1. NATIONAL HEALTH CARE
WASTE MANAGEMENT
(HCWM) PLAN
Longacres Lodge
26th
November, 2015
1
Ms. Chilekwa Mibenge
Chief Environmental Health Officer
2. Presentation outline
• Current situation on HCWM
• Effects of improper HWCM
• Assessments of Zambian HWCM
• Efforts towards improvement of HWCM
• National HWCM plan
• Health care waste financing
• Conclusion
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3. Current situation on HCWM
• The HCWM plan (2010 - 2014) was not successfully
implemented due to non availability of funding
• The non implementation of HWCM plan led to queries by
parliament
• According to the MoH assessment (2013), HCWM is
generally unsatisfactory at all levels of health care delivery
• There is no responsibility by most of the HF for the waste they
generate to ensure safe, sustainable and environmentally
acceptable methods for segregation, storage, collection, pre-
treatment and transportation, and final disposal for both
within and outside their premises
3
4. Effects of Improper HCWM
• The unsafe disposal of HCW poses public health risks
• WHO (2000); contaminated syringes caused 21 million
hepatitis B virus infections (32% of all new infections)
• HCW containing polyvinyl chloride (PVC), if incinerated at
>800o
C lead to emissions of dioxins and furans and other
toxic air pollutants
• Exposure to dioxins and furans may lead to :
– impairment of the immune system;
– impairment of the development of the nervous system;
– endocrine system; and
– reproductive functions
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5. Assessment of HCWM
• Several assessments have been conducted on HCWM in
Zambia by several institutions;
The World Bank HCWM Study in Zambia (2004-2006);
WHO HCWM assessment (2011);
Auditor General’s report findings (2009);
MoH HCWM Assessment (2013)
COWI/EIB Assessment (2015)
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6. Findings of the assessments
• Most HF did not maintain records of the quantities of waste
generated
• Colour coding and labelling not adhered to
• Improper and ineffective treatment of HCW
• No orientation of members of staff in HCWM
• The current HCWM guidelines need to be revised /updated
• Inadequate funding and equipment
• No maintenance for defective equipment (e.g. incinerators)
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7. Efforts towards sustainable
HCWM
• Improvement of Water, Sanitation and Healthcare Waste
project for Public Health Facilities in Zambia - Supported by the
EIB
• Reducing UPOPS and mercury releases from the health sector
in Africa project supported by the GEF/UNDP
• ZHSIP working in 5 provinces: Northern, Western, North-
western, Luapula and Muchinga Provinces, however Eastern,
Central, Lusaka, Southern and Copperbelt are NOT covered
• The MOH has revised and updated the HCWM plan and
through planning will support the implementation of some of the
activities of the HCWM plan (2015-2019)
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8. National HCWM plan 2015-2019
• The overall objective of the plan is to develop a National
Plan that will mobilize resources and build capacity for
reducing health risks in a sustained manner, while at the
same time being open to technological options that promote
sustainable development
• Total budget :$43,056,644.58
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9. Regulatory framework
• The plan is based on the principles of the National Solid
Waste Management Strategy (NSWMS) for Zambia
(2004)
• Environmental Management Act of 2011 (EMA 2011)
• Public Health Act Cap 295 (PHA Cap 295)
• Environmental Management (licensing) Regulation
(Statutory Instruments No. 112 of 2013)
• Ionizing Radiation Protection Act No.19, of 2011
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10. NHCWM plan focus
• Create an enabling environment in which compliance to the
legal, policy and administrative framework and SOPs on HCW
is adhered to and sustained for the protection of both the
patients, workers and communities
• Ensure that health facilities comply to health management
through the development of sense of ownership and exercise
the ”polluter pay principle”
• Regularly conduct assessment and examine gaps in
management of HCWM practices in HFs and local authority
disposal sites
• Quantify the amount of HCW generation in HFs
• Enhance access to efforts of Private Public Partnership (PPP)
in HCWM
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11. NHCWM plan focus
• Provide appropriate equipment and materials for HCWM
systems i.e generation, storage, collection, treatment and
disposal in order to ensure minimal risks (or no risk at all)
• Refocus the traditional methods and broaden the
technological options of dealing with HCWM in line with
the MoH vision of upgrading HFs
• Explore the options of dealing with HCW that are climate
change sensitive
• Prepare a costed HCWM plan taking into consideration of
PPP in relation to cost recovery based on the polluter
pays principle
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12. Benefits of the plan
• Addresses gaps identified in the current HCWM
practices
• Seeks to move towards friendlier and smarter
environment technologies that reduces pollution
in the environment
• Zambia is a signatory to the Climate Change
conventions addressing impact of pollution on
climate change hence the need to commence
embarking on smart technologies such as non
incinerable waste for category of waste
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13. Factors should be used in the Selection of
Treatment Methods
• Types and quantities of waste for treatment and disposal
• Capability of the healthcare facility to handle the waste
quantity
• Technological capabilities and requirements
• Availability of treatment options and technologies
• Capacity of systems.
• Treatment efficiency (microbial inactivation efficacy)
• Occupational health and safety factors
• Environmental releases
• Volume and/or mass reduction
• Installation requirements
• Space available for equipment
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14. Factors should be used in the Selection of
Treatment Methods
• Operation and maintenance requirements
• Infrastructure requirements
• Skills needed for operating the technology
• Location and surroundings of the treatment and disposal
sites
• Options available for final disposal
• Public acceptability
• Regulatory requirements
• Capital cost of the equipment
• Operating and maintenance costs of the equipment
• Other costs including costs of shipping, customs duties,
installation, commissioning /decommissioning, transport
and disposal of residues
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15. Recommended technologies
Type of health
institution
Recommended technology at various levels
Private health care
facilities
• This will depend on the level and location of the institution i.e. clinic, health centre/
hospital and rural/urban setting
Health Post • Land disposal with safe burying with provision and use of liners to prevent ground
water contamination
Health Centre
(Rural)
• Land disposal with safe burying with provision and use of liners to prevent ground
water contamination
• Brick incinerator
• Where there is electricity, free-burn incinerators are recommended.
Health Centre
(Urban)
• Land disposal with safe burying with provision and use of liners to prevent ground
water contamination
• Chemical disinfection
• Rotary kiln incinerator
• Where there is electricity, free-burn incinerators are recommended.
First Level
(District Hospital)
• As for Urban Health Centre
Second Level (General
Hospital)
• Land disposal with safe burying with provision and use of liners to prevent ground
water contamination
• Pyrolytic incinerator
• Chemical disinfection
• Wet thermal or steam treatment
• Free-burn Incineration
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16. Recommended technologies
Type of health
institution
Recommended technology at various levels
Third Level:
(Central Hospital)
• Land disposal with safe burying with provision of liners to prevent ground
water contamination
• Pyrolytic incinerator
• Chemical disinfection
• Wet thermal or steam treatment disinfector
• Microwave irradiation for teaching hospital
• One waste collection vehicle per institution
National
Reference:
(University
Teaching Hospital),
Regional:
(centralized) waste
disposal sites
(Lusaka and
Copperbelt
provinces)
• As for third level, except the number of units will be twice those at level
three
• Two waste collection vehicles
• Free-burn Incineration
• Three at each station of either Pyrolytic incinerator or incinerator 350 to
1000 LA wood / coal fired.
• Four waste collection and two utility vehicles per station
• Free-burn Incineration
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17. Non Incineration Treatment Options
• Non-incineration technologies are used to disinfect
infectious health-care waste, while avoiding the
formation and release of dioxins
1)Low heat Thermal: Autoclaves
2)Chemical: Dissolved chlorine dioxide, bleach, lime
solution or dry inorganic chemicals
3)Biological: Composting,vermiculture (digestion of
organic wastes through the actions of worms), bio-
digestion, natural decomposition through burial
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18. Non Incineration Treatment Options
4) Irradiation: Batch and continuous microwave
systems
5) Mechanical: Shredding, grinding, mixing, and
compaction
6) Inertisation (Stabilisation): Mixing waste with a
mixture containing lime, cement and water in order
to minimize the risk of toxic substances
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19. Health care waste financing
• The plan is expected to be implemented with financial
support from the Government Republic of Zambia
• Funding will also be supplemented by the World Bank
through the Zambia Health Services Improvement Project
(ZHSIP), , Water Supply Sanitation and Healthcare Waste
(WSSHW) Project for Public Health Facilities (EIB), UNDP
and GEF through the UPOP project, UNICEF and WHO
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20. Conclusions
• Health-care waste includes all the waste generated by
health-care establishments, medical research facilities
and bio-medical laboratories and thus requires a lot of
support is lives are to be prevented
• The HCWM plan has since been submitted to ZEMA for
them to conduct a Strategic Environmental Assessment
that shall assess the potential environmental issues
arising from the plan
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HCW which contains polyvinyl chloride (PVC), if these plastics are incinerated at low temperatures (less than 800oC ), dioxins and furans and other toxic air pollutants [e.g. co-planar Poly Chlorinated Biphenyls (PCBs)] are produced as air emissions or end up as solid residues in the bottom or disperse in the air contributing to climate change (WHO, 2011)..
