NATIONAL HEALTH CARE WASTE MANAGEMENT

(HCWM) PLAN

Longacres Lodge26th November, 2015

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Ms. Chilekwa MibengeChief Environmental Health Officer

Presentation outline• Current situation on HCWM• Effects of improper HWCM• Assessments of Zambian HWCM• Efforts towards improvement of HWCM• National HWCM plan• Health care waste financing• Conclusion

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Current situation on HCWM• The HCWM plan (2010 - 2014) was not successfully

implemented due to non availability of funding

• The non implementation of HWCM plan led to queries by parliament

• According to the MoH assessment (2013), HCWM is generally unsatisfactory at all levels of health care delivery

• There is no responsibility by most of the HF for the waste they generate to ensure safe, sustainable and environmentally acceptable methods for segregation, storage, collection, pre-treatment and transportation, and final disposal for both within and outside their premises

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Effects of Improper HCWM• The unsafe disposal of HCW poses public health risks

• WHO (2000); contaminated syringes caused 21 million hepatitis B virus infections (32% of all new infections)

• HCW containing polyvinyl chloride (PVC), if incinerated at >800oC lead to emissions of dioxins and furans and other toxic air pollutants

• Exposure to dioxins and furans may lead to :– impairment of the immune system; – impairment of the development of the nervous system;– endocrine system; and – reproductive functions

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Assessment of HCWM• Several assessments have been conducted on HCWM in

Zambia by several institutions; The World Bank HCWM Study in Zambia (2004-2006); WHO HCWM assessment (2011);Auditor General’s report findings (2009);MoH HCWM Assessment (2013)COWI/EIB Assessment (2015)

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Findings of the assessments• Most HF did not maintain records of the quantities of waste

generated

• Colour coding and labelling not adhered to

• Improper and ineffective treatment of HCW

• No orientation of members of staff in HCWM

• The current HCWM guidelines need to be revised /updated

• Inadequate funding and equipment

• No maintenance for defective equipment (e.g. incinerators)

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Efforts towards sustainable HCWM• Improvement of Water, Sanitation and Healthcare Waste

project for Public Health Facilities in Zambia - Supported by the EIB

• Reducing UPOPS and mercury releases from the health sector in Africa project supported by the GEF/UNDP

• ZHSIP working in 5 provinces: Northern, Western, North- western, Luapula and Muchinga Provinces, however Eastern, Central, Lusaka, Southern and Copperbelt are NOT covered

• The MOH has revised and updated the HCWM plan and through planning will support the implementation of some of the activities of the HCWM plan (2015-2019)

 

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National HCWM plan 2015-2019• The overall objective of the plan is to develop a National

Plan that will mobilize resources and build capacity for reducing health risks in a sustained manner, while at the same time being open to technological options that promote sustainable development

• Total budget :$43,056,644.58

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Regulatory framework• The plan is based on the principles of the National Solid

Waste Management Strategy (NSWMS) for Zambia (2004)

• Environmental Management Act of 2011 (EMA 2011)

• Public Health Act Cap 295 (PHA Cap 295)

• Environmental Management (licensing) Regulation (Statutory Instruments No. 112 of 2013)

• Ionizing Radiation Protection Act No.19, of 2011

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NHCWM plan focus• Create an enabling environment in which compliance to the

legal, policy and administrative framework and SOPs on HCW is adhered to and sustained for the protection of both the patients, workers and communities

• Ensure that health facilities comply to health management through the development of sense of ownership and exercise the ”polluter pay principle”

• Regularly conduct assessment and examine gaps in management of HCWM practices in HFs and local authority disposal sites

• Quantify the amount of HCW generation in HFs• Enhance access to efforts of Private Public Partnership (PPP)

in HCWM

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NHCWM plan focus• Provide appropriate equipment and materials for HCWM

systems i.e generation, storage, collection, treatment and disposal in order to ensure minimal risks (or no risk at all)

• Refocus the traditional methods and broaden the technological options of dealing with HCWM in line with the MoH vision of upgrading HFs

• Explore the options of dealing with HCW that are climate change sensitive

• Prepare a costed HCWM plan taking into consideration of PPP in relation to cost recovery based on the polluter pays principle

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Benefits of the plan• Addresses gaps identified in the current HCWM practices

• Seeks to move towards friendlier and smarter environment technologies that reduces pollution in the environment

• Zambia is a signatory to the Climate Change conventions addressing impact of pollution on climate change hence the need to commence embarking on smart technologies such as non incinerable waste for category of waste

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Factors should be used in the Selection of Treatment Methods

• Types and quantities of waste for treatment and disposal• Capability of the healthcare facility to handle the waste

quantity• Technological capabilities and requirements• Availability of treatment options and technologies • Capacity of systems.• Treatment efficiency (microbial inactivation efficacy)• Occupational health and safety factors• Environmental releases• Volume and/or mass reduction• Installation requirements• Space available for equipment

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Factors should be used in the Selection of Treatment Methods• Operation and maintenance requirements• Infrastructure requirements• Skills needed for operating the technology• Location and surroundings of the treatment and disposal

sites• Options available for final disposal• Public acceptability• Regulatory requirements• Capital cost of the equipment• Operating and maintenance costs of the equipment• Other costs including costs of shipping, customs duties,

installation, commissioning /decommissioning, transport and disposal of residues

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Recommended technologiesType of health institution

Recommended technology at various levels

Private health care facilities

This will depend on the level and location of the institution i.e. clinic, health centre/ hospital and rural/urban setting

Health Post Land disposal with safe burying with provision and use of liners to prevent ground water contamination

Health Centre (Rural)

Land disposal with safe burying with provision and use of liners to prevent ground water contamination

Brick incinerator Where there is electricity, free-burn incinerators are recommended.

Health Centre (Urban)

Land disposal with safe burying with provision and use of liners to prevent ground water contamination

Chemical disinfection Rotary kiln incinerator Where there is electricity, free-burn incinerators are recommended.

First Level (District Hospital)

As for Urban Health Centre

Second Level (General Hospital)

Land disposal with safe burying with provision and use of liners to prevent ground water contamination

Pyrolytic incinerator Chemical disinfection Wet thermal or steam treatment Free-burn Incineration

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Recommended technologiesType of health institution

Recommended technology at various levels

Third Level: (Central Hospital)

Land disposal with safe burying with provision of liners to prevent ground water contamination

Pyrolytic incinerator Chemical disinfection Wet thermal or steam treatment disinfector Microwave irradiation for teaching hospital One waste collection vehicle per institution

National Reference: (University Teaching Hospital), Regional: (centralized) waste disposal sites (Lusaka and Copperbelt provinces)

As for third level, except the number of units will be twice those at level three

Two waste collection vehicles Free-burn Incineration Three at each station of either Pyrolytic incinerator or incinerator 350 to

1000 LA wood / coal fired. Four waste collection and two utility vehicles per station Free-burn Incineration

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Non Incineration Treatment Options• Non-incineration technologies are used to disinfect infectious health-care waste, while avoiding the formation and release of dioxins

1)Low heat Thermal: Autoclaves2)Chemical: Dissolved chlorine dioxide, bleach, lime solution or dry inorganic chemicals

3)Biological: Composting,vermiculture (digestion of organic wastes through the actions of worms), bio-digestion, natural decomposition through burial

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Non Incineration Treatment Options4) Irradiation: Batch and continuous microwave systems

5) Mechanical: Shredding, grinding, mixing, and compaction

6) Inertisation (Stabilisation): Mixing waste with a mixture containing lime, cement and water in order to minimize the risk of toxic substances

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Health care waste financing• The plan is expected to be implemented with financial

support from the Government Republic of Zambia

• Funding will also be supplemented by the World Bank through the Zambia Health Services Improvement Project (ZHSIP), , Water Supply Sanitation and Healthcare Waste (WSSHW) Project for Public Health Facilities (EIB), UNDP and GEF through the UPOP project, UNICEF and WHO

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Conclusions • Health-care waste includes all the waste generated by

health-care establishments, medical research facilities and bio-medical laboratories and thus requires a lot of support is lives are to be prevented

• The HCWM plan has since been submitted to ZEMA for them to conduct a Strategic Environmental Assessment that shall assess the potential environmental issues arising from the plan

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WebsitesAccess and downloading:•http://www.moh.gov.zm/publications/

Comments :•http://www.moh.gov.zm/nhcwmp/

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THANK YOU!!!!!!

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