HEALTHCARE WASTE MANAGEMENT
IN DHAKA CITY - BANGLADESH
Habibur Rahman, professor of civil environmental engineering, Bangladesh University of Engineering &Technology in Dhaka, reports on the challenge of improving healthcare waste management.
Dhaka, capital of Bangladesh, is expanding rapidly and is expected to be the world's ninth largest city by 2015.The present population of Dhaka City is around eight million, with a high annual growth rate (5.6 per cent).
Healthcare waste (HCW) includes the waste mainly originating from healthcare establishments, laboratories and research facilities, blood banks and collection centres, funeral and ambulance services, and some wastes arising from treatment in the home. A large fraction comes from residences, administrative and general house-keeping services.
Health care services in Bangladesh are inadequate, although rapid growth of private healthcare has tended to alleviate this problem in recent years. According to World Bank data, between 1990 and 1997, there were 5,000 Bangladeshis for every physician. ln south Asia the figure is 2,500 people for each doctor, and in Europe and central Asia there are only 280 people for each doctor. There are about 250 healthcare centres in Dhaka city, including hospitals, clinics, nursing homes and dental hospitals. Of these, more than 98 per cent simply dispose of their waste into the dustbins of city corporation.
The proper management of waste (particularly the disposal of hazardous portion of HCW) is often over-looked. Most healthcare establishments have no waste management policy or plan, a documented waste handling procedure, pre-treatment options or dedicated staff. Many private healthcare establishments are located in renovated residential buildings without waste handling facilities. Often HCW sources are unsatisfactorily identified, controlled and managed by government/municipal authorities.
The main problems associated With HCW management in Dhaka are:
Categories of HCW
HCW in poorer regions can be classified into two broad categories:
This includes waste from catering services, administrative establishments, packaging etc that do not pose special handling problems to health or the environment .
This includes infectious waste, sharps, pathological, pharmaceutical, genotoxic, chemical, and radioactive wastes; pressurised containers; and, wastes with high concentration of heavy metals.
Quantities of HCW
The quantities of HCW wastes in Dhaka city are estimated on the basis of the data collected during an intensive survey during the March to May, 1998 period, results are shown in Table I. The average generation rate (kg/bed/day) of HCW in Dhaka is about 1.2 which is lower than North America (7-10) or Europe (3-6), but is in the range of many Latin American countries (1- 4.5). The proportion of hazardous waste in Dhaka city (15 per cent) is much higher than that of Netherlands (5 per cent) and Sweden (9 per cent), but is lower than the USA (28 per cent), and is close to the rate in Germany (14 per cent). Differences may be due to geographical location, living habits and standards, availability of different treatment facilities, and perhaps to the ways in which wastes are catego- rised in different countries.
Recycling and reuse
Though recycling and re-use are generally encouraged for environmental or economic reasons, the need for sterile equipment for healthcare should always overrule desires to re-use or recycle contaminated items. However, extensive recycling is carried out informally in Dhaka city. Scavengers collect waste at every stage (from bins, communal collection points, sweeping points and final disposal sites). Cases of worm infections, skin disease, diarrhoea, chronic dysentery, viral hepatitis have been reported. The scavengers normally salvage every possible item of value from HCW with bare hands and feet, and are unsurprisingly the most vulnerable group. They also suffer through illiteracy, low resistance to disease (due to diet, unhealthy living environment, appalling sanitary conditions and poor access to healthcare services).
Table 1 shows that about 15 per cent of HCW needs special attention.The remainder can be treated as MSW, if segregated. A few changes in procurement processes (to minimise quantities of hazardous waste) are helpful:
To improve HCW management in Bangladesh, it is essential that different authorities (governmental and private sector) involved in healthcare establishments, and in environmental protection should recognise the nature of the problem.
HCW generation rates in Dhaka city ranges between 0.8-1.67 kg/bed/day. This includes about 15 per cent hazardous material which needs much more careful attention to handle. lndiscriminate disposal of HCW in Dhaka city poses serious health hazards to city dwellers, particularly to the poorest of the poor, the scavengers. Healthcare establishments need hygienic systematic approaches in handling, segregation, storage, transport, treatment, and disposal of their wastes by methods that at all stages minimise the risk to public health and the environment. Public awareness through mass media, proper hygiene education to the scavengers, mandatory staff education in waste segregation, and legislation to regulate HCW management systems are needed to change the traditional habits of different actors involved in this sector.
Professor Habibur Rahman can be contacted at: Department of Environmental & Civil Engineering, BUET
Dhaka - 1 000 - Bangladesh