Financing HCWM in small HCFs

Small HCFs, typically primary healthcare centres (PHCs) are particular cases in that they produce both limited quantities and types of hazardous HCW (mainly sharps, infectious waste and some pharmaceuticals…).

Human and financial resources being often very limited the management of waste at this level is usually dealt with by the doctor/ nurse in charge of the facility. Equipment to containerize waste and treat/ dispose it is usually reduced to the strict minimum: a plastic dustbin or cardboard boxes and a waste pit.

Despite these basic means, there is often room for improvements by:

It is often possible to reduce the number of unnecessary injections performed thereby diminishing drastically the production of sharp waste.

Even if all wastes end up in the same burial pit, separating sharps from other infectious waste is an advisable measure to avoid accidental needle-stick injuries to the HCF staff.

Different solutions exist, ranging from the use of needle removers or discarding the entire combination (needle + syringe) into a puncture-proof recipients such as empty plastic bottles or metallic paint cans, etc. if no specific containers are available.

In most cases the "choice" is limited to using a burial pit or a small-scale incinerator (SSI) such as the "de Montfort", unless the HCF can participate in a regional HCW treatment strategy. This will impact on the segregation practices and containers/ bags to be used.

Calculate and monitor costs

Although limited, expenses linked to the management of HCW should be carefully monitored so as to be able to prepare a meaningful annual budget.

A specific budget line should normally be allocated to HCWM.

Finding sustainable funds

If, ideally, HCWM expenses should be covered by the MoH and/or the MoEnv. budget(s), in many instances small HCFs will have to rely on local support either from an NGO and/ or the community [read more…]

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.

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.

Costing values

HCW treatment costs vary greatly depending on the amount of waste generated and the level of utilization of the treatment system. Calculations made by WHO in 2003 show that the cost per kg of waste incinerated with a SICIM can vary from 0.08 USD/kg to 1.36 USD/kg.