Details for Reform Option "Biomedical waste management at Community Health Centre, Himachal Pradesh"
Biomedical waste can pose numerous health and safety hazards to patients, health care providers and to the community at large. In response to the threat, the Government of India passed the ‘Biomedical waste (management and handling rules) 1999’, under the Environment (Protection) Act 1986. However, very few health institutions are implementing them properly because of a lack of awareness and difficulties at the institutional as well as operational level such as lack of resources, including personnel, space and equipment, lack of technical knowledge for scientific waste disposal. In addition, waste disposal is monitored by the Pollution Control Board and Environmental Ministry which has no linkage with the Health Department.
Keeping in view the potential health and safety hazards associated with biomedical waste and the legal urgency to abide by the rules, a model programme of Biomedical Waste Management (BMWM) was launched at a Community Health Centre (CHC) Daulatpur in Una district in April 2004, under the Basic Health Project of the German development agency GTZ.
Selection of CHC in Daulatpur was based on the following criteria:
(i)It was an average hospital so other facilities could identify with it and follow its lead.
(ii)It was a difficult case to work on because of adverse media reporting and overflowing hospital waste.
In order to overcome both institutional and operational difficulties, a Non Governmental Organisation (NGO), the Energy and Environment Group (EEG) was hired by State government for one year. They formed an 8-member committee, which was made responsible for implementing, training and ensuring sustainability of the new programme.
The first step was the planning phase which included:
(i) Assessment of the waste production in the health institution
(ii) Evaluation of the existing practice
(iii) Estimation of the required equipment and supplies
(iv) Development of formats for monitoring, supervision and record management
(v) Defining responsibilities of staff.
This was followed by the procurement and setting up of equipment and supplies.
Simultaneously with the procurement of equipment, in house training of staff at all levels was organised, with special focus on the principals of waste management such as segregation of the waste from the point of generation to point of disposal, disposal method of the waste etc. Training was the vital step in the implementation of the BMWM. After the initial training frequent orientation/refresher training programmes (twice in a month) was required at least for about six months to enable people to get used to the new system.
Results:Proper disposal of waste generated in the hospital has resulted in clean and hygienic health facilities and has reduced the potential risk of exposure of the staff and patients to nosocomial infections. In terms of visible impact, change in the hygiene of the health facility before and after the programme is seen in the attached photograph (see References). For objective indicators for change, the hospital has data, but has yet to analyse.
GTZ’s Basic Health Project financed this model programme. The cost for setting BMWM was INR 63,000 per annum for a 50-bedded hospital. This includes various equipments, deep burial yard with 4 pits, IEC Material, one time training cost and quarterly supply of the bags.
Pilot programme is in operation in CHC Daulatpur, District Una,Himachal Pradesh from April 2004.
Around two months for orientation of staff, planning and procurement of equipment and supplies.
Reduced risk of exposure to potential hazards: The potential risk to all associated with biomedical waste is lowered.
Quality of healthcare services: After the initialisation of the Waste Management Programme visible improvement in services was noticed. As a result, the infection rate at the hospital level has gone down.
Improved environment: The working environment of the hospital is cleaner and better.
Staff dissatisfaction: The system may increase their workload.
Willingness of the health care institution to participate. Motivated health staff that want to work for a better hospital environment. Committed resources (personnel, space, equipment and supplies) to ensure sustainability.
Quality training is a vital step in implementing BMWM. The staff should also accept and be committed towards the new system.
Who needs to be consulted
Pollution Control Board and the relevant authorities from the Health Department.
Sustainability depends upon the commitment of the head of the health institution as well as the staff towards implementing the programme.
Provision for the various supplies (such as bleaching powder, gloves, bags) and repair and maintenance of the BMWM equipment has to be taken care of.
Close monitoring and supervision (involving effective, efficient and accurate record keeping) by the Project, NGO or by any nodal person for at least a year is required.
Chances of Replication
After the success of the pilot programme at CHC Daulatpur, the programme has recently been taken up in CHC Gagret and CHC Haroli in Una district of Himachal Pradesh.
Biomedical waste management is an important service area, which needs to be addressed in order to enhance the output from other related departments and reduce the potential risk of exposure to hospital acquired infections. But success of the initiative depends on the stakeholders who are involved in the production of the BMW as well as in its disposal.
Dr. Anuradha Davey, Research Consultant, National Institute of Medical Statistics, ICMR. March 2006.