Financial ressources

At national level, once an initial assessment of the HCWM situation prevailing in the country has been carried out and an efficient management structure been put in place, the following steps should be taken to ensure the healthcare waste management efforts have the required financial resources to be sustained on the long run.

To get detailed information about each step, click on the title.

Using either the initial estimations or simplified system costing method, figure out the foreseeable capital and recurent costs for the set up, progressive expansion and sustainable operation of the HCWM system

With first costing elements in hand, finding funds for both the initial capital investments (training, purchase of equipment, etc.) and long term recurrent costs requires investigating and lobbying the different sources of funding available, both external (International and non-governmental organisations) and internal (governmental and private):

  • List what could be financed externally by immunization partners (using the "polluter pays" principle, whereby programs would be required to contribute a per-syringe fee to the country’s medical waste management system);
  • Investigate to see how Inter-agency Co-ordination Committees (ICCs) could help mobilize external funds;
  • Discuss what internal mechanisms could be used by the Government to cover HCWM costs such as additional charges on medical supplies for waste disposal;
  • etc.

In most situations, external initial capital support will be conditioned to Government commitment for medium-long term recurrent expenditure coverage. By teaming together, the MoH and MoEnv will be more effective in their lobbying efforts to obtain this necessary financial support.

As already mentioned, the creation of a specific budget line for HCWM at all levels of the accountancy from MoH to HCF is the only way to be able to track expenditures and prepare meaningful budgets to obtain the resources required.

The HCWM budgets prepared by HCFs should be aggregated at regional/ national level to help prepare the annual national HCWM financial envelope to be requested.

After 2-3 years of implementation and the availability of more abundant and detailed data, it should be possible to perform more precise calculations that can start being used to measure cost-effectiveness and later on cost-benefits of the HCWM system at national level.

Ideally both recurrent costs and amortization to ensure capital equipment replacement should steadily integrate into the MoH and/ or MoEnv budget(s).

As a rule, it is better to set up a simple HCWM system that can be sustained financially in the long run and improving it progressively than aiming too high and not having the funds to keep it working smoothly.

Ensuring that waste treatment installations comply with the regulatory framework requires regular surveillance.

Charging a levy for environmental monitoring of permit holders, in particular in instances where non-compliance requires increased frequency of inspections is a means of financing this important task. The fees levied should reflect actual costs.

Having a regional approach for the treatment of HCW is in many instances a more cost effective solution than developing small units at HCF level. Studies show clearly that HCW treatment costs depend mainly on the level of utilization of the treatment equipment.

This strategy that is typically suited to urban and densely population areas is nevertheless strongly dependent both on transport means and road conditions as well as the involvement of private operators.

To encourage HCFs to optimise segregation and the overall management of HCW, financial incentives can be envisaged if training and awareness efforts don't seem sufficient to induce lasting changes.