Financing HCWM in large HCFs

Teaching (University) hospitals due to both their size and the diversity of medical activities carried out require specific HCWM systems to be put in place. Such HCFs should idealy serve as models and support centers that can help "coach" smaller units in the region they cover.

According to the "Polluter Pays Principle", the waste generator (each HCF) must pay for all the costs associated with the appropriate treatment and disposal of their HCW. This basic principle stated, the question is how to keep these costs as low as possible. Here are a few hints.

Optimizing current practices to lower operating costs

Also large HCFs usually have more financial resources at there disposal, it is nevertheless important to optimize the existing system through the following steps.

Carrying out an in-depth study of all the waste streams of the HCF can help determine what alternatives can be taken with regards to source reduction, reuse and recycling. The aim here isn't just to reduce the quantity but also the toxicity of waste produced (which diminishes both disposal costs and hazards to health workers and the environment).

If initial costs of materials that can be reused are likely to be higher, the savings in terms of reduced quantities to be purchased and eliminated can mount to hundreds or even thousands of USD per year.

This requires proper training of staff which has a cost. The medium - long term benefits are nevertheless obvious. Such training will also result in better understanding of waste streams and improved operations for the HCF as a whole.

Investing in waste segregation (mainly a training issue) that requires having appropriate containers for each waste category is the best way to reduce treatment and disposal costs significantly.

Expenditures typically include:

  • Purchase of color-coded containers/ bags (+ eventual labels);
  • Training of HCF staff;
  • Personal protective equipment (PPE);
  • Storage spaces within the facility;
  • Packaging and transportation costs, if waste is treated off-site.

The segregation structure as well as the type of containers used will depend to a large extent on the HCW treatment system chosen. Will needle cutters be used to separate the steel needle from the plastic syringe for subsequent recycling or is the entire combination going to be disposed of into a sharp box to be autoclaved, encapsulated or incinerated?

As mentionned earlier, the choice depends on numerous parameters that vary from one area to another and should be carefully assessed.

Before choosing a HCW treatment system, there is an initial point that needs to be decided upon: does one favor on-site or off-site treatment ?

If the costs between on and off-site treatment options can be similar or quite different depending on the context, the advantages of an on-site system are that it complies with the "proximity principle"; provides better control over how HCW is treated and gives complete control of the total treatment costs.

The drawback is that one has to take into account the following costs:

  • Installation and facility costs, including security costs;
  • Labor costs to operate the treatment and disposal equipment and personal protective equipment required for this task;
  • Operating and utility costs such as fuel, electricity, water, etc;
  • Costs of pollution control equipment, permitting, compliance and monitoring fees… and eventual fines;
  • "Down time" costs including repair (parts and labor), and alternative treatment;
  • (see final disposal costs below), etc.

Off-site treatment, on the other hand, has the advantage of enabling the HCFs to concentrate on its core medical activities; reduces risks of on-site pollution and avoids having to reserve a protected area to treat waste; it also avoids one having to take into account the costs listed above.

When evaluating treatment options, it is important to take into account final disposal costs that can vary significantly depending on the treatment system used: if incineration reduces significantly the volume and weight of waste left, the ashes can still contain certain toxic components; steam sterilization systems that don't include dryers may even increase the weight of waste to be disposed of, etc.

Final disposal costs typically include:

  • Construction of temporary storage and hauling areas for treated wastes, including security costs;
  • Labor costs for hauling, waste documentation and maintenance of temporary storage areas;
  • Transport containers and hauling costs;
  • Landfill tipping fees and/ or costs of encapsulation, inertization, septic vault, etc.

 

Financial sustainability

Finding funds for the required initial investments is often easier than being able to mobilize resources to ensure medium-long term financial sustainability [read more…]

It is therefore critical for each HCF to estimate what financial resources it can realistically rely on before setting up a system and purchasing equipment that can't be maintained in the long run due to insufficient funds.

If, ideally, recurrent costs and amortization should be covered by MoH and/ or MoEnv. budget(s), local recurrent costs in most HCFs are often best covered by local recurrent budgets. Hospitals should therefore budget for their own recurrent HCWM costs.

Looking into possible partnerships with surrounding HCFs to set up and use a common HCW treatment system when no private operators exist are simple yet effective ways of sharing costs.

Financial monitoring

Keeping track of what HCWM costs is the best way to: [read more…]

  • Ensure one will have the required funds to maintain the system (one can't budget something who's cost is unknown);
  • Gain support from potential external donors by showing them that funds are properly tracked and well managed;
  • Optimize the current system in terms of cost-effectiveness by being able to compare current expenditures with those linked to an eventual other technical/ management system.

To simplify this monitoring task, a specific HCWM accounting line is strongly recommended.