Development work in Nepal

1. Concept Note
On
“Documentation of Action Plan for
Healthcare Waste Management of Dhulikhel
Hospital”

2. Contents
1. BACKGROUND ................................................................................................................................3
1.1 OBJECTIVE OF ASSIGNMENT.........................................................................................................3
1.2 SCOPE OF WORK ...........................................................................................................................3
2. DETAILED WORKS................................................................................................................................4
 Desk study...................................................................................................................................4
 Literature review.........................................................................................................................4
3 .Expected Outcomes ............................................................................................................................5

3. 1. BACKGROUND
Healthcare waste management is one of the major environmental and public health problems.
Healthcare waste management is the responsibility of all the healthcare facilities or concerned
authority who produce healthcare waste. Various infetious deseases can be minimized through
proper management of the healthcare waste. Healthcare waste not only affect the waste
generators but also the waste handlers and the general public.
As defined by WHO, Healthcare waste is the by-product of the health care that includes sharps,
non-sharp bllod contaminated items, blood, body parts and tissues, chemicals, pharmaceuticals
and radioactie materials (WHO 2019). The healthcare waste generation of Nepal is in range of
0.99 to 1.73 kg per bed per day, out of this hazardous waste is 0.33 to 0.59 kg per patient per
day.(WHO 2016). National Healthcare Waste Management Standards and Operating
Procedures, 2020 is a practical technical guidence to all the stakeholders that will assist to
improve the healthcare waste management system in healthcare facilities. Thereby, this study
wil be based upon the above mentioned guideline.
1.1 OBJECTIVE OF ASSIGNMENT
The main objective of the study is to document the baseline information regarding the existing
Healthcare Waste & it's present management scenerio of the Dhulikhel Hospital and to formulate
the action plan for its sustainable management.
Specific Objectives:
 To quantify and characterize the healthcare waste generated in Dhulikhel Hospital.
 To understand the current/existing scenario and practices of Healthcare waste
management.
 To formulate the action plan for initiating change towards waste management at the grass-
root level.
1.2 SCOPE OF WORK
This study will document all the activities to be done during operational period and resources
required for the efficient Solid Waste Management (SWM)in the Hospital area. Separate strategy
and action plan will be formulated for different management process of solid waste, which will
be divided into five major steps/process: Generation/Source, Collection/Transportstion,
processing & recovery, Storage & Disposal .
 Generation/Source: This is the initial step of management, which focuses on the
management practices to be adopted for the waste at its source. Major activities
that will be considered here are proper implementation of the segregation
practices and identification of the appropriate number, place and size for dustbins.
 Collection/Transportation: After the dustbins get filled, they need to be collected
and transferred to the respective site. Collection of the waste is also an important

4. step as it will determine the fate of the waste. Well planned collection strategy
will reduce the effort and resource used.
 Processing and recovery: After the waste being collected, recyclables and non-
recyclables waste need to be sort-out. Proper seggregation helps to increase the
extraction of the recyclables materials.
 Storage: Storage focuses on two different types of waste, first the segregated ones
and the next to be disposed.
 Disposal: Identifiaction of the proper disposal methods depending upon the type
of the waste.
After this process, either the waste will be recovered and managed accordingly and remining
discarded waste will be sent to disposal site (as identified by the respective Local bodies).
2. DETAILED WORKS
 Desk study
 Literature review
Review of reports , case studies, guidelines, etc.
Planning
 Identification of baseline data required
 Identification of appropriate methods and methodologies
 Identification of sampling sites in each wards(based on the size of the wards, no. of
representative samples will be chosen)
 Data collection
 Primary Data
The primary source of data should be collected from various field studies.
 Standard questionnaires
This baseline survey would be conducted by the use of standard questionnaires which
included questionnaires on waste generation, waste management practices, awareness
levels and solid waste management aspects of the hospital.
 Observation and photography
Observations should be made to understand the current situation of waste management
practices in Dhulikhel Hospital. Photographs will be taken to record those
observations.

5.  Secondary data
Secondary data which should be obtained from the secondary sources are the
supplementary data to produce primary data, the following secondary sources of
data should will be used for this survey study.
 National Healthcare Watste Management Standards and Operating Procedures-
2020
3 .Expected Outcomes
Following outcomes are expected after the study is completed:
1. Quantitative and qualitative analysis of Health care waste generated in Dhulikhell
Hospital.
2. Well documented action plan based on the standard procedures (As listed in annex 1 &
2).

6. Annex-1 : Different steps and their respective strategies and plans.
S.N.
Steps of
SWM
Strategies Necessary Activities
Short-term Plan Long-term Plan
1
Generation/
Source
 Identification
of shape,
size, number
and
Placement of
dustbins.
 Segregation
practice….
 Practice of source
segregation
 Awareness programs on
waste management
 Trainings for policy
makers. staffs involved in
waste handing
 Continuous
review and
improvement
in source
segregation
practice.
2
Onsite
handling/
storage &
processing
 Number of
people and
materials
required
 proper functioning of the
installed bins.
 Separate storage of
recyclables materials
Improvement in
collection
practices
3
Collection
and
transportation
 Identification of
the area
 Introduction of
appropriate collection
route and schedule
 Implementation of
transportation and
maintenance cost
analysis.
 Implementation and
vehicle capacity analysis
and plan for
procurement of new
vehicles.
 Arrangement
of transfer
station.
 Continuous
review and
improvement
of collection
and
transportation
system
4
Processing
and recovery
Storage for both
segregated
(recyclable waste
and waste to be
dumped)
 composting
 segregating recycling
materials
prediction of
growth and plan
and implement
accordingly
5
Disposal
Proper disposal
of the discarded
wastes.
 Transferring to the
municipal landfill
Sustainable
soution for safe
disposal.
Annex 2: Level wise action plan for SWM.

7. Responsibilities action to be done
Organizational
Level
 Decisions making
 Interdisciplinary & comprehensive
approach to HCWM
 Co-ordinating related sections for
effective implementation of project.
 Arrangements of the
necessary resources
 mobilizing and monitoring
the waste management team
Technical Level  Technical discussion, coordination
and knowledge sharing on various
aspects of HCWM.
 Assurance of safety measures
Operational Level  Technical and administration
coordination on the management
of specific operation (eg:HCWM
related facilities) among main
stakeholders.
 Timely collection
 Effective source seggregation
 Maintaining cleanliness