situation of healthcare waste management in nepal and an effort for improvement at resource poor...
TRANSCRIPT
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”