1. SITUATION OF HEALTHCARE WASTE MANAGEMENT IN NEPAL AND AN EFFORT FOR IMPROVEMENT AT RESOURCE POOR SETTINGS JAYENDRA BHATTA PROGRAMME OFFICER/CIVIL ENGINEER GTZ-HSSP/PAM, KATHMANDU NEPAL

2. Map of Nepal slide 2_NepalMap

3. Healthcare facilities in Nepal: Public Sector Hospitals 280 Health post & SHP 3860 Out reach clinics13700 Total Beds4458 Bed Occupancy rate72% Private Sector Specialty,NGO,Mission123 Total Beds3804 Bed Occupancy rate50% Total Beds8262

4. 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

7. Situation of healthcare waste management in Nepal Total HCF surveyed 346 Central, Regional, Zonal,Teaching 30 District hospital33 Primary Healthcare Centers52 Health Post86 Sub Health Post145

8. 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

9. slide 9_photo

12. Situation of Healthcare waste management in Nepal contd.. Waste pit disposal system21% Open dumping and burning69% Using municipal containers60% Incinerators not functioning70% Waste segregation in practice2% Knowledge of legal responsibility0.6%

17. 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.

18. 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 services2280 Kg/day

19. 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

23. 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

25. 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)

26. R.C.C. SLAB REMOVABLE TO CLEAN THE PIT IN LONGRUN METALIC CHIMNEY (HEIGHT AS PER SITE CONDITION) PROTECTION WALL WET 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 GAP 4.5” HT BRICK WALL WET 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” 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

28. Simsar Ponds

31. 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” 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”