HCWM has been an integral part of the National Health Policy since 1998 and in 2000, the program started being implemented. Waste management is one of the indicators used in the Annual performance Review (APR) of the National Health Program.
Quantification of waste generated has been carried out and the following figures obtained:
- 0.64 kg/day/bed of general waste;
- 0.14 kg/day/bed of hazardous waste.
HCWM is being applied systematically in 4 Medical college hospitals and 20 District hospitals. The efforts focus on solid waste management for the time being.
1. Management / institutional aspects
At National level, overall supervision is carried out by the National Implementation Coordination Committee that works within the Ministry of Health.
At secondary and tertiary HCF level, it is the Director-Hospital & Clinics and Line Director-Improved hospital services management that are also in charge of HCWM coordination and supervision.
At primary HCF level, the Director-Primary health care and Line Director- Essential service delivery act as the reference persons for HCWM.
The above mentionned Directors work within the Directorate General of Health services. They have no specific manpower or vehicles allocated for HCWM.
2. Training aspects
Doctors, nurses, paramedics, cleaners, ward boys and support services are included in the training program and separated into three groups.
The standard program includes one day of theoretical information and another of practical training. Nurses, paramedics, cleaners, ward boy and support services receive an extra training on logistics.
The courses avoid one way information by including group discussions, etc. Overhead projectors and multimedia are used as training aids.
A draft training manual has been prepared and is currently being tested to identify possible gaps and ensure it is the most suitable possible.
3. Regulatory aspects
At National level, HCWM rules have already been drafted in local language («Medical waste management and handling rules») under the Environmental Conservation Act (1995). This rule covers both public and private sector HCFs.
These rules have already been approved by the Ministry of Environment and Forest and are now waiting for vetting by the Ministry of Law and Parliament. Once approved, they will be notified by Gazette.
At HCF level, guidelines for the logistics of HCWM have been issued as well as operational guidelines / pocket book for the nurses.
4. Financial aspects
At present the HCWM program is financed by the GOB and Development partners.
The MOH is taking further necessary steps to ensure sufficient resources of the HCFs are allocated to HCWM.
5. Technological aspects
The present final treatment and disposal technique used is the institutional based PIT disposal method.
A work group is defining centrally based treatment methods for very large cities.