Hi- Tech Centralized Facilities in Developing Countries Are they realistic? Ravi Agarwal Srishti and Health Care Without Harm

SIGN WHO meeting August 29, Indian Urban Context Nature of Facilities Diverse ( 2 beds to over 1500 beds). Beds divided between Govt. and Private sectors. Located amongst Residential Areas. Low Medical waste generation per facility. Low technical skills available. Cost of on-site facilities high. Siting difficulties.

SIGN WHO meeting August 29, Urban context ….. Growing regulatory pressure to comply. Public/media averse to dumping of medical waste.

SIGN WHO meeting August 29, Centralized/Shared facilities ….. enabling factors Legally permitted under new legislation. Demand from private and medium/ small facilities. Minimizes individual facility capital expenditure requirements. Eliminates need for trained operators. Minimizes additional space requirements.

SIGN WHO meeting August 29, ……. Easier compliance/licensing from regulatory authorities. Facility can concentrate on in –house needs segregation/training/occupations safety/ sharps management. More predictable cash flow planning. Eliminates problems of over an idle capacity.

SIGN WHO meeting August 29, Operator participation enabling factors Guaranteed waste quantity for sizing. Accessible site to minimize transport. Final disposal site. Secure and safe transport. Timely collection and efficient route planning.

SIGN WHO meeting August 29, …….. Regulatory authorizations. MOU with multiple civic agencies/ environmental/ municipal/ land/ transport.

SIGN WHO meeting August 29, The Delhi Experiment: Background Over 25,000 beds. Over 1500 facilities, dispersed over 1500 sq km. (> 500 beds: over 30, > 100 beds: Over 200) – Rest: clinics, blood banks, path labs, dispensaries, nursing homes etc. 60 tonnes/ day waste – 15 tonnes/ day infectious 59 incinerators new and old, 11 Autoclaves

SIGN WHO meeting August 29, Centralized Facility 2 operators – 1200 clients and 100 clients. 4 leased (3 govt) facilities with excess capacity (incinerator and autoclave). Rs 3 per bag per day cost of collection. Dedicated collection vehicles. Bags supply, collection, treatment, disposal. Providing basic training to facilities. 2 year lease contract.

SIGN WHO meeting August 29, Hyderabad Experiment 2 centralized facilities (incinerator plus autoclave). Of 454 facilities coverage of ,500 beds covered (5500 and 8000). 1.3 tonnes waste per day. Cost Rs 2 per bed per day. Incinerator/ Autoclave combine.

SIGN WHO meeting August 29, Health facilities still have to.. Have top management commitment to waste. Involve personnel for proper segregation. Conduct ongoing Training. Ensure safe transport and storage within hospital. Equip for segregation, occupational safety, sharps management, disinfections where needed. Ensure ongoing monitoring and improvement.

SIGN WHO meeting August 29, But now can… Concentrate on critical in-house issues of waste management and minimization. Avoid developing non-related technical expertise. Pay on waste generation basis rather than on fixed capacity basis. Ease regulatory requirements.

SIGN WHO meeting August 29, Issues Questions of liability unresolved. Quality of service not established. Viability of operator economically Health faculties tend to pass responsibility- lead to in-hospital apathy.

SIGN WHO meeting August 29, Conclusions High tech centralized facilities can help provide essential service in waste management in urban settings. They must be installed using appropriate technology mixes and their capacities. Quality standards of operation have to be ensured both through standardization of protocols as well in choice of operators.

SIGN WHO meeting August 29, Finally High Tech Centralized Facilities to succeed have to be viewed only as a component, albeit a critical one, of the overall waste management hierarchy which extends from waste minimization, on-site segregation at point of disposal to final treatment and disposal offsite