This document summarizes a study comparing the cost of outsourcing biomedical waste management versus establishing an in-house facility at a government hospital in Chandigarh, India. The study found that establishing an in-house facility would cost approximately Rs. 8.6 per bed per day to operate, compared to Rs. 10.90 per bed per day for outsourcing, resulting in a net annual savings of over Rs. 500,000. Additional savings could be achieved by expanding the in-house facility's capacity or by generating revenue from other hospitals. The upfront installation costs of the in-house facility would pay for itself within 12-13 years of operation. In conclusion, an in-house biomedical waste

1. A STUDY OF COST COMPARISON OF OUTSOURCING VERSUS INBUILT FACILITY FOR BIOMEDICAL WASTE MANAGEMENT IN GOVERNMENT MEDICAL COLLEGE AND HOSPITAL, CHANDIGARH.

2. Objective. Introduction Methodology Observations and results Interesting facts. References Agenda

3. Objective General To calculate and compare the cost of outsourcing versus erecting facility for bio-medical waste management at Government Medical College and Hospital, Chandigarh. Specific To study the process of biomedical waste management. To calculate the cost incurred on outsourcing of biomedical waste management To calculate the cost of setting up biomedical waste management facility. To suggest measures, if any, to improve the process and to increase its efficiency to benefit the hospital.

4. Hospitals are health institutions providing patient care services. Directly through patient care or indirectly by ensuring a clean, healthy environment for their employees and the community. In the process of health care, waste is generated which usually includes sharps, human tissues or body parts and other infectious materials also referred to as ‘‘Hospital Solid Waste’’ and ‘‘Bio-medical Solid Waste.’’ The onus lies on hospitals and other health care institutions to ensure that there are no adverse health and environmental consequences as a result of their waste handling, treatment and disposal activities Introduction

5. Methodology Study Design The study was descriptive and observational in nature to understand the biomedical waste management process in the hospital. The study was designed towards achievement of all its objectives Study Area The study was carried out in Government Medical College and Hospital, Chandigarh from 15 May 2010 to 15 June 2010. Study population Manufacturers of incinerators, contractors, engineers, supervisors and workers of biomedical waste handling were included in the study.

6. Continued…. Study Tools Observation was main tool to study the handling, transportation and disposal of biomedical waste. Unstructured Interview of the contractors, manufacturers and engineers was done to estimate the cost of installation of new incinerator. Records Study was done to know the amount of waste generation and cost of current process of disposal. Data Analysis The data collected was analyzed using Microsoft Excel. The various costs were studied to find out the total cost of setting up of incinerator and compare it with current process of waste disposal.

7. Observation and Results Total amount of waste generated in a day approx. 150 kg. Sent to the GMSH, Chandigarh for disposal. Sent to the PGIMER, Chandigarh only when GMSH’s incinerator is not working and on first day of every week when quantity of biomedical waste generated is more than 150 Kg. The present model reflects a net saving of Rs. 2.27/bed/day as the inbuilt biomedical waste management facility would cost Rs. 8.6/bed/day if the incinerator of capacity 100 kg/hour was working for 2 hours in a day as compared to outsourcing which would cost around Rs. 10.90/bed/day. In both the cases the cost related to handling, segregation and salary of the staff except salary of the operator remained the same, so these were not included in calculating the cost

8. Break up of Outsourcing Cost per Bed

9. INSTALLATION COST Cost of the destromatpyrolytic incinerator with = 6400000 venturi scrubber capacity 100 KG/HR (thermax make) 2. Construction cost including incinerator = 650000 building, waste storage room, offices Total installation cost 7050000 Break up of In-House Facility Cost

10. OPERATING COST: FIXED COST Depreciation on machine = 384000 Depreciation on building on the basis of = 34411 Salary of the operator = 360000 Maintenance cost = 300000 Total fixed operating cost 1078411

11. VARIABLE OPERATING COST Fuel consumption = 1012364 Electricity consumption = 30660 Total variable operating cost = 1043024 Total fixed operating cost 1078411 Total annual operating cost = 2121435 Total operating cost (rupees/bed/day) = 8.6

12. Interesting Facts Annual cost of outsourcing of biomedical waste management was Rs.2673000, Annual cost of erecting the facility was Rs.2121435. Net saving of Rs.551565 per year which accounts for 21 % of the total cost incurred during outsourcing of biomedical waste disposal. The installation cost of erecting the facility can be covered in just 12 and a half years. Which can be reduced further to 5 years if the hospital extend this facility to other biomedical waste generating units. Suppose for 100 Kg of biomedical waste per day outsourced for other hospital, the net revenue earned per year would be Rs.792488 after deducting increased variable and fixed operating cost from total revenue generated and this would ultimately increase our net saving to Rs.1344053.

13. Secondly if in the future hospital will increase its bed capacity by 100 beds, the average biomedical waste generation will increase by 22 Kg. Thus for that increased part of biomedical waste the outsourcing cost will increase by Rs.392040 per year whereas there will not be any rise in the operating cost of running the facility. Thus this will further increase our net savings.

14. Conclusion May be this study is not important for installation of individual incinerator because Government of India has discouraged this practice under new regulations but it can be useful in CBWTF as it can help State Pollution Control Boards in negotiating with Private Suppliers by calculating their cost of providing the service and profit margins.

15. For Further Details Kindly Contact.. Dr. VarunGoyal Project Associate EPOS HEALTH (INDIA) PVT. LTD. 445, UdyogVihar Phase-III Gurgaon - 122016, Haryana, India Ph #. 91 9650639318 Tel #: 91 124 4264900 Fax #:91 124 4264906 Email: varun.goyal@epos.in Skype: varungoyal1984 Website – www.epos.in