The Ministry of Health and Population (MoHP) estimates 13,613.5 tonnes of waste are generated by health institutions across the country every year. Up to 25 percent of these wastes are hazardous.

A survey in 2013 conducted by Central Bureau of Statistics showed that on an average 28.47 kg biomedical wastes are generated by 301 private hospitals across the country. The report “Census of Private Hospitals in Nepal 2013” had collected information like segregation status of hospital waste products, daily production quantity of waste and its distribution by type of wastes, type of bins used to collect or segregate waste, disposal location of wastes, recruitment status of employee for hospital waste management, and average monthly cost  for waste management. The report showed that majority of the hospital wastes were segregated in various bins while their disposal was municipality collection centre.

There are many successful projects being run in government hospital which, experts believe, can be replicated in various other hospitals as well. On July 20, 2010, Bir Hospital launched a medical waste management programme, which has since become an example for the country. The hospital administration, with support from Health Care Foundation-Nepal (HECAF), started the programme to manage and dispose off hazardous medical waste that had long been finding its way into community landfills.

Sumitra Amatya, executive director at the Solid Waste Management Technical Support Centre (SWMTSC) said that around

Rs 2 million is enough to set up a decent waste treatment facility

in a hospital. Besides installing a private waste management system, she said establishment of a common waste treatment facility is another way to ease the problems of many hospitals.          

“Common waste treatment facility is a centre where health institutions can bring their wastes for disposal and pay for treating the wastes,” said Amatya. “This can be a good business and has been successful in India and Bangladesh.”

Despite the government regulation, requiring every hospital to properly dispose off waste, authorities have failed to enforce it. The Solid Waste Management Act 2011, states: “the responsibility for processing and management of hazardous waste, medical waste, chemical waste…under the prescribed standards shall rest with the person or institution that has generated the solid waste”.

 Amatya said that the government should take the initiative to set up waste treatment facility. “Hospitals are not interested in waste management and it is hard to convince them,” she said, adding that there

is a confusion among the implementing agencies, including the

Ministry of Local Development, as to who should take the lead role in the area.

The World Health Organization (WHO) has repeatedly expressed concerns over poor management of biomedical wastes in the country.

The Solid Waste Act also clearly states that until the health institutions comply with the standards for medical waste management, the concerned government body will not grant a licence of operation.

Dr Guna Raj Lohani, chief of Curative Division of the MoHP, said they have stopped granting affiliation to those hospitals that do not have waste management facility. He said the new ‘Directives on Establishment, Operation and Upgrading of Health Institute 2013’ stipulates the hospitals, among others, to be earthquake resistant, have health care waste management facility, which a majority of the hospitals did not follow in the past. “Those hospitals that had skipped these rules in the past have been asked to enforce them strictly. If they fail to do so, we will not renew their operational licences,” said Dr Lohani.

For a standard waste management facility, going by the standards of Bir Hospital, three separate bins should be put in place to segregate biodegradable, degradable and non-degradable waste. Additional bins are required for special wards such as the Intensive Care Unit and chemotherapy. Each ward should have a needle disposing machine to destroy syringes after use. At Bir, the waste is then transported to the Waste Treatment and Storage Area every 24 hours, located on its premises, and segregated into hazardous and non-hazardous wastes and their disposal.

According to WHO, 260,000 new HIV infections were directly related to poor management of medical waste worldwide in 2000. One infected syringe carries a 30 percent risk of Hepatitis B, 1.8 percent risk of Hepatitis C and 0.3 percent of HIV.