Om Prakash Ghimire

Managing wastes generated from hospitals and other health care facilities has emerged as one of the serious health issues globally. Such wastes are required to be managed separately considering their potential health hazards for the people. Combining these wastes with general ones poses additional health risks. It is challenging tasks to manage hospital wastes properly and reduce their potential risks as they may have an adverse impact on human health as well as the environment.
Numerous have been concerns raised at a recently held national workshop on Integrated Health Care Waste Management and WASH. Participated in by more than 300 participants the gathering was first of its kind in Nepal. Extensive discussions were held on integrated health care waste management at the initiative of the government. The workshop brought major health issues associated with hospital wastes to light and piled pressure on the authorities to address them with high priority.

National status
Currently, there are about 6,000 health institutions, including big hospitals and health posts, in Nepal. With the expansion of infrastructure and services, the quantity of wastes generated by this sector has been increasing every year. A survey conducted on some health institutions in various parts of the country, including Kathmandu following the 2015 earthquake revealed that 27 per cent of infectious waste generated from health institutions was mixed with general waste, increasing the infectious waste to 55 per cent.
The country’s health care sector produces about 1.35 kg of waste per patient daily. According to a study conducted by the Ministry of Health and Population, about 15 to 20 per cent of the waste generated by health institutions is contagious. The amount of waste production is even higher in developed countries. There is a lack of adequate disposal and management of such waste.
Only 84 per cent of health institutions have good water supply, according to another survey. It was conducted on the status of environmental health in 31 hospitals from 5 different areas of the country. The survey disclosed that only 45 per cent of toilets were functional, three per cent of hospital waste water was managed, and 35.5 per cent of health institutions had waste management practice. However, only three per cent of hospitals were found opting for an integrated waste management system. This shows that the condition of the integrated health care waste management is very poor in Nepal. The incinerated substance containing chlorine produces dioxins and furans adversely affect human health. Hence, the problems associated with hospitals can be minimised through proper waste management.
The mortality rate of patients suffering from non-communicable disease is 67 per cent in Nepal. Studies show that environmental factors have played significant role in spreading non-communicable diseases. Adverse environmental conditions are said to be responsible for nearly two dozen diseases. About 22-57 per cent of such diseases are associated with environmental factors. For example, 57 per cent of the causes of diarrhea have something to do with the environment. About 12.5 million people die worldwide annually. As per a report published by the World health Organisation (WHO), environmental hazards are responsible for about 23 per cent of the total deaths.
Such facts clearly illustrate the close link between human health and sanitation and cleanliness of the environment. Referring to the hazardous wastes being generated by health care facilities, Minister for Health and Population Bhanubhakta Dhakal said the number of people getting sick due to such wastes was much higher than those who get cured at the facilities.
It is the responsibility of all the federal, state and local governments to properly manage wastes generated from health care facilities. The Constitution has assigned them to regulate the health care institutions in an effective manner. Therefore, to seek a sustainable solution to the problem of health care waste management, there is a need for all the governments to have more effective policies. They also need to make necessary institutional arrangements and work in a coordinated manner. The workshop also came up with a 12-point resolution to addressing the issue with joint efforts from the government, the private sector, non-governmental organisations and the community. If dedicated efforts are made to translate the commitment into reality, the country will make headway in addressing the burning issue of the health care waste management.

Way out
The general public, development partners, and private sector have also committed to moving ahead hand-in-hand with the government to deal with this problem. The government should focus on integrated management of health care waste. The health facilities can join hands with the private sector to provide pure drinking water and improve the condition of sanitation and hygiene. Moreover, every health care facility must develop a health care waste management guideline and follow it strictly. An effective implementation of the recently adopted 12-point declaration will be instrumental in addressing the issue. An operational work plan needs to be developed in order to do away with the protracted problem of health care waste management in the country.

(Social science researcher/TV journalist, Ghimire is associated with Watchdog Media Services Pvt. Ltd.)