SIGN Cambodia Oct. 2002 1

From Urban to Rural Health Care Waste

Management in India

Srishti Health Care Without Harm

India

SIGN Cambodia Oct. 2002 2

Srishti

Not for profit, non-governmental environmental organisation

•working of issues of waste, recylcing and toxics since 1992

•areas of policy, research, projects, advocacy

SIGN Cambodia Oct. 2002 3

Brought attention to the issue in India in 1994.

Involved in national legislation and standards setting.

Coordiante a national multistakeholder network.

Implemented 5 model hospitals, training programs, awareness campaigns.

Documentation of best practices, field guides.

Advocacy for cleaner appropriate technologies.

Participated in WHO database, 1999, UNEP Basel Guidelines for bio-medical wastes,2000,SIGN –India partner

Work on Medical Waste

SIGN Cambodia Oct. 2002 4

Rapid Changes in Urban settings since 1995

Perspective shift from technology to management solns.

New national legislation in 1998 with tech. standards.

Focus on In hospital program implementation.Training and capacity building.Segregation and sharps management.Offsite treatment and disposal with transport.

Understanding of occupational safety issuesInstallation of off-site centralised facilities in 6 cities.

Adoption and local manufacture of non-burn technologies

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Lessons learnt in Urban Settings

Waste mgmt as part of housekeeping/ infection

control.

Hosptial staff has a rapid learning curve.

Raising awareness about occupational safety issues

is key.

Simple devices work better such as for sharps mgmt.

Rapid incorporation of non-burn technologies where

availability is assured.

Preference of technologies with lower cost of

operation.

Training and awareness play a citical role.

Industry eager to fill in new markets with products.

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Non-Burn Technologies Being Used for Sharps

•On – site needle cutters and destroyers.

•On site Designed waste pits.

•Off site Waste encapsulation.

•On site and off site Autoclaving.

•On site and off site Micro waving.

•Off site Needle smelting.(Srishti study carried out for SEARO – WHO for evaluating above- Yr2002)

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Legislation applicable to Rural/peri urban settings in India

Mandatory waste management system by 31st

Dec’2002.

Segregation of waste at source.

Secured collection and transportation.

Deep burial allowed (in populations < 500,000)

Burning plastics/ especially chlorinated plastics

not recommended.

SIGN Cambodia Oct. 2002 8

Broad Rural Health Structure

Community Health Center (CHC)A 30 bedded Hospital/Referral Unit for 4PHCs with

specialized services

Primary Health Center (PHC)A referral unit for 6 sub centres

4-6 bedded

Sub Center (SC)Most peripheral contact point between Primary

health care system and community

District Hospital

Sub-District Hospital

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Coverage

Rural Population: 72.2% of total population (2001 census)

Community Health Centre: Caters to a population of 1.2 lakh. Approx 2600 nos.

Primary Health Centre: Caters to a population of around 30,000. Approx 23000 nos.

Sub Centre: Caters to a population of 5,000. Approx 36,258 nos.

Other Health Care Facilities: Missionary health care facilities and Day care clinics

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Types of Health Services

Routine Services provided in rural areas:

Day care/ observatory beds Laboratory investigationsTuberculosis centersMother and Child Care

Campaigns:

-Immunization drives

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Waste Types (based on survey of 5 centers)

Infectious Waste: Body tissues, Blood soaked cotton and gauze pieces and body fluids

Infectious Plastic: Disposable syringes, tubings, IV bottles and gloves

Sharps: Broken glasses and metal sharps like scalpels and needles

Average quantity of bio-medical waste/bed/day: 0.075- 0.1Kg

II. General Waste: Packaging material & food waste

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Exisiting Practices Waste Segregation:

•Waste is generally mixed in a single bin/bag.

•In some districts waste is being segregated into different categories.

Waste collection and storage:

•Open bins and drums.

•Bins are not bagged.

•Spills on floor at the time of generation.

•No regular pattern of waste collection and the waste is collected as and when required.

 

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Segregation at Source

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Existing Practices

Waste Transportation:•Waste is transported manually from point of generation to final treatment/disposal site.

•No protective gears are provided to the health care workers.

•No immunization/accident reporting.

Waste Treatment:

No specific waste treatment pattern is followed except in 2 cases.

 

SIGN Cambodia Oct. 2002 15

Existing PracticesWaste Disposal: Open dumping of waste around the health

care facilities

Open burning of waste

Scavenging of waste by waste sorters and animals

Furnaces for burning of waste in some PHCs

In facilities near urban areas waste is being carried by centralized facility

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Needle Destroyer

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Final Storage of Waste in a

Health CareInstitution

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Treatment and disposal methods observed:

• Encapsulation.

• Pit Disposal.

• Needle Devices – Destroyers/ cutters. • Small autoclaves.

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Deep Burial Pit

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Autoclaves

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Training and Awareness

Staff are not aware of the concept of waste management.

No specific training sessions on waste management.

No posters/awareness material provided at the health care settings.

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Interventions possible•Incorporating waste mgmt. into housekeeping and infection control.

•Raising occupational safety awareness.

•Training and capacity building for better

segregation.

•Resolving transport issues (onsite/offsite

decisions)•Incorporating safe-easy to use, low operating cost technologies

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Lessons, understandings and perspectives from the urban experience can be applied

to rural and peri-urban areas.