“Support for healthcare waste management in Kathmandu”: setting milestones for sustainable practices

In Nepal, hospitals and health care centers generate between 1 and 1.7 kg* of health care waste per bed each day. Sustainable health care waste management brings benefits not only to hospitals and health centers but also to the communities they serve. By implementing these criteria, hospitals can reduce pollution and greenhouse gas emissions from waste burning. Additionally, this approach helps protect health workers from infection and injuries, creating a cleaner and more safe and pleasant environment for everyone within the hospital premises.

With this in mind and intending to support Nepal's health sector by fostering environmental resilience and improving health care waste management practices, Health Care Without Harm and the Health Environment and Climate Action Foundation (HECAF 360) joined forces with the Deutsche Gesellschaft für Internationale Zusammenarbeit (German Development Agency, GIZ) in 2021 for a 22-month project, which has recently concluded.

The "Support for healthcare waste management in Kathmandu 2021- 2023" initiative was designed to empower and support 13 hospitals in becoming environmentally resilient and set examples in sustainable health care waste management per national standards. Additionally, it aimed to build capacity in four of those hospitals to implement the Ministry of Health and Population's (MoHP) 2020 National Health Care Waste Management Standards and Operating Procedures guidance.

Throughout the two-year project, hospitals and their staff received various tools, including waste trackers, standard operating procedures, draft long-term plans, and diverse levels of training and awareness. The training activities encompassed the Master Training of Trainers (MTOT), specialist training on autoclave operation, on-the-ward training, and awareness-raising during model ward creation and replication. Over 670 staff members at the four hospitals underwent training through the project in four different training curricula, including master training of trainers, which empowers hospitals to train their own staff.  In addition, all the staff of wards with the new segregation system received an orientation, including safe handling of waste and needle cutting. 

One of the project's primary objectives was to reduce the percentage of infectious waste through an improved segregation system, and this goal was successfully achieved.  In the wards where the new system was implemented, hospitals excelled in segregation, significantly reducing the percentage of hazardous waste.  All hospitals came close to or even exceeded the minimum infectious waste targets estimated in the initial assessments, with reductions ranging from 56% to 87%.

Stewardship and ownership of hospital management, adaptation of non-burning technology for waste treatment, and adherence to the principle of circular economy and resource recovery from recyclable waste will foster the sustainability of the project’s initiations in the long run.

As part of the project's outcomes, a brochure addressing the critical issue of medical waste disposal was developed in English and Nepali.

The commitment of hospitals participating in the project has stood out and is a driving force to move this critical work forward. In the future, we aim to continue leveraging these experiences and commitments to advance sustainable health care waste management further by working with sub-national level governments with an integrated approach and hospitals will be able to collaborate and support each other through the Global Green and Healthy Hospitals network.

(*) Source:  Information from the National Health Care Waste Management Standards and Operating Procedure of Nepal: https://climate.mohp.gov.np/downloads/National%20Health%20Care%20Waste%20Standard%20Operating%20Procedure-2020.pdf