SITUATION OF HEALTHCARE WASTE MANAGEMENT IN NEPAL AND AN EFFORT FOR IMPROVEMENT AT RESOURCE POOR

SETTINGS

JAYENDRA BHATTA

PROGRAMME OFFICER/CIVIL ENGINEERGTZ-HSSP/PAM, KATHMANDU

NEPAL

Map of Nepal

slide 2_NepalMap

Healthcare facilities in Nepal: Public SectorHospitals 280

Health post & SHP 3860

Out reach clinics 13700

Total Beds 4458

Bed Occupancy rate 72%

Private SectorSpecialty,NGO,Mission 123

Total Beds 3804

Bed Occupancy rate 50%

Total Beds 8262

Current practices of Solid waste management

• Institutionalization in 1981 as SWMRMC

• First landfill site was closed down due to public opposition and political conflict

• At present no landfill site is in operation

• New sanitary landfill site is under construction but this is also not without conflict

• Total waste generation in the capital city is 975 cu.m/day

• Currently dumping along the river banks

Situation of healthcare waste management in Nepal

Total HCF surveyed 346

• Central, Regional, Zonal,Teaching 30

• District hospital 33

• Primary Healthcare Centers 52

• Health Post 86

• Sub Health Post 145

The study revealed the following situations:

• First, almost all HCF are focusing just on the solid waste disposal

• Second, most urban HCF are using municipal waste containers without prior treatment or segregation

• Third, adoption of very poor disposal system by some HCF i.e.. Open dumping and burning, earthen pit disposal etc.

• Some have no any waste disposal system in place

slide 9_photo

Situation of Healthcare waste management in Nepal contd..

• Waste pit disposal system 21%

• Open dumping and burning 69%

• Using municipal containers 60%

• Incinerators not functioning 70%

• Waste segregation in practice 2%

• Knowledge of legal responsibility 0.6%

Legal situation of Healthcare waste management in Nepal:

• No specific policies and rules for HCW management

• HCT Policy is in the process of approval since two years

• Environmental Protection Act and Regulations- 1997 is not being enforced in reality

• Provision of EIA is only applicable for more than 25 beds hospitals but not yet implemented

• SWMRMC Act - 1987 is not in practice

• The Local Self Governance Act 1999 has included the solid waste disposal.

Healthcare Risk Waste (HCRW) Quantity estimate:

• HCRW generation(average) 0.1 Kg/b/day

• HCRW generation by hospitals 1301 Kg/day

• HCRW generation by health post

and healthcare services 2280 Kg/day

Effort for Improvement

• MoH is formulating HCW management Plan

• Awareness and training programs are being conducted by NGO/INGO/Media forums

• Healthcare waste management is a priority program of GTZ-HSSP/PAM from new phase

• KMC is operating an Incinerator for city hospitals

• Some private and mission hospitals are practicing waste segregation system

Effort for Improvement contd..

Healthcare waste Design Set• An integrated approach for healthcare waste management

• Affordable for resource poor settings

• Investment cost in average is about US$ 350.0/HCF and Management and Operation cost is about US$ 120.0/HCF

• GTZ-HSSP/PAM is in process of implementation

• Incinerator part in similar design has been installed and in

operation for testing purpose

HC design set consists of five components:

1. Incinerator with attached pit and with boiler/autoclave and smoke filter system

2. Waste water treatment ponds (Simsar ponds)

3. Lab waste collection and treatment pit

4. Compost box

5. Store for bottles and plastics. (sterilization/HLD prior going to the store)

R.C.C. SLAB REMOVABLE TO CLEAN THE PIT IN LONGRUN

METALIC CHIMNEY (HEIGHT AS PER SITE CONDITION)PROTECTION WALLWET WASTE FEEDING DOOR

BOILER AND SMOKE FILTER UNIT

5” THICK R.C.C. SLAB WITH HT BRICK (3 PIECES) 9 " BRICK WALL

FUEL TANK TO INJECT THE FUEL

3" AIR GAP4.5” HT BRICK WALLWET WASTE

ASH COLLECTION CHAMBER

DRY WASTE BURNING CHAMBER

AIR INLET PIPES (1” Ø 0-3NOS)

SMOKE OUTLET CHAMBER

R.C.C. FOOT STEPS

8’ 6” 9”9”

7’

0”9”

1’

6”

2’

0”5”

9”

WASTE BURNING CHAMBER

SMOKE BURNING CHAMBWR

PORFORTED SHEET (MESH)

ASH DROPING SHUTTER

Section of HC incinerator + waste pit

Simsar Ponds

BARBED WIRE @ 9” C/C 14’ 0” × 8’ 0”

4” 5” 4’ 7” 4’ 0” 9” 4’ 7” 4”

14’ 8”

5”9”

4”

8’ 8

”

Store for plastics & bottles

6’ 8

”9”

9”4”

COMPACTED EARTH

R.C.C. BAND 4” THICK

9”

FLAT BRICK SOILING WITH CEMENT POINTING

Plan of store for plastics & bottles

4”5”

14”

22”18”

14”

18”

22”