Financing HCWM

In most LEDCs (Less Economically Developed Countries), resources spent on HCWM are extremely limited. The activity is rarely included in the public health budget and HCFs are often not allocated any or insufficient funds to ensure the safe management and disposal of healthcare waste (HCW) [read more…]

Allocating insufficient financial resources to manage HCW properly has an even greater financial cost on the medium-long run in terms of morbidity and mortality as well as environmental damage, that will, in the end, impact negatively on peoples’ health.

For equity reasons, measures should be taken in all areas/ regions and not only urban centres.

This costing/ financial section has three aims:

  • Provide a rational for investing in HCWM;
  • Help set priorities/ identify the most cost-effective measures that can be taken and list the steps that should be taken;
  • Provide a set of tools to help estimate/ calculate the financial resources that will be necessary to set up an effective and sustainable HCWM system.

Rational for investing in HCWM

The reasons to invest in healthcare waste management are:

Knowing that over 23 million infections of hepatitis B, C and HIV occur yearly due to the use of contaminated syringes, managing and disposing infectious HCW and sharps in particular in a safe and environmentally-friendly manner becomes a moral obligation.

International agreements and principles, in particular the "Polluter Pays Principle" provide clear incentives for sound HCWM.

At national level, Constitutions, environmental and health laws and regulations normally provide the necessary framework that obliges both public and private health actors to manage HCW in a safe way. Investing in HCWM is therefore a legal obligation.

The consequential costs to rectify the effects of poor HCWM are also often not recognised. As with most pollution/ public health related issues, "preventive" measures usually cost less than "curative" expenditures…

Financial aspects related to HCWM should be analysed not only in terms of cost-effectiveness but also cost-benefits: investing in HCWM is an investment for improved public health.

Prioritizing cost-effective measures

At different steps along the HCW stream, simple actions can be taken to help reduce overall HCWM costs with limited financial investments.

"The less waste you produce and the more you recycle/ reuse, the less you will have to spend on HCW treatment and final disposal" is another way of formulating what waste minimization is about.

Actions should be taken both before waste is generated (also called "source reduction") - through efficient purchasing policies and good stock management (which are effective ways of reducing purchasing, storage and elimination costs) - and after, by recycling or reusing non-hazardous materials.

In many countries, a high percentage (up to 70-90%) of the injections administered are unnecessary, either because the substance injected is inappropriate (such as injecting vitamins to address fatigue) or because the substance can be given in non-injectable (primarily oral) form. Reducing the number of unnecessary injections is a high priority issue. It will not only help eliminate an important number of unsafe injections (see point 4) but will also reduce purchasing costs (injection equipment) and waste treatment and disposal costs significantly.

Proper HCW segregation and containerization is one of the most critical actions in terms of security and cost effective, since this reduces significantly the amount of waste that needs specific and costly treatment (treating HCRW costs approx. 10-20 times more than general waste).

In most instances, implementing a simple three-bin system (with appropriate colour-coding) will already introduce significant improvement:

  • Sharps (yellow or red containers)
  • Infectious HCW (yellow or red bags/ bins)
  • General non-infectious HCW (black bags/ bins)

If a number of low-cost solutions exist such as burial pits, they may not be sustainable due to space constraints for example. It is therefore critical to take into account the different parameters that will help select the most appropriate system for medium-long term sustainability.

Whenever possible, implementing a regional centralised HCW treatment policy through the installation of larger units is not only more cost effective, reduces the amount and number of point sources of pollution, but also renders monitoring of these treatment facilities easier to carry out.

The technical database provides costing information (capital and recurrent costs) as well as capacity data that can be used to help select the most appropriate solution for a given setting.

Each year some 16 billion injections are performed worldwide for both the curative and immunization sectors. Due to both the high percentage or needle reuse (approx. 40% of all injections globally) and the number of needle-stick injuries, some 21 million hepatitis B (30 percent of all new infections), 2 million hepatitis C (40 percent of all new infections), and over 1/4 million HIV infections (5 percent of all new infections) occur each year.

As published in a WHO study (Bulletin 81(4), 2003: p. 277-285), the cost-effectiveness of implementing safe and appropriate use of injections (which includes sharps waste collection and management) has been demonstrated.

Currently, it is estimated that for each injection 0.01 USD is spent on sharps waste disposal interventions. By investing 0.04 USD per injection to improve current disposal systems, one could reduce significantly the current public health burden caused by this especially hazardous HCW category.

Investing in sharps waste management is a critical component of injection safety and shouldn’t focus only on immunization services that represent only a fraction (approx. 6% of all injections) performed.