In the whole world there is a trends of rapid urbanization
and it should be addressed accordingly. So local government
in the cities are facing the challenges to provide the
basic services to the city dwellers. Among the services one
of the major components is solid waste management and
hospital waste is the most risky among the urban waste. A
portion of HW might be so hazardous, which causes a
health risk for the urban dwellers. It is one of the important
factors, which effects the urban environment. So if we talk
about solid waste management, clinical/hospital waste
management should get the highest priority. Keeping pace
with this urbanization, the numbers of hospital, clinics and
pathologies have also been increased. These organizations
are producing a huge amount of hazardous waste

Monir A. Chowdhury (7221764)

English

Loughborough University Institutional Repository

CHOWDHURY5528th WEDC Conference Kolkata (Calcutta), India, 2002A participatory approach to hospital waste managementMonir Alam Chowdhury, BangladeshSUSTAINABLE ENVIRONMENTAL SANITATION AND WATER SERVICESIN THE WHOLE world there is a trends of rapid urbanizationand it should be addressed accordingly. So local govern-ment in the cities are facing the challenges to provide thebasic services to the city dwellers. Among the services oneof the major components is solid waste management andhospital waste is the most risky among the urban waste. Aportion of HW might be so hazardous, which causes ahealth risk for the urban dwellers. It is one of the importantfactors, which effects the urban environment. So if we talkabout solid waste management, clinical/hospital wastemanagement should get the highest priority. Keeping  pacewith this urbanization, the numbers of hospital, clinics andpathologies have also been increased. These organizationsare producing a huge amount of hazardous waste.BackgroundIn Bangladesh the authorities responsible to manage thishazardous waste cannot perform their job efficiently for lotof limitations. Generally the hospital wastes are beingmanaged with the domestic waste. It is disposed in the opencommunity bin along with the normal waste. It is com-monly scavenged by the boys/girls without any precaution,which might cause health hazard and infectious disease forthe poor. Doctors, nurses and cleaners in the health insti-tutions can also be affected from hazardous waste. Prodipanan NGO took a noble initiative to start a clinical wastemanagement service in Khulna city, situated in the southernpart of Bangladesh. Prodipan felt it when it was developinga community based solid waste management in the city.ApproachInitial approaching to initiate a clinical waste managementservice was not an easy task. The clinic and pathologyowners used to dispose of their waste in the community bin,which was very easy for them. So once we approached it tothem, they were very reluctant towards the service, becausethis would  require additional care, workers and money.We conducted detailed survey to assess the whole situationof hospital waste management. Then the dialogue wasinitiated with different stakeholders related with the serv-ice, Khulna City Corporation, Bangladesh Medical Asso-ciation, Clinic/Pathology Owners Association and all theowners of clinic and pathologies. With the participatoryappraisal, project organized a number of meetings, roundtable discussion and workshops to motivate the authorityto bring them under CWMS. At one stage the owners wereconvinced and put the recommendations to initiate theservice. But again when question came of financial contri-bution, the majority owners of clinic and pathologies saidno to the service. Various initiatives took place to convincethem. Finally City Mayor took the initiative to call everybody in a meeting and urged them to participate in theservice for the betterment of the city dwellers.ServiceFinally in a very participatory way Prodipan started theservice with 20 clinics and pathologies out of 80 privateclinic and pathologies in the city. The president and secre-tary of the clinical owners association settled amount ofservice charge from the clinic and pathologies. The benefi-ciaries had to involve extra labor, manpower and manage-ment to participate in the service. A colorful inaugurationwas made on 13th May 2000 at 1500 hrs in a local hotel.Khulna. City Mayor was the chief guest of the program.In three stages the service was implemented:? Separation at source? Collection and transportation? Systematic treatment and disposalSeparation at sourcesTo ensure a sound hospital waste management, separationat source is a prime condition. So project tried to train theconcerned staffs of Clinic/pathologies to do it properly.They do it in four ways:? Needle and sharps: A plastic bottle is supplied todispose this waste along with a bottle stand. After fill itup, the service staff collect it.? Syringe, saline bag and other plastic: These are beingkept in the covered plastic bin and cleared by the stafflater.? Gangue, Bandage, Human organ, paper materials andothers: This also kept in the covered plastic bin andcleared later.? Kitchen waste: It is kept outside within a plastic coveredbin. In case of big clinics, it is cleared by the communityservice with the other domestic waste. Small quantity iscleared by the CWM service.Collection and TransportationOnce the waste is kept properly, it is very important tocollect and transport it systematically. One collector alongwith a van driver performs this job. One supervisor looksCHOWDHURY56after the overall service. The collectors are equipped withmask, hand gloves and long boots. Normally the staff starttheir collection in the morning at 0800 hrs every day fromsame clinic and same time. Collectors carry two buckets totake the waste from the clinic/pathologies.Project has procured a specially designed auto van totransport the waste up to disposal site. One driver andcollector are engaged with the van. It has been developedwith four blocks. After collecting the waste it is transportedto the disposal site, which is eight km distance from the city.A systematic treatment and disposalAfter collecting the clinical waste properly, sanitary dis-posal is very important. To have land, project approachedto KCC to allocate a piece of land in their final disposalpoint. Khulna City Corporation has allocated a piece ofland in their disposal site. It is about 8 kilometers south ofthe city. Project has fenced the disposal ground. There is aconcrete blocked box to dispose the needle, syringe, sharp,glass type waste and other plastics. It has been made toprotect the illegal reuse. There is another box to dispose thewaste other then plastics.? Burning pit: There is a local made single chamberburning pit. As the incinerator is too costly to procureand use as well, so to destroy the hospital waste projecthas installed the burning pit. It is a bit safer, as it hasbeen installed in the disposal site. Hospital wastes otherthen plastic are burned here. This type of burning unithas the following main activities:? Removal of ashes left inside the ash chamber.? Manual loading of waste packages to be incinerated? Operate the ignitionThe brick made furnace has the following components:? Chimney (15 ft height)? Burning chamber? Flap lid? Fire bar? Ash chamberAt a time it can burn 30 kgs of waste.? Shredder Machine: It is important to give the priority onthe treatment options, once the collection is doneproperly.  One of the major risks is reuse the syringe andother plastics illegally. To protect that project hasprocured a shredder machine. This has become a tech-nical development towards establishing a healthy hos-pital waste management. Before giving it for shreddingthe syringe are washed by the bleaching power. Aftercutting the syringe in pieces, there is a possibility ofrecycling it.Financial mattersService charge collectionTo make the service cost effective, it is very important tolook into the financial contribution from the beneficiaries.Service charge was imposed from the clinic and pathologies.In the first stage few clinics and pathologies were opposedto paying the service charge, but seeing the service veryregular and quality, they paid the service charge.The clinic and pathologies are paying service charge, as perthe capacity, ranging from Tk. 150.00 to Tk.600.00 permonth. So total income per month is about Tk. 6100.00Still the service is expending about Taka 10,000 permonth, but income per month is about Taka 6100 permonth still there is a difference between income andexpenditure of the service. The clinical waste managementcommittee initiating dialogue with the city mayor to ar-range the fuel support from KCC. If it is possible, then theservice will be cost effective. Simultaneously initiatives arecontinuing to enroll other clinic and pathologies with theservice. Also the existing service charge expected to beincreased with mutual understanding.We took certain steps to make the serviceeffective.A) Training for the clinical staffs: We have organized anumber of training for the  Clinical staff like, nurses,cleaners and management staff. It was very hard tomake the service effective without having skilled staff.Clinic and pathology authority also expressed theirsatisfaction on the training.  We have already developedsome papers and photograph and made transparenciesfor conducting training. Up to the year of 2001, weorganized the training for the individual clinic andpathologiesB) New enrollment in the service: In the year of 2000 westarted with 20 clinics and at the end of the project nowwe are running with 25 clinics and pathologies. Thereis a demand from other clinics and pathologies but wecould not take it due to the limitations in the transport.C) Approach to government hospital:  As the governmenthospital is generating a huge quantity of waste, so weapproached to them. They agreed in principle. Wediscussed this matter with KCC. Honorable Mayor toldus to give a transport for this, but finally KCC could notgive it for their limitations.Government hospital also having lot of formalities toenroll them with the service, like permission from con-cerned directorate and arranging fund to contribute for theTable 1. Service charges collected in first 18 months1st six months 2nd six months 3rd six months Tk.30, 900.00 Tk. 29,420.00 Tk.35, 190.00 CHOWDHURY57service.  So they were convinced to start the service withtheir hospital. Even we provided training to the doctors,nurses and cleaners about how to maintain a healthyHWM. But for the unavailability of the sufficient transpor-tation, we could not intervene the service with govt. hospi-tal.D) Position of KCC: It is true that Mayor took a verydynamic role to initiate the service in KCC area. ButKCC could not take step to enroll the other clinic andpathologies with the service. They have also the re-source limitations and lack of coordination with theother govt. body particularly the department of Envi-ronment.Learninga. To make a program successful, it should beparticipatoryb. There should be good coordination between city au-thority and the concerned stakeholdersc. Service must be regular and qualitative to ensure theparticipation of the beneficiaries.MONIR ALAM CHOWDHURY, Project Coordinator,Municipal Solid Waste Management Project, Prodipan,Khulna, Bangladesh.d. They must contribute financially which will develop theownership among them.e. In case of underdeveloped country, the program likehospital waste management should initiate with lowtechnologyf. The program should start with small area and subse-quently replicate in the other area.g. It is very important to impose the strict law from theconcerned authority to participate with the process.h. A massive awareness movement should continue.i. Different treatment options should initiate gradually.

A participatory approach to hospital waste management

https://repository.lboro.ac.uk/articles/A_participatory_approach_to_hospital_waste_management/9588305/files/17227376.pdf

A participatory approach to hospital waste management

Abstract

Similar works

Full text

Available Versions

Loughborough University Institutional Repository