thermometer substutes run
as high as 600% compared to mercury thermometers.
China also epressed that technologies for the manufacture of alternaves are oen not available locall. This
signicantl causes a dent into the China econom where manufacturers of mercur measuring devices number
at least 16,000 and earn from eporng 40% of their produce.
Price also determines, to a great etent, the accessibilit of the alternaves.
Thus, the logic of swinging the demand for alternaves. The good news is that most local suppliers of mercur
measuring devices in the presenng countries also carr digital alternaves in their product lines. A swing inthe demand for alternaves eventuall causes an increase in their suppl and a relave lowering of prices.
IssuEs aNd ChallENgEs
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WASTe MAnAgeMenT And diSpoSAl
CleAnUp, STorAge
Much of the technology for the proper cleanup, storage and disposal of mercury waste in health care facili-es has et to be promoted and popularized. The Philippines’ San Lazaro Hospital under its Mercur Man-
agement Team shared its experiences in the handling and on-site storage of phase-out devices and health
care waste while Dr. Jorge Emmanuel of the UNDP underscored “double-packaging ” or “packaging redun-
dancy “as a salient feature of proper handling and storage of mercury and toxic wastes.
FinAl diSpoSAl
Soluons toward the nal disposal of mercur waste remain elusive but not hopeless. It was pointed out
that no countr successfull addressed nal disposal of mercur waste without some form of adverse eect
on the environment. Incineraon contributes to toic waste in the atmosphere and in both land and
water bodies.
In the Philippines as well as in India, knowledge about and pracces pertaining to mercur waste storage
and disposal sll need to be properl shared and popularized.
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The mercury-free campaign may be escalated by
working with what has been gained in the region
and in the countries involved so far-- local and
naonal policies calling for phase out and a shi
to alternaves, replicang and popularizing best
pracces, connuing educaon and populariza-
on of knowledge products, consciousl shiing
demand for alternaves b developing informed
audiences.
Polic and legislaon help facilitate the campaign
at all levels. Naonal policies fast-track imple-mentaon but local legislaons ensure proper
operaon at manageable levels. Regional polic
shall ensure cooperaon and mutual benet
among partner countries. Global polic and legis-
laon however, paves the greatest wa toward a
mercury-free future.
There is an expressed need to develop knowledge
products such as researches on the health impact
of mercury on health care professionals and
other vulnerable sectors, other mercury sources
in the health care facilit, materials on praccal/household handling of mercury waste.
There is also a need for basic informaon sources on
standards for alternaves to mercur measuring devices
and the storage and disposal of health care waste.
ThE way ahEad
Th Maa dcaat f 2011 s a fft twa
ffct a c-ma a uts
cmmats fm th cfc atcats
ass t th fw scts:
governMenT And regionAl bodieS to formulate
policies and direcves toward the phase out of mercur
measuring devices in the health care sector, to promote
regional cooperaon along these lines, to promote alter-
naves and provide informaon to peoples, to idenf
alternaves and best pracces for storage and disposal
and to work towards the forging of an internaonall
binding legal instrument on Mercury-Free Health Care.
For WHo And Un AgenCieS to provide technical as-
sistance and informaon, to encourage polic-making
among governments and help mobilize resources toward
Mercury-Free Health Care.
For Civil SoCieTy groUpS to advocate for policies,
act as watchdogs to the implementaon of the
iniave, and help in networking and inuencing
public percepon.
For the privATe SeCTor to oer and produce alterna-
ves to mercur measuring devices, phase-out
producon of mercur-based instruments, eercise
extended producer responsibility and support the goals
of Mercury-Free Health Care.
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Maa 2011 dcaat Mcu F Hath Ca
gath Maa, phs th ccas f th Asa ra Cfc Mcu-F Hath Ca, m tha 100
stats f msts f hath a mt, hath fssa aats, hstas, a th hath sct
aats fm Asa cuts cam tth t ass c a tchca ssus a th susttut f
mcu-as mca cs. Th u ma th fw caat:
aPPENdIx
Recognizing,
- the important role the health sector plas in protecng and promong public health;
- the negave consequences of mercur polluon on human health
- the negave impacts of mercur polluon on the environment
- and mercur’s toic, persistent and bioaccumulave nature;
Recognizing that,
- alternaves to mercur-based medical devices are available, aordable and at least as accurate as mercur devices in their use;
- health sstems in man countries in Asia have switched or are in the process of switching to the available alternaves;
- the WHO-HCWH Global Iniave for Mercur-Free Health Care aims to substute 70 percent of mercur thermometers
and blood pressure devices globall b 2017;
- the substuon of mercur-based medical devices will contribute to health sstem strengthening b improving the qualit of health care and the occupaonal health and safet of health care workers;
- the world’s governments are negoang a legall binding treat to phase-out most uses of mercur;
We, the parcipants in the Asia Regional Conference on Mercur-Free Health Care recommend the following plan of acon:
FOR GOVERNMENTS AND REGIONAL BODIES:
- Formulate the polic and direcves to phase-out the use of mercur devices in the health sector’s da-to-da pracce.
- Promote mul-sectoral collaboraon for beer implementaon of polic-based plans, including collaboraon between
Ministries of Health, Environment and Industry.
- Provide informaon to the people including health professionals regarding the harmful eects of mercur, thereb educang
and communicang with a diversit of stakeholders.
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- Replace mercur devices with alternaves that are at least as accurate and well-calibrated as mercur devices in public health facilies.
- Idenf not onl alternaves to mercur-based medical devices, but also provide for the safe storage and disposal of these mercur
devices including potenall mandang etended producer responsibilit.
- Encourage the development of an appropriate plan for the phase-out of mercury thermometers and sphygmomanometers in the
Internaonal Negoang Commiee to Prepare a Global Legall Binding Instrument on Mercur.
FOR WHO AND OTHER UN AGENCIES:
- Make technical assistance and eperse available to the Government and other health sector organizaons for mercur
substuon and safe disposal.
- Produce informaon, educaonal and technical guidance materials.
- Mobilize resources for the iniaon of Mercur-Free Health Care.
- Encourage policy makers to work towards Mercury-Free Health Care.
FOR CIVIL SOCIETy ORGANIZATIONS:
- Advocate for policies and pracces that substute mercur-based medical devices with safe, accurate, aordable alternaves.- Change the public percepon of the issue through educaonal acvies.
- Work as a watchdog for the implementaon of government acvies and policies.
- Network with dierent stakeholders, government organizaons and civil societ organizaons to see the eecve implementaon.
- Promote iniaves in the private sector health instuons, as well as with manufacturers for Mercur-Free Health Care.
FOR THE PRIVATE SECTOR:
- Phase-out the producon, sale and markeng of mercur-based medical devices.
- Epand producon and distribuon of non-mercur devices, making qualit, aordable and validated alternaves available
at aordable prices.
- Provide for Extended Producer Responsibility by taking back phased-out mercury equipment and managing the mercury waste.
SUPPORT THE GOALS OF MERCURyFREE HEALTH CARE.
Manila, the Philippines, March 15, 2011
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