WHO Costing Tools - World Banksiteresources.worldbank.org/INTUSWM/Resources/... · WHO COSTING TOOLS for Health-Care Waste ... • Indicative values – Unit prices of each item above,

Sadat Associates, Inc.Sadat International, Inc.

Engineering and Environmental Services

WHO COSTING TOOLS for

Health-Care Waste Management

TOPIC 6



• Objective– To help estimate costs and annual budgets related to

health-care waste management• Intended Users

– Senior management or other trained personnel– Consultants– National policymakers

Note disclaimer

WHO Costing Tools



• Approach–Calculations based on key indicative values–Costing done at facility and national levels–Equivalent annual cost method:

Annualized cost = annualized capital costs (ACC) +

annual operating costs (AOC)CC = capital cost, r = discount rate,

where n = equipment lifespan

WHO Costing Tools

( )

( )nr111

rCCACC

+−

⋅=



WHO Costing Tools

• Four Tools– Costing Assessment Tool (CAT)– Expanded Costing Assessment Tool for Low-income

countries (ECAT-L)– Expanded Costing Assessment Tool for Middle-

income countries (ECAT-M)– Expanded Costing Assessment Tool for High-income

countries (ECAT-H)



CATSeven sections

–Introduction: Provides basic information–Tool A: Initial estimate of total annual cost–Tool B1: Costs for small HCFs–Tool B2: Costs for medium HCFs–Tool B3: Costs for large HCFs–Tool B4: Costs at national level and

Summary of costs at all levels–Tool C: List of items and average values

HCF = health-care facility



CAT Tool A – Initial estimates

• Input– Total amount of waste generated per year– Total number of staff– Total beds– Total number of small, medium and large facilities

• Indicative values– Cost to treat 1 kg health-care waste, waste generation

per bed per day, staff/patient ratio, average number of beds for small (4 beds), medium (40 beds) and large (400 beds) HCFs, etc.

Calculates initial estimates for national costs



CAT Tool B1 – Costs for a small HCF

• Input– Numbers of bins, personal protection equipment,

needle removers, treatment system, small pit– Annual numbers of safety boxes, bags, fuel, health-

care waste worker, maintenance, training• Indicative values

– Unit prices of each item above, fuel rate, wage rate, maintenance as % of capital cost

Calculates annual capital and recurrent costs for a small HCFTotal annual costs for all small HCFsCost per kg of treated waste



CAT Tools B2 and B3

• Tool B2: Costs for a medium HCF– Add a wheeled bin, storage area, and large pit

• Tool B3: Costs for a large HCF– Add a larger treatment system, sharps pit, long-term training,

waste management officer, and cleaning productsCalculates annual capital and recurrent costs for a medium or large HCFTotal annual costs for all medium or large HCFsCost per kg of treated waste



CAT Tools B4 and C• Tool B4: Costs at national level

– Office/equipment, vehicle, training set, staff, transportation, meeting per diem, maintenance

Calculates annual capital and recurrent costs at national levelSummary of total annual capital and recurrent costs for all small, medium and large HCFsGrand total cost and cost per kg of waste

• Tool C– Listing of unit prices of all items



ECAT

• Expands the CAT– Differentiates between low, middle and high

income countries– Expands the size categories of HCFs– Allows several treatment options– Allows centralized and/or decentralized

treatment– Computes potential revenues from the sale of

sterilized plastic parts for re-melting



ECAT

• Size Categories– Small HCFs: 0 to 4 beds– Medium HCFs: 5 to 99 beds– Large A HCFs: 200 to 499 beds– Large B HCFs: 500 beds or higher– Medium cluster: 300 to 1000 kg/day– Large cluster: greater than 1000 kg/day



• Ten sections– Introduction: Provides basic information– Input: Input required data– Assumptions: List of assumed costs & average values– Small HCFs: Costs for small HCFs– Medium HCFs:Costs for medium HCFs– Large HCFs: Costs for large HCFs– Clusters: Costs at the facility level and costs at

the central facility level for the clusters– National: Costs at national level – Results: Tabulation of all costs– Summary: Summary table and graph

ECAT



ECAT• Key indicative value

– “Infectious waste” generation rates• kg / bed per day

Low-Income Countries

0

0.10.2

0.30.4

0.50.6

Ban

glad

esh

Ban

glad

esh

Bhu

tan

Cam

bodi

a

Indi

a

Indi

a

Indi

a

Kyr

gyzs

tan

Lao

PD

R

Nep

al

Nig

eria

Nig

eria

Pak

ista

n

Pak

ista

n

Tanz

ania

Vie

tnam

Vie

tnam

Kg

per b

ed p

er d

ay

0.2 kg/b-d



Middle-Income Countries

0

0.5

1

1.5

2

2.5

Bra

zil

Bra

zil

Bra

zil

Bot

swan

aB

ulga

ria

Bul

garia

Col

umbi

a

Col

umbi

aC

uba

Gua

tem

ala

Guy

ana

Iran

Jam

aica

Jord

an

Jord

an

Leba

non

Mal

aysi

a

Mol

dova

Per

u

Phi

lippi

nes

Phi

lippi

nes

Sou

th

Sri

Lank

a

Sri

Lank

aTh

aila

nd

Thai

land

Turk

ey

Kg

per b

ed p

er d

ay

High-Income Countries

0

0.5

1

1.5

2

2.5

Fran

ce

German

y

Hong K

ong

Italy

Japa

nJa

pan

Kuwait

Netherl

ands

Norway

Portug

al

Saudi

Arabia

Spain

Switzerl

and

United

Ara

b Emira

tes

United

King

dom

United

Stat

es

Kg

per b

ed p

er d

ay

“Infectious waste”

generation rates

0.5 kg/b-d



ECAT• Key indicative value

– Sharps waste generation rates• kg / bed per day

Sharps waste generation rates

0

0.01

0.02

0.03

0.04

0.05

0.06

W. Euro

pe

Botswana

hosp

itals

Botswana

hosp

itals

Botswana

hosp

itals

Botswana

health

post

Botswana

clini

cs

Uganda

health

cente

rs

Kenya

hosp

ital

Bhutan

hosp

itals

kg p

er b

ed p

er d

ay

0.1 kg/b-d



ECAT - L• Four options for low-income countries

1. Autoclave, sharps pit – small & medium HCFsAutoclave, reusable sharps container, sharps pit –large HCFsAutoclave, shredder – cluster or central plant

2. Incinerator, ash pit – small, medium & large HCFsIncinerator with pollution control that meets international standards – large central plant only

3. Same as Option 1 but with on-site needle removers at small, medium and large HCFs

4. Same as Option 2 but with on-site needle removers at small, medium and large HCFs



ECAT - M• Higher infectious waste generation rate• Same basic four options as in ECAT – L• Option 1 and 3:

– Added shredders to the autoclaves of large HCFs as well as central plants

• Option 2 and 4: – Increased the level of pollution control for

incinerators of medium and large HCFs– Added stack testing of incinerators used in clusters

or central plants



ECAT - H• Higher infectious waste generation rate• Includes cost of disposing hazardous chemical

waste• Replaces all safety boxes with plastic sharps

containers• Different four options:

1. Autoclaves for small and medium HCFs; Autoclave-shredders for large HCFs and central plants



ECAT - H• Four options (continued)

2. Incinerators for large HCFs and central plants; autoclaves for small and medium HCFs

– All incinerator designs meet international standards (e.g., temperature control of primary and secondary chambers, high residence time, controlled loading, ash sump, etc.)

– Pollution control meets international standards– Parametric monitoring and periodic stack testing– Disposal of incinerator ash in hazardous waste

landfills



ECAT - H• Four options (continued)

3. Small to large microwave treatment systems for small, medium and large HCFs as well as for central plants

4. Advanced steam treatment systems (e.g., double-walled autoclave with internal shredding, cooling and drying) for large HCFsand central plants; regular autoclaves for small and medium HCFs



Questions and Comments by Audience



ECAT-L Demonstration

184301P

11501U

18471T

11271102S

63002142R

14191272Q

571205302O

22291N

182525973M

4050442L

17271K

11501J

261311I

39501102H

18481G

44167872F

38402642E

1955352D

46422002C

32501B

243001A

Smallbedsbedsbeds# hosp.District

Low-income country

Total small HCFs = 452Total medium HCFs = 19

- average beds = 46Total large HCFs = 8

- average beds = 214Total very large HCFs = 0

Number of medium clusters = 1Total small HCFs in cluster = 77Total medium HCF in cluster = 1

- total beds = 19Total large & very large HCFs = 5

- total beds = 1291



ECAT-L Demonstration• Population: 1765000 • Total beds: 3900• Annual health budget: $365355000 • GDP: $10317000• Wage – HCW worker: $ 3/day• Wage – WMO: $24/day• National staff: $4130/year• Electrical cost: $0.047/kWh• Water/sewage cost: $1.09/cubic meter



ECAT-L

Demonstration



ECAT-L Demonstration: Results with cluster

$821,558Needle removers, incinerators and lined ash pits for small, medium and large HCFs; transport vehicle(s), medium to large incinerators and lined ash pits for clusters; only the incinerator for large clusters meets international standards

4

$608,696Needle removers, autoclaves and small pits for small and medium HCFs; needle removers, autoclaves, reusable sharps containers and small pits for large HCFs; transport vehicle(s), medium to large autoclaves and shredders for clusters

3

$815,737Incinerators and lined ash pits for small, medium and large HCFs; transport vehicle(s), medium to large incinerators and lined ash pits for clusters; only the incinerator for large clusters meets international standards

2

$657,309Autoclaves and sharps pits for small and medium HCFs; autoclaves, reusable sharps containers and sharps pits for large HCFs; transport vehicle(s), medium to large autoclaves and shredders for clusters

1

Total Annual Costs ($/yr)

DescriptionOption

Summary of Results

$0

$100,000

$200,000

$300,000

$400,000

$500,000

$600,000

$700,000

$800,000

$900,000

1 2 3 4

Options

Tota

l Ann

ual C

osts

Potential revenues: $6,801



Central vs. On-Site Treatment,

ECAT-M & Pollution Control

Country G

$0

$50,000

$100,000

$150,000

$200,000

$250,000

1 2 3 4

Options

Tota

l Ann

ual C

osts

Decentralized 1 cluster

ECAT-LLow-Income Country

ECAT-MMiddle-Income Country



ECAT Sample ResultsCollect ion &

st orage

Treat ment & disposal

Labor & t raining

Collection & storage

Treatment & disposal

Labor & training

Facility collection &

storage

Central treatment and

disposal

Facility labor and training

Transportation

Central plant labor and training

ECAT-M: Country P

ECAT-L: Country S

Central/ClusterTreatment



ECAT Sample ResultsTotal Annual Cost per bed

0200400600800

10001200

B1 B2 B2 S G G P P A

Country

$/be

d pe

r yea

r

Option 1 Option 2

Total Annual Cost per Capita

00.5

11.5

22.5

3

B1 B2 B2 S G G P P A

Country

$/ca

pita

per

yea

r

Option 1 Option 2

European Union:$400 - $1000 /bed per year

(WHO reference document)

Low-Income: B1, B2, SMiddle-Income: G, PHigh-Income: A



WHO Costing Tools• To get a copy of the Costing Tools, go to:

For CAT: http://www.healthcarewaste.org/en/documents.html?id=217For ECAT:http://www.healthcarewaste.org/en/documents.html?id=218

• To comment on these tools or to send costing information that could help build the knowledge base, contact WHO: E-mail: [email protected]



Questions and Comments by Audience

Documents

WHO Costing Tools - World Banksiteresources.worldbank.org/INTUSWM/Resources/... · WHO COSTING TOOLS for Health-Care Waste ... • Indicative values – Unit prices of each item above,