Beruflich Dokumente
Kultur Dokumente
njhiyNgrp
uf.a wxlh
Telephone 2698507
vdJ ,y
My No:
*elaia 2692913 Tfns wxlh
ngf;]; 2694860 ckJ ,y
Fax Your No:
úoaHq;a ;emE,
kpd;dQ;ry; Kfthp postmaster@health.gov.lk oskh
e-mail jpfjp
fjí wvúh
Date 08 / 11/ 2012
,izaj;jsk; www.health.gov.lk
iqjisrsmdh
website Rtrphpgha
SUWASIRIPAYA
fi!LH wud;HdxYh
Rfhjhu mikr;R
Ministry of Health
In the health sector, environmental issues creating adverse impacts vary widely in nature. Of them
Health Care Waste Management (HCWM) is considered to be one of the significant issues, although
some other important issues like food safety, occupational health and safety, management of industrial
carcinogens, indoor air pollution etc also deserve due attention. Over the program period, support
will be provided to expand/improve the services of health care facilities throughout the country. This
is likely to generate more HCW which in the absence of safe management and disposal practices can
greatly increase the risks to people and the environment through exposure of infectious and hazardous
substances contained in it. Apart from health care waste, other environmental impacts directly caused
by program implementation are likely to be triggered by the construction of Health Care Facilities
(HCFs) which is likely to be relatively small scale, spread in different locations of the country and
most likely confined to existing premises of the medical institutions and with localized impacts.
The objective of this report is to present a framework for improving HCWM in the country.
the policy and legislative framework for HCWM in the country and related technical guidelines,
evaluate HCWM practices, treatment and disposal technologies in use, provide an update of the
achievements and gaps in the implementation of HCW systems (especially in view of the policy and
national action plan prepared in 2001), present level of compliance with legal requirements and the
presentation of an action plan for improving HCWM based on identified gaps. In addition, the report
also provides safeguard requirements for managing impacts from civil works construction under the
proposed 2nd HSDP.
We greatly appreciate the comments made by you on this draft document. Please provide your
feedback to Director(Environmental and Occupational Health), Ministry of Health, 385, Baddegama
Wimalawanse Thero Mw, Colombo 10 on or before 10th December 2012.
385" mQcH noafoa.u jsu,jxY ysus udj;" fld<U 10" 385, tzf;fj;Jf;Fhpa gj;Njfk tpkytq;r NjNuh khtj;ij, nfhOk;G 10.
385, Rev. Baddegama Wimalawansa Thero Mawatha, Colombo 10, Sri Lanka.
Draft Environmental Management Framework 2012
Draft
Ministry of Health
June 2012
Abbreviations
Table of Contents
Chapter 1: Overview of the Second Health Sector Development Program
1.1: Program objectives and proposed activities ... .. .. .. .. .. 6
1.2 Development Objectives of the 2nd HSDP ... .. .. .. .. .. 6
1.3 Project Description ... .. .. .. .. .. .. .. .. 6
1.4: Objectives of the framework and the intended audience ... .. .. .. .. 12
1.5 Structure of the report ... .. .. .. .. .. .. .. .. 13
1.6 Sources of information .. .. .. .. .. .. .. .. .. 14
Annexes
Healthcare Waste Management –Rapid Assessment Tool .. .. .. .. 63
Assessment of Healthcare Waste Management in Major Health Institutions.. .. 70
List of Tables
Table 1: Health Institutions and bed strength by District .. .. .. .. 16
Table 2: Overview of the administration of Health Services and classification of
medical institutes .. .. .. .. .. .. .. .. 17
Table 3: National Colour Code for segregation of HCW .. .. .. .. 22
Table 4: Production of non-risk and hazardous HCW per district .. .. .. 26
Table 5: Average production of HCW in different categories of HCFs .. .. 27
Table 6: The daily generation of healthcare waste in government-owned hospitals
in Sri Lanka, calculated using bed capacities in year 2000 .. .. 28
Table 7: Estimates of hazardous waste generation in government hospitals of Sri Lanka
in 2000 .. .. .. .. .. .. .. .. .. 28
Table 8: Quantities of HCW generation in selected HCFs in the Galle District .. 29
Table 9: Quantities of hazardous HCW generated in selected hospitals in the
country (results of the rapid assessment done in 2011) .. .. .. 32
Table 10: Current practices in handling HCW in 33 major hospitals evaluated .. .. 34
Table 11: Description of current practices in handling HCW in 33 major
hospitals evaluated .. .. .. .. .. .. .. .. 35
Table 12: Treatment technologies and infrastructure employed in the country for
HCWM treatment .. .. .. .. .. .. .. .. 36
Table 13: Suitable treatment and disposal technologies according to the different
categories of HCW .. .. .. .. .. .. .. .. 53
For the country’s vision as reflected in the Mahinda Chintana to be realized, investing in the
modernization of the health system would be a critical pre-requisite. A more modern health
system of international standards, commensurate with the aspirations of a middle-income country
population would not only help achieve the objective of improving living standards and social
inclusion; rather it would contribute to all the objectives set out in the vision document, including
sustained economic growth, and shifting toward a knowledge-based and competitive economy.
Without a healthier population and a system that is geared to handle the health challenges thrown
up by the rapid demographic and epidemiological transitions facing Sri Lanka, the quantum leaps
needed in the availability of highly skilled and more productive labor force would remain an
unrealized dream. The Bank’s Country Partnership Strategy seeks to deepen the World Bank
Group’s support to Sri Lanka in addressing its emerging middle-income country agenda. The
Second Health Sector Development Program (2nd HSDP) would be an important contributor to
all three sub-areas under the area 3 (Improving Living Standards and Social Inclusion) of the
Country Partnership Strategy. Thus, its higher level objective would be to enable the health
system to play its critical part in helping Sri Lanka actualize its aspirations of economic growth,
overall development and improved quality of life of all Sri Lankans.
The Project disbursement will be linked to 8-10 Disbursement Linked Indicators (DLIs)
identified from the focus areas of the National Health Development Plan (NHDP); in close
collaboration with the MoH and the 9 Provincial Health Ministries.
Malnutrition:
The Government of Sri Lanka has been committed to ensuring optimal nutrition for all Sri
Lankans irrespective of their geographical locations, socio-economic status, or physiological
status. The Mahinda Chintana underscores the importance of specifically targeting health and
nutrition interventions to vulnerable populations (and especially the estate populations) in
addition to strengthening the delivery of effective national nutrition interventions.
However, decades of nutrition programming have yielded less than expected results in Sri Lanka,
and hence there needs to be a fundamentally different approach to prevention and control of
malnutrition. The facts that under-five children of even the richest quintiles show 10-12%
underweight prevalence and that over-nutrition and under-nutrition are present side by side,
sometimes in the same family, show that absence of food alone is not the primary determinant of
under-nutrition in Sri Lanka. Rather, it is the feeding and caring practices among pregnant and
lactating women, and for the under-two children that need to be modified. For such behavior
change to occur at the household level, community-based interventions are required,
demonstrating to the care-givers the impact of appropriate feeding and caring practices.
Implementation of “1000 days” interventions and with a focus on the under-served areas:
Nutrition interventions specifically targeted at: Pregnant Women (monitoring and promotion of
weight gain during pregnancy; iron/folate and calcium supplementation; deworming); Children
0-2 years of life (Bevioural Change and Communication related to breastfeeding, timely
introduction of safe and nutritionally adequate complementary foods, appropriate nutritional care
for sick children and hygiene practices; zinc supplementation during treatment/management of
diarrhoea; integrated management of severe acute malnutrition through facility- and community-
based interventions; de-worming) will be supported/monitored by the project. The project will
also ensure targeting of these interventions to underserved areas, plantation communities and the
urban poor. The use of community groups/mobilizers will be promoted for the implementation
community-based nutrition activities.
Capacity Enhancement/Worker Empowerment: The project will support the Government of Sri
Lanka to build capacity - through various forms of training, monitoring and supervision – to
deliver effective and appropriate nutrition interventions at facility and community levels, since
weak capacity could also weaken Sri Lanka’s nutrition program. Enhancing the capacity of, as
well as empowering community organizations to plan, implement and monitor relevant nutrition
interventions will be prioritized.
Nutrition Surveillance / Monitoring and Evaluation: The availability and use of quality data is
essential for evidence-based decision making to improve nutrition programming. The project
will support the GoSL to; establish and island-wide indicator-based M&E and Nutrition
Surveillance (NS) systems to monitor the implementation of the key nutrition (1000 day)
interventions; strengthen the utilization of NS reports for decision making at national and
divisional levels; link the NS data to the National Nutrition Information System and to existing
HIS tools and systems of the Government of Sri Lanka.
Non-communicable diseases
The recently completed joint Bank-GOSL study of NCDs in Sri Lanka confirmed that in addition
to the maternal and child health and infectious diseases, there is now a growing burden of
chronic NCDs, resulting in what is commonly called the double burden of diseases. The study
shows that during the past half-century the proportion of deaths due to circulatory disease (such
as heart disease and stroke) has increased from 3 percent to 24 percent while that due to
infectious diseases has decreased from 42 percent to 20 percent. This epidemiologic transition in
the country is compounded by a demographic transition with the proportion of people 60 years
and older is likely to more than double by 2040 to above 24 percent. Because NCDs are
commoner with aging, timely actions to address NCDs could result in benefits such as healthy
aging, lower disability, and longer, more productive lives.
In addition to the demographic and epidemiologic transitions, economic development along with
changing life styles, urbanization and increased motorization are increasing the burden due to
acute injuries such as road traffic injuries, falls, suicides, violence and mental health disorders.
The proportion of deaths due to injuries is approximately 15% of total deaths and the proportion
of mental health disorders is also known to be high.
The GOSL has prepared a policy (1996), a Master plan upto 2017 and a National Health
Development Plan for 2013 to 2017. The proposed program of support to the GOSL will provide
resources for implementing the following aspects of acute and chronic NCD control and
prevention.
The priority diseases supported for primary prevention include cardio-vascular diseases (CVD),
(includes strokes and hypertension), diabetes mellitus, cervical, breast and few other selected
cancers, asthma, thalassemia, mental diseases, injuries, cataracts, and chronic kidney disease of
unknown etiology.
Strengthening primary prevention program for NCDs: The primary prevention activities
considered and agreed with the GOSL include strengthening the implementation of and
institutionalizing legislation for better implementation of Framework Convention for Tobacco
control (FCTC) and the Tobacco control act and introducing legislation for the control of indoor
air pollution, pesticides, alcohol, salt, sugar and ‘trans’ fat usage. In addition, appropriate and
targeted communication strategies through mass media, work places, schools, youth clubs etc.
for targeted populations is required. These communication messages are expected to improve the
knowledge, attitudes, practices with regard to the risk factors that can be controlled with
legislation (salt, fat, sugar, tobacco, alcohol use, restriction on pesticide use and control at sales
outlets, vehicle seat belt and child restraint use, helmet use, etc) and for reducing risk factors like
physical inactivity, low fruit and vegetable usage and road traffic injuries and suicides.
Furthermore, initiatives to support pilots and a subsequent scaling up of elderly care services and
community based interventions for safety promotion and NCD related risk reduction approaches
through the preventive and primary care levels will be implemented.
Tertiary prevention: At the tertiary level, specialized hospitals will improve the ICU services
available and increase the ratio of ICU beds to general beds in the facilities. Furthermore, based
on a needs assessment, required expansion of services including strengthening the laboratory
services, investigative services and other ancillary services required to manage cases will be
introduced. Furthermore, initiatives will be taken to establish at least one comprehensive
rehabilitation unit in the most advanced health facility in every province. It is planned that these
units will be linked with a forward and back referral arrangement with the secondary and
primary care levels for follow up care. Opportunities for public private collaboration for the
establishment of advanced centres on cord blood, stem cells and other centres will be explored.
A better coordination between preventive and curative programs at various levels is needed for a
more efficient approach to deal with the NCD burden. In addition, improving the availability of
drugs and supplies in the health facilities at all levels, improving the infrastructure to manage the
increasing number of NCDs patients will be supported. Moreover, a pre hospital emergency
service will be supported.
Systemic improvements
Improved planning and management of health infrastructure
Health infrastructure development by careful planning and management is very much required as
it is the backbone of the health services. Such improvements are vital to achieve the expected
results from the proposed project
Sri Lanka’s HMIS is largely paper-based and its various components (e.g., preventive services,
patient records, inventory and supplies, human resources information, and financial data
systems) are not integrated into an inter-connected system. Two other lacunae in the health
information system are: the absence of out-patient data in the public sector and little linkage with
the private providers. HMIS is in urgent need of modernization, in line with the country’s
overall vision of promoting e-governance, information and communication technologies and
turning Sri Lanka into a “knowledge economy”. Apart from making data collection, reporting
and analysis easier, faster, and more accurate, computerization and e-solutions have great
potential to increase efficiency in hospital management and facilitate smoother patient flow, e.g.,
by linking clinical examination information with laboratory results and prescriptions, which
could be sent through the computer network to the respective service stations. Planning and
management at the facility level could also be greatly enhanced by electronic management
information systems, linking the data on patients, human resources, supplies and inventory
management (including the calculation of pharmaceutical requirements based on disease
burden), equipment maintenance and financial information. Several isolated pilot initiatives to
computerize health information have been undertaken in Sri Lanka. While the fact that such
pilots have been tested in Sri Lanka holds the promise of national scale-up, their uncoordinated
implementation runs the risk of developing incompatible systems in various parts of the country.
The program will assess the gaps in the system, review the experience with automation of HMIS
in-country and outside Sri Lanka and initiate the modernization of HMIS nationally. Specific
results have been identified for achievement in this area, which are disbursement linked
monitored through disbursement indicators.:
When OP 4.01 is triggered the borrower is required to carry out an assessment of potential issues
triggered by the project/program and to prepare necessary mitigation plans. The 2nd HSDP being
a sector support will supplement the national health budget and monitor performance in selected
strategic areas. As such, the exact activities funded by IDA resources may not be earmarked and
hence what is possible is to look at the key environmental issues in the health sector and come up
with a framework of actions to be supported during program implementation.
In the health sector, environmental issues creating adverse impacts vary widely in nature. Of
them Health Care Waste Management (HCWM) is considered to be one of the significant issues,
although some other important issues like food safety, occupational health and safety,
management of industrial carcinogens, indoor air pollution etc also deserve due attention. Over
the program period, support will be provided to expand/improve the services of health care
facilities throughout the country. This is likely to generate more HCW which in the absence of
safe management and disposal practices can greatly increase the risks to people and the
environment through exposure of infectious and hazardous substances contained in it. Apart
from health care waste, other environmental impacts directly caused by program implementation
are likely to be triggered by the construction of Health Care Facilities (HCFs) which is likely to
be relatively small scale, spread in different locations of the country and most likely confined to
existing premises of the medical institutions and with localized impacts.
The objective of this report is to present a framework for improving HCWM in the country.
the policy and legislative framework for HCWM in the country and related technical guidelines,
evaluate HCWM practices, treatment and disposal technologies in use, provide an update of the
achievements and gaps in the implementation of HCW systems (especially in view of the policy
and national action plan prepared in 2001), present level of compliance with legal requirements
and the presentation of an action plan for improving HCWM based on identified gaps. In
addition, the report also provides safeguard requirements for managing impacts from civil works
construction under the 2nd HSDP.
Chapter Focus
Curative services
For curative services, the government has a well established referral system that functions
through an extensive network of HCFs situated across the country. As such, it has been estimated
that a majority of the population has easy access to free western type government health care
services within an average 4.8 Km of a patient’s home2.
The network of HCFs comprises of, hierarchically, Peripheral Units (PU) at the village level,
District Hospitals at the district level, Base Hospitals which act as referral units with Medical,
Surgical, Paediatrics and Obstetrics and Gynaecology (OBG) specialties, District General
Hospitals in each district with specialties like ENT/Ophthalmology, Dermatology, Radiology
apart from Medical, Surgical/Paediatrics and OBG, Provincial General Hospitals in each
province and one National Hospital in Colombo which has all the specialties, and super
specialties, and which is the apex referral centre in the health system. In addition, there are
Teaching Hospitals attached to Medical Colleges with all the specialties. Table 1 provides details
of the different HCFs available and the total bed strength by district.
Preventive services
For preventive services, each Divisional Secretariat has a Medical Officer of Health (MOH) in
charge who is responsible for an average population of 60,000 people. The Medical Officers of
Health are assisted by Public Health Mid Wives (PHMs) and Public Health Inspectors who are
responsible for the Mother & Child Health programme and the Environmental and Occupational
health programme including food safety respectively. In addition, preventive health care services
are overseen at the district level by a Deputy Provincial Director of Health Services (DPDHS)
and at the provincial level by a Provincial Director of Health Services (PDHS). At the national
level, all health care services come under the purview of the Director General of Health Services
(DGHS).
1
Annual Health Bulletin, (2003), Ministry of Health
2
Annual Health Bulletin, (2003), Ministry of Health
3
Annual Health Bulletin, (2003), Ministry of Health
4
Annual Health Budget, 2012, Ministry of Health
Administratively, the national health system which comprises of a network of curative and
preventive health care facilities as described above is divided into three levels – Central,
provincial and district. While the MOH administers the major hospital categories such as the
National Hospital, Teaching Hospitals and the Central Blood Bank at the central level, the
provincial services are administered through the Provincial Directors of Health Services (PDHS)
offices which in turn deliver services through Provincial General Hospitals, General Hospitals,
Base Hospitals, District General Hospitals and Peripheral Units. They generate all sorts of HCW
in significant quantities. Rural Hospitals, Central Dispensaries and Maternity Homes come under
the direct supervision of the MOH units. They do not have surgery units and mostly generate
only general medical wastes and sharps.
District Level District General Curative health care and Same as Base
Deputy Provincial Hospitals only small surgery that hospitals but small
Director of HS Regional Blood do not require general quantities
Banks anesthesia
Peripheral Units Disposable syringes in
small quantities and
Divisional Director Rural Hospitals Mainly outpatients small quantities of
or MOH Maternity Homes and Primary health care general medical waste
Central Dispensaries including vaccinations.
Central Dispensaries
(Primary Care Units)
5
Adopted from the Situation Analysis and National Action Plan, 2001, Ministry of Health
With health care waste gaining greater importance as a significant public health and
environmental risk, the GOSL has, over the last decade or so, taken several positive steps to set
up better standards of HCWM in the country and to consider HCWM as an integral part of the
delivery of health care services. The background to this was paved when between 1994 and 1997
the Colombo Environmental Improvement Project published findings of a study on solid waste
management in the city of Colombo, which indicated that prevailing HCW disposal practices
posed a huge threat to the public and hence needed drastic improvement. Subsequently, when the
CMC defined a 25 year plan to treat municipal waste in a composting plan with private sector
participation, it stipulated that no medical waste should be present in the waste collected. As a
result, an urgent need arose to find a satisfactory alternative solution for the disposal of HCW
generated from the hospitals in the Greater Colombo Area (GCA).
In 2000, the GOSL requested external support to assist the Ministry of Health (MOH) to develop
an integrated Health Care Waste Management system for the country. As a result, within the
framework of the HIV/AIDS Prevention Program initiated by the GOSL and funded by the
World Bank, a three phased program was launched under the direct supervision of the National
Steering Committee for Clinical Waste Management (NCCWM). Initially, an assessment was
carried out in analyzing HCWM practices in HCFs around the country with a specific focus on
hospitals located in the GCA. In the subsequent phase, National Guidelines and the National
Policy for HCWM were drafted and a National Action Plan was prepared aimed at gradually
expanding improved HCWM practices throughout the country in a systematic way over a period
of 5 years including a specific system for the hospitals in the GCA. It was intended that with the
implementation framework in place, the final phase would to be dedicated to implementation of
the recommendations provided in the first two phases. In addition, under the HIV/AIDS
Prevention Project, it was also determined that specific and immediate action needed to be taken
to reduce biological hazards associated with HCW generated from chest clinics, STD clinics and
the blood banks within the country6. As such, a situation analysis and an action plan were
prepared targeting this specific sector of the health services. Equipment was supplied and
training programmes were conducted.
Over the past several years the MOH has successfully implemented a number of programs in
support of the key recommendations made above to improve HCWM in the country. A system to
treat all infectious waste generated from public hospitals within the GCA, which was estimated
to be about 25% of the total generated in 2001, was commissioned and is currently operating.
Several more treatment equipment has been commissioned in various major HCFs across the
6
Situation Analysis and National Action Plan, 2001, Ministry of Health
Situation Analysis and Action Plan for Chest Clinics, STD Clinics and Blood Banks, 2002, Ministry of Health
country with external as well as government funding support. Despite such achievements (which
are highlighted in greater detail later in this chapter as well as the next), safety from HCW is still
a challenge for Sri Lanka given its total national generation and the resources available for
treatment/disposal. Addressing these challenges in order to have a standardized HCWM system
covering the whole island with sustainable solutions that suit local requirements and conditions
would certainly require current efforts to be stepped up both qualitatively and quantitatively.
The package of enforcement and backstopping documents which were developed by the MOH
between years 2001–2002, referred to above, basically form the implementation framework for
HCWM in the country. Although a decade has passed, these documents still provide a sound
basis on which better HCW planning can be enforced and hence should be strongly considered in
deciding the way forward for future HCWM activities/programs. The sections below provide
greater detail of the policy and legislative framework.
Policies, guidelines, procedures and codes of practice are essential to support any health care
waste management system. In 2001, the Government of Sri Lanka drafted a comprehensive
national policy on health care waste management. It was divided into three main sections:
General considerations on Healthcare Waste Management (HCWM) and the institutional
mechanism for policy implementation that should be set up at national level.
Provisions for the safe management of HCW in medical Institutions, including
regulations and HCWM plans.
Provisions for the implementation of and the monitoring of HCWM plans at national and
provincial levels including legislation, provision of human and financial resources,
training and awareness and participation of private sector7.
Some salient features of the draft policy are discussed here below.
The draft National Policy for Healthcare Waste Management states that all healthcare
waste generated by the medical institutions of the public and private sector must be safely
handled and disposed of. It states that every hospital is legally responsible for the proper
management of waste that it generates until its final disposal and considers HCW as an
integral part of hospital hygiene and infection control. It refers to the legal responsibilities
of HCFs under the NEA and other regulatory needs, internal hospital rules etc for
creating the legal and regulatory framework for HCWM at the national, provincial and
institutional levels.
7
Draft National Policy on Health Care Waste Management, 2001, Ministry of Health
Another important feature of the draft policy is that it requires major hospitals to prepare
specific HCWM plans outlining needs, objectives, strategies, procedures for approved
management and disposal of HCW and timeframe for implementation and submit to
Central or Provincial Health Services for validation and support. At the provincial level,
the draft policy requires PHS to set up annual Provincial and District HCWM plans
presenting the strategy for HCM that should be developed at the regional level. This plan
shall compile all the HCWM plans of the HCFs they are responsible and approved by the
Central Health Services before implementation.
The policy recommends specific budget lines to be developed relating to hospital hygiene
and HCW management in the National Accountancy of the Health System in order to
ensure sufficient human and financial resources are allocated to implement the HCWM
plans in medical institutions.
It also states that policy implementation needs to be monitored on the basis of the specific
objectives defined in the National Action Plan (the plan developed to implement the
policy country wide - see section below) and that institutionally, the National Steering
Committee on Clinical Waste Management will be responsible for the overall monitoring
and evaluation and the PHS for the implementation of monitoring procedures in HCFs
within their area of jurisdiction.
Approved HCWM practices, equipment for treatment and disposal, training and
awareness, involvement of civil society, private sector participation are some of the other
key aspects reviewed in the draft policy.
Though the draft policy was submitted to the Cabinet of Ministers and referred to different
agencies for their feedback, official approval was not granted as before the process could be
completed a cabinet reshuffle took place and the process was interrupted and remain as it is up to
date.
In 2001, the GOSL drafted national guidelines for health care waste management with an aim to
providing a better understanding of the fundamentals of HCWM planning and directing HCFs in
setting necessary procedures and standards to comply with policy and legislative requirements.
These were drafted in a form that attempts to provide fundamental elements that should be
integrated into future legislation specific to HCW. Although guidelines were reviewed by the
National Committee for Clinical Waste Management as well as the Ministry of Health it did not
receive formal endorsement by the government.
The draft national guidelines contained both practical and conceptual information on HCWM
covering four main sections:
Definition and categorization of HCW including potential harmful effects that can result
from its harmful management
Procedures for segregation, packaging, labeling, collection, storage, transportation and
disposal of HCW that should be applied and followed in all HCFs in the country and for
selection of appropriate treatment and disposal technologies and facilities
Instructions for the implementation of health care waste management plans including
detail description of duties and responsibilities of health care provider at various levels
Instruction for personnel of Central and Provincial Health Services that should deal with
HCWM to ensure smooth implementation of the guidelines and to set up regular
monitoring mechanisms
In 2007, concise guidelines for HCWM were prepared under the Hospital Efficiency and Quality
component of the Sri Lanka Health Sector Development Project based on the detailed draft
guidelines prepared in 2001. The concise guidelines which mainly contain sections in waste
categorization and health care waste management procedures, have been formally adopted and
incorporated into the Handbook of Infection Control.
Management of HCW is an integral part of hospital hygiene and infection control that must be
reinforced with internal rules. As such the GOSL developed a Code of Hygiene for STD/TB
clinics in 2008. The national code of hygiene contains HCWM procedures and is seen as part of
an overall set of actions to control the hygiene conditions within the hospital. It sets out duties
and responsibilities of medical and non-medical staff regarding hygiene procedures to be
applied, recommended practices to maintain high level of hygiene and on-going management
and managerial activities to be carried out in the hospital.
The code of practice has to be implemented along with the HCWM guidelines.
Separating different waste streams based on the type of treatment and disposal practices is a key
step in the HCW management cycle. To implement a uniform system of segregation throughout
the country, the Ministry of Health developed a National colour code for health care waste, dated
March 2006 and circulated to all the government health care institutions, which is presently being
implemented. With a view to streamlining the collection of waste, technical specifications for bags
and bins to be used for different waste types were also made available for all hospitals. The national
colour code identifies 7 specific categories.
National legislation is the backbone for planning HCWM in any country and provides the legal
basis for establishing controls and permits. It is vital in making medical and non medical staff in
hospitals for being responsible at their own level and in securing the HCW disposal process.
In Sri Lanka the NEA No 47 of 1980 and its amendments (No 56 1988 and No 53 of 2000) are
the basic legal documents that regulate hazardous waste and consequently HCWM in the
country. Although it’s a comprehensive document and specific regulations on hazardous waste
has been in force since 2002, medical institutions were not included in the list of
institutions/activities for which an Environmental Protection License (EPL) must be requested
from the Central Environmental Authority (CEA) until 2008.
The comprehensive analysis of the situation regarding HCWM in the country conducted in 2001
highlighted that the lack of a legislative framework for HCWM as one of the main shortcomings
and recommended that the government consolidated existing legislation by editing a specific
regulatory document most appropriate for the management and disposal of HCW. In 2008, the
GOSL consolidated the NEA by incorporating medical institutions in the list of
institutions/activities that require an EPL.
Part II of the National Environmental (Protection & Quality) regulation No. 01 of 2008
includes “Health care service centers generating infectious wastes, including medical
laboratories and research centers” as a prescribed activity that requires a license.
Schedule VIII lists Healthcare waste as a scheduled waste from specific sources that no
person shall generate, collect, transport, store, recover, recycle or dispose except under
the licence issued by the Authority and in accordance with standards and other criteria as
may be specified by the Authority.
Source - Guidelines for the management of scheduled waste in Sri Lanka (2009)
Accordingly, every HCF is legally responsible for the proper management of health care waste
from the point of generation until its final disposal to ensure minimum environmental and public
health impacts.
However, the regulations on HCWM classifiy all categories of HCW and emphasizes the
importance of safe disposal of all categories of hazardous waste.
Caring for the Environment (CFE) 2008-2012, which is the second successive sectoral
environmental action plan prepared by the Ministry of Environment and Natural Resources to
implement the National Environmental Policy of 2003, recognizes HCWM as a significant
public health issue in the country that needs intervention, The CFE, which has been focused on 6
key sectors and addresses clinical waste under the waste management sector, has been prepared
with close consultation with the relevant sector agencies including the MOH. With regard to
clinical waste, the CFE broadly identifies the related public health and environmental issues and
refers to the draft national policy and other initiatives that were planned and on-going at the time
with the support of the MOH. Given below in the table are the key strategic actions
recommended in the CFE in order to achieve better institutional and administrative mechanism
for HCWM.
The institutional mechanism for implementing the national policy was broadly envisaged under
three levels of management:
At the central level, co-ordination and development of strategies and mechanisms to
implement policy commitments, in accordance with national requirements, has been
vested with the NCCWM. In addition, development of training and capacity building
packages, training implementation supervision, setting up of HCW monitoring protocols,
overall monitoring and evaluation has been assigned to the NCCWM. The Central Health
Services are responsible for technically backstopping HCFs under its management
purview.
At the provincial level, implementation of the policy has been vested with the Provincial
Councils. In particular the PHS is responsible for setting up provincial HCWM plans,
synthesized from individual hospital HCWM plans coming under its area of jurisdiction,
development of financial resources and for the implementation of HCW
monitoring/auditing procedures.
At the local level, setting up of HCWM plans that outline needs, objectives, strategies,
procedures and timeframes for medical institutions has been vested with the hospital
management.
The WHO classifies hazardous waste into the following categories. The major hospitals in which
all the ranges of medical activities are performed, produce the following HCW categories
In addition to the above, waste generated in hospitals include non-risk HCW or domestic waste
that include waste that are not contaminated with infectious or pathogenic agents and includes
food residues, paper, cardboard, plastic wrappings etc
A comprehensive national survey to measure types and related quantities of HCW generated in
different HCFs across the country has never been undertaken in Sri Lanka due to practical
reasons. However, various research papers and situation analysis have attempted to estimate the
national generation using different calculations and methodologies. Of these, the most
comprehensive baseline values estimated on HCW quantities generated in Sri Lanka so far is the
situation analysis undertaken by the MOH in 2001 with funding support from the World Bank.
The following section attempts to furnish and discuss findings on HCW generation quoted in
various surveys and investigations reported in the last decade or so including the rapid survey
conducted in a sample of major HCFs in support of the preparation of this framework. In general
a wide variation in the reported rates of HCW generation is observed in the various sources
reviewed. This is primarily due to the fact that different methodologies, calculations and
observations have been used in different investigations. Therefore, it is difficult to carry out a
proper comparative analysis or to establish patterns of HCW production associated with different
levels of HCFs over time.
The following table has been extracted from the draft SA and NAP, and presents the results of an
initial assessment undertaken in the various medical institutes in support of the preparation of the
NAP in 2001. As stated earlier, this was not a national survey but a comprehensive calculation
using direct measurement methods in a sample of different levels of HCFs. The methodology
used for the estimation of HCW quantities has been based on the number of containers used for
medical waste collection during a defined period of time, subjected to volume adjustments based
on a filling rate used for each category of container and finally adjusted applying a volumetric
mass ratio according to the type of waste thrown into the container and their humidity rates.
The Situation Analysis estimated overall production of hazardous HCW at the national level to
be about 15 tons/day. As can be noted in the table above, important disparities in waste
generation were highlighted between districts with Colombo responsible approximately for 25%
of the generation. In Colombo, it was found that HCW generation is concentrated within the
Greater Colombo Area with an estimated 4.2 tons/day (including private hospitals) justifying the
fact that a specific solution had to be found for the district. In addition, 30%of the national
estimate of HCW generation came from Gampaha, Kandy, Kurunegala, Galle and Anuradhapura
and were recommended as priority districts for the application of the NAP.
The national strategy and action plan for the implementation of the Environmental Policy, Caring
for the Environment 2008-1012, reports that a study conducted jointly by the MENR, CEA and
the BOI in 2003 on Hazardous Waste Management estimated clinical waste generated to be
5,643.8 tons per year which is in line with the daily generation estimated by the SA in 2001.
It also presents the following estimates relating to daily generation of HCW in different
categories of hospitals as indicated in the table below. The data has been sourced from an article
published in the Ceylon Medical Journal in September 2004 which uses international daily waste
generation rates from high income countries as a comparative scale to estimate HCW generated
in Sri Lanka. The study does not include the private sector hospitals and assumes that its
exclusion will compensate for the over-estimation that would result in using data from high-
income countries.
According to the study, estimates from global arena suggests that the University hospitals
generate higher quantities of healthcare waste at 4.1-8.7 kg/bed/day and that General hospitals,
district hospitals and primary healthcare units generate much lower quantities viz. 2.1-4.2
kg/bed/day, 0.5-1.8 kg/bed/day, and 0.05-0.2 kg/bed/day, respectively. Using these rates and the
bed capacities in year 2000, the daily HCW generation in the government sector hospitals of Sri
Lanka has been given as below.
Table 6 -The daily generation of healthcare waste in government-owned hospitals in Sri Lanka,
calculated using bed capacities in year 2000.
According to this analysis the total HCW produced by listed government sector hospitals is
between 76,624 and 170,790 Kg daily. Out of the total healthcare waste generated, the WHO
estimates that only 10-25% falls into the hazardous category. In line with this, the estimated
daily hazardous waste generation in Sri Lanka has been estimated as given in the table below.
Even at the lower estimate of 10% of total healthcare waste being hazardous, the figure is
significantly higher that what has been reported in study by the MENR on hazardous waste
generation (2003) but significantly lower than the figure reported in the Situation Analysis
undertaken by the MOH (2001).
In 2006, the University of Ruhuna carried out a Situation Analysis in the Galle District of the
Southern Province, with funding from the World Bank supported Health Sector Development
Project (HSDP), in order to complete a needs assessment and subsequently a prioritized action
plan for HCWM for the district. This activity was started as a pilot project under HSDP in order
to implement HCWM island wide. During the study 29 hospitals of different categories in the
district were investigated using a survey questionnaire and site visits supported by discussions
with hospital staff and quantities of HCW generated were calculated. The table below present the
results of a sample of hospitals investigated for which detailed results were presented in the
report.
Name of Hospital Bed Total waste Non-risk Hazardous Total Waste Haz Waste
Strength generation Waste Waste 8 Generation Generation
(Kg/day) (Kg/day) (Kg/day) (Kg/bed/day) (Kg/bed/day)
Peripheral Units
Induruwa 33 14.95 11.96 2.99 0.45 0.09
District Hospitals
Udugama 148 177.5 166.85 10.65 1.19 0.07
Unawatuna 68 40.4 39.18 1.21 0.59 0.02
Baddegama 98 30.2 21.14 9.06 0.31 0.09
Base Hospitals
Balapitiya 275 681.7 613.53 68.17 2.4 0.25
Elpitiya 171 134.6 122.48 12.11 0.79 0.07
Hiniduma 102 140.5 139.09 1.4 1.38 0.01
Teaching Hospitals
Karapitya 1410 1559 1057.5 352.5 1.11 0.25
Mahamodara 406 442.9 252.45 190.44 1.09 0.47
Table 8 – Quantities of HCW generation in selected HCFs in the Galle District
According to the analysis above, the two teaching hospitals in the district produce hazardous
waste in the range of 0.25-0.47 kg/bed/day which is close to the average production rate of 0.37
kg/bed/day reported in the Situation Analysis of 2001. However, the rates reported for Base
Hospitals, District Hospitals and Peripheral Units is show a significant variation from the
average figures reported in the Situation Analysis 2001.
8
Mainly sharps and infectious waste
In November 2011 the MOH conducted a rapid assessment of a selected sample of medical
institutions belonging to major HCFs in order to briefly assess the current levels of waste
generation and HCWM practices employed using a survey questionnaire. The questionnaire is
attached as Annex 1. Out of 40 hospitals targeted, 35 responded. Feedback on estimated waste
quantities in different waste categories reported by the hospital authorities has been summarized
in the table below.
Table 9 – Quantities of hazardous HCW generated in selected hospitals in the country (results of the rapid assessment done in 2011)
It is difficult to calculate the daily average production of hazardous HCW per medical institution
from the results above as the information is not complete. Most hospitals have provided only
estimated quantities for infectious waste and sharps generated while other types of wastes are not
properly accounted for. With regard to infectious and sharp wastes, the daily average production
indicates a wide variation even within the same category of hospital. For example, for infectious
waste the values range from 0.05 – 0.8 kg per bed for Teaching Hospitals, 0.05 to 1 kg/bed for
District General Hospitals and 0.02 to 0.37 kg/bed for Base Hospitals. The lowest generation of
infectious waste for Teaching Hospitals is recorded from the Infectious Diseases Hospital.
Similarly, the daily average production of sharp waste range from 0.008 to 0.1 kg/bed for
Teaching Hospitals (as opposed to 0.02 calculated in the SA, 2001), 0.03 to .0.4 kg/bed for
District General Hospitals and 0.005 to 0.04 kg/bed for Base Hospitals.
A proper estimation of the quantities of HCW produced should be made over a period of time to
arrive at average figures while taking into account potential slack periods or other unusual
circumstances that may cause significant variations in the waste quantities. While this type of
rapid surveys itself have a number of limitations, it is doubtful if hospitals possess accurate data
with regard to HCW generation.
Observations
Reasonably accurate data and information on waste production and waste management practices
are essential for planning an effective waste management programme. As such, it is important for
medical institutions to properly record current levels of waste production and document waste
management practices as it forms the basis for formulating a suitable HCWM strategy for the
institution and consequently at the regional and national levels. As mentioned earlier, although
there have been various attempts to estimate the national HCW generation in the last decade or
so, as outlined above, of which the Situation Analysis conducted in 2001 could be considered as
the best estimate, no comprehensive national survey has been undertaken.
As can be seen from the above, even the various attempts made so far to estimate baseline HCW
generation levels in different years show wide variations which makes it difficult to carry out a
comparative analysis over time or to project future levels based on established historical patterns.
According to yet another study conducted by the AIT on health care waste management in South
Asia in 2008, medical waste generation in Sri Lanka was presented as 0.36Kg/bed/day 9. This
figure is in line with the average production of medical waste reported for the major HCF under
the Situation Analysis (2001). Using this rate, assuming there has been no change in the demand
for health services and given the total bed strength of 69,501, the current level of hazardous
HCW production in the state sector hospitals would be around 25 tons per day. However, this is
a very rough estimate (on the upper side) which does not take into account the various factors
that would influence the total quantity of hazardous waste generated such as the size and
9
Visvanathan, C., 2008, Medical Waste Management in Asia, Asian Institute of Technology
functions of different HCFs (smaller facilities generate small quantities of hazardous wastes),
occupancy rates, the increased quality of segregation in the larger facilities and the consequent
reduction of infectious waste etc.
The handling of health-care waste is critical in minimizing risks associated with human health
and the environment. As such, implementation of safe HCWM procedures aimed at minimizing
potential risks should be practiced at every stage of the waste management cycle starting from
segregation and identification of hazardous and non-risk HCW, packaging, storage, treatment
and disposal. The rapid assessment conducted by the MOH in 2011 investigated some activities
relating to the handling of HCW in the selected HCFs surveyed. Presented here below is a
general picture obtained from the survey outcome as well as information available with the
MOH.
Description Responses
Yes No No Response
Segregation of waste according to national 35 None None
colour code
Waste collection and on-site transportation 35 None None
Waste storage 35 None None
Waste Storage Space 30 4 1
(2 not
satisfactory)
Off-site transportation 1
Waste treatment 24 8 1
Open
burning
Waste disposal No clear response
Table 10: Current practices in handling HCW in 33 major hospitals evaluated
On-site storage Most of the hospitals evaluated have dedicated space for on-
site storage of HCW excepting 4. However, standards of
hygiene of these storage rooms may considerably vary from
one place to another and it’s not clear from the feedback
whether these sites are adequate (excepting two which have
highlighted inadequate storage space) for the purpose with
restricted access and enough protection from the effects of
weather, scavenging by animals etc.
Waste Transportation In most situations final disposal sites are situated quite a
distance from the point of generation and with low technology
used during transportation, spills can easily take place which
can be a potential source of infection transfer. In most of the
hospitals waste is transported to the on-site storage facility by
sanitary laborers using carts and trolleys or by hand. These
laborers do not wear adequate protective gear. Off-site
transportation to treatment facilities is carried out by a few
hospitals which are part of the integrated HCWM system
implemented in the GCA.
Waste treatment and disposal Of the 33 hospitals evaluated, 3 hospitals use steam sterilizers,
13 use incinerators (type and capacity not mentioned), 5
outsource to a private sector service provider, 8 open burn.
The hospital in Nuwera Eliya is making use of the semi-
engineered landfill operated by the Municipal Council to
dispose of the hazardous waste. In addition, a few hospitals
operate sharp pits and placenta pits to dispose of sharps and
placentas in a safe way.
3.4: Summary of treatment technologies and infrastructure employed in the country for
HCWM
1. Burial – Infectious and general waste are being buried in some of the health institutions
where land space is available.
2. Open burning - Mixed waste or infectious waste separated are being burnt
3. Barrel incinerators – Infectious waste are being put to a barrel placed on bricks and a
mesh and then burnt
4. Sharp pits- Deposit sharps in a pit layer wise covering with lime
5. Needle burners - burning of infected part (metal) of the syringes.
6. Incineration – Some institutions use low temperature (below 1000’c) single chamber
incinerators and some use dual chamber high temperature (above 1000’c) incinerators for
incinerating infectious waste and sharps.
7. Steam Sterilization
Autoclaving ; laboratory cultures and some infectious waste are autoclaved before
disposal
Indirect Steam Sterilization – Few hospitals (04) use indirect steam sterilizers for waste
treatment.
8. Chemical disinfection - Some infectious waste are chemically disinfected. (Sodium
hyperchloride)
9. Placenta pits – Placenta are put in to a series of pits alternatively for natural digestion.
Table 12 – Treatment technologies and infrastructure available in some of the health institutions
funded under different agencies.
3.5 Achievements and gaps in the implementation of the policy/national action plan and
lessons learnt
In 2001, a National Action Plan (NAP) was prepared by the MOH, under a consultancy
assignment, to translate the national policy and guidelines into action as part of the government’s
long-term goal to upgrade and standardize HCWM procedures throughout the country, and there
by ensure the safe, environmentally friendly and cost effective management of HCW. The NAP
was broadly made up of seven packages of actions that were grouped thematically and was
complete with defined institutional responsibilities and potential indicators for each action, a
rough cost estimate for implementation and a timeframe which recapitulates each specific action
recommended for implementation within each package. The overall duration of the NAP was
intended to be 5 years.
Implementation of the NAP has been selective. While some important specific actions have been
implemented, the overall implementation success of the NAP has been limited and as a result the
desired outcomes in standardizing HCWM in the country have not been fully realized. The
section below elaborates on the gaps, achievements and lessons learnt from the last 10 years of
implementation experience.
Key Achievements
Consolidation of the National Environmental Act by gazetting disposal of HCW as a
prescribed activity that needs to be carried out under an environmental protection license.
Development and the implementation of the national colour code
Development of national guidelines on HCWM and code of hygiene and instructions
booklet for STD/TB clinics
Creation of a budget line for HCWM in the national budget for the health services.
Establishment of a health care waste management system for the public hospitals within
the Greater Colombo Area with two semi-centralised autoclaves and related
administrative/management arrangements for continued operation.
Provision of infrastructure and equipment to improve HCW disposal practices in a
number of major hospitals in the provinces with government and donor funding (see table
above).
Provision of training on HCWM for healthcare workers and other personnel in several
state hospitals under the HIV/AIDS Prevention Project, Health Sector Development
Project and WHO sponsored programs. A HCWM cell was established in the Department
of Community Medicine (Colombo Medical Faculty) which conducts training programs
on HCWM on an annual basis to about 60 hospital staff in collaboration with the MOH.
Inclusion of HCWM in the academic curricular for several post graduate courses
conducted by the Medical Faculty of the University of Colombo.( M. Sc in Medical
Administration/ Community Medicine)
Development of guidelines for transportation of cytotoxic waste for treatment & disposal
Post graduate research has been carried out on HCWM
Key Gaps
Formal adoption of the draft national policy and detailed guidelines on HCWM (note:
HCWM guidelines included in the National Guidelines on Infection Control are very
concise and do not carry details on institutional responsibilities, detail procedures etc for
waste handling). Cabinet approval for these documents has been long overdue.
Lack of validation and formal adoption of the NAP, setting up of working groups and
evaluation criteria to monitor progress
An officially recognized and dedicated institutional arrangement to co-ordinate, assist
and monitor implementation of the NAP. The NAP proposed the official designation of a
national project coordinator, officers within the PHS and HCWM officers at the major
hospital categories to oversee implementation of the recommended actions.
Subsequently, the establishment of a HCWM unit at the MOH was proposed and
initiated. Neither of these materialized.
Specific technical guidelines and format for the preparation of hospital HCWM plans
A protocol for the monitoring and auditing of HCWM plans
Although a specific budget line for HCWM is identified for each medical institution, it
may not relate to the actual costs associated with implementation of a proper HCWM
plan
Lack of research on HCWM or number and type of accidents associated with the
mishandling of HCW.
government regulations has been a stumbling block in the smooth functioning of the
HCWM system implemented within the GCA.
Hospitals may not be maintaining a proper information system on waste generation which
is amply shown in the rapid questionnaire survey conduced by the MOH in 2011 in
support of this framework. Information on waste generation is the basis on which the
management system should be decided upon; as such this is an important area the
hospital authorities should pay attention to.
The MOH allocates around Rs 50 million (0.067 % of the health budget) to the HCFs under the
central government for HCWM. Provincial Authorities also allocate some funds to HCWM,
however, data not readily available on this due to various reasons. Some of the deficiencies
found in the rapid appraisal 2011 can be directly linked to the inadequate funding. GOSL and
MOH find it difficult to increase the allocation due to budgetary constraints.
Hospital HCWM plans or provincial HCWM plans should be the basis on which financial
allocations should be decided upon for inclusion in the health budget. However, having said that,
given the multiple demands placed on health services and the limited resources available,
government funding for the health sector may not be able to provide the needed injection of
capital finance for installing sustainable technology for the management and disposal of HCW.
Thus, it is important for designated officers of the MOH and the PHS to work closely with other
sectoral government agencies, donor agencies etc to source necessary support for the
implementation of HCWM plans. So far, external funding in the management of HCW has been
a huge impetus in Sri Lanka and should be further collaborated with to continue taking HCWM
forward to better levels.
4.1: Summary of HCWM strategies addressed in the National Health Development Plan
Environmental & Occupational Health Unit has identified the following objectives and strategies
under HCWM.
Objectives
1. To develop a national policy on healthcare waste management ( HCWM)
2. To develop a national plan on HCWM .
3. To implement HCWM plan in hospitals
4. To harmonize the HCWM plan in all institutions
5. To build capacity among health staff on HCWM at all levels
Strategies
1. To review and update institutional capacities
2. To improve the infrastructure facilities
3. To improve the competencies of staff
4. To transfer the ownership of HCWM to respective institutions
5. To build inter-sectoral coordination securing the intra sectoral coordination
6. To promote the usage of appropriate technology for HCW treatment.
Based on the above objectives and strategies the following national action plan has been
constructed for implementation.
Although HCWM has increasingly gained recognition as an area of critical importance over the
last decade and many steps have taken towards establishing better management, it still remains a
significant environmental and public health issue in the health sector. Reaching complete safety
from the risks of HCW produced in the country requires current efforts to be extended both
quantitatively and qualitatively in a progressive manner.
With support from the Second Health Sector Development Project funded by the World Bank,
the following key actions are recommended for implementation during the lifetime of the project.
1. Establishing policy commitment and Draft National Policy on NSCHCW & MOH
responsibility for HCWM HCWM updated and
formally endorsed and
approved.
It is important that a formal commitment to a national policy is made before any action plan for
improving HCWM can be undertaken. While a comprehensive national policy was developed in
2001, the objectives and underlying principals of which are detailed on page 19, it was not
formally endorsed by the government. Therefore it remains to be a draft policy to this date
pending approval.
As more than a decade has passed since the policy was drafted, it is recommended that the
National Committee on Clinical Waste Management review the policy and update it as
necessary to suit current challenges and demands in HCWM. Following the review and
agreement to its content by the MOH, the draft policy should be re-submitted for cabinet
approval subsequent to which a stakeholder consultation should be conducted and finally
approved with parliamentary endorsement.
Strengthening the Directorate of Environment and Occupational Health of the MOH is essential
in managing a HCWM program at the national level and ensuring continued efforts in
implementing a national HCWM program and its long-term sustainability. HCWM is a
specialized service requiring technical skill and know-how. As such, a strengthening the unit
staffed with suitable expertise can play a vital role in strategically directing the sector,
technically backstopping HCFs to improve the management of HCW within their institutions
and providing monitoring oversight at the national level.
Although the creation of a specialized unit for HCWM was initiated under HSDP long delays
were experienced in getting the necessary management clearances and as a result administrative
formalities could not be completed prior to project closure. The Management Services
Department, which is responsible for creating cadre had several discussions with the MoH but
could not get the approval for cadre during the project period. Therefore it is recommended that
the Environmental & Occupational Health Unit be strengthened providing technical oversight
and co-ordinating and guiding hospital authorities on HCWM issues.
A formal institutional arrangement that links the E&OH unit to the health institutions be agreed
upon.
While draft national policy/guidelines may provide the framework for standardizing HCWM
procedures across the country, translating recommended practices at the HCF level by either
improving or initiating HCWM systems is unlikely to be sustainable unless a process of
planning is introduced and established.
It is important that the major HCFs introduce a process of planning for HCWM that culminates
in the preparation of HCWM plan specific to each institution, which can be updated on a yearly
The draft national guidelines prepared in 2001 include guidance on some of the key steps
involved in preparing a HCWM plan. However, if required, the MOH could supplement this
with a practical guide for developing a hospital HCWM plan. Several useful sources 10 are
available on the internet from which a supplementary guide could be developed for the use by
hospital management.
Teaching hospitals are the largest type of HCF in the country and generate all sorts of hazardous
health care wastes in significant quantities. Given that the overall capital and operational costs
for implementing and standardizing HCWM measures remains high, it makes sense to first start
improvement in HCWM in the larger hospitals and then extends to smaller health-care
establishments.
It is recommended that the MOH review current HCWM practices employed in all THs and
assist them in setting up specific HCWM plans, which can be updated periodically, and which
will progressively lead the institutions to comply or improve compliance with legislative
requirements. The establishment of HCWM plans and monitoring its implementation will
oblige medical institutions and administrative authorities to consider HCWM as an integral
issue of health care services and progressively reinforce organizational capacities to achieve
better standards.
10
WHO, 2002, Basic Steps in the Preparation of Health Care Waste Management Plans for Health Care
Establishments (Health Care Waste Practical Information Series No 2)
Apart from Teaching Hospitals, Provincial General Hospitals, District General Hospitals and
Base Hospitals are the other major HCFs that offer a range of specialized health care services
and consequently produce significant quantities of hazardous HCW. According to the National
Health Budget of 2012 there are 87 major HCFs spread across the country.
As it may not be possible to cover all of the 87 major hospitals under the 2nd HSDP, it will focus
on the major facilities in those provinces that rank high in terms of the quantity of HCW
produced.
Based on HCWM plans of medical institutions under its purview, it is recommended that the
PHS set up annual provincial HCWM for the selected provinces which will present the strategy
for HCWM at the regional level. It will provide the PHS a clear analysis of the prevailing
situation in the province/region and help set up short, medium and long term objectives and
associated expenditure.
An officially nominated focal point in the PHS (recommended – RE) should be in charge of
developing the provincial HCWM plan with technical backstopping from the proposed HCWM
unit within the MOH.
Under the HIV/AIDS Prevention and Health Sector Development Projects, the MOH carried out
numerous training programs to train health care workers in the proper management of HCW.
Currently, the MOH in collaboration with the University of Colombo conducts a HCWM
training program annually for a small selected group. In order to achieve acceptable practices in
health-care waste management and compliance with regulations, it is essential to continue
training specifically targeting managers and other personnel primarily involved in the waste
stream management in different HCFs across the country. Also, it may be important for hospital
waste management teams and focal points in the PHS to receive technical training on the
development of HCWM plans.
It is essential that the monitoring framework provide the necessary tools to measure if the
objectives of a HCWM program have been achieved. They would broadly include;
2 Strengthen E&OH Unit i. Formal mandate for the unit with detail job 2015
descriptions for recommended cadre
positions developed.
ii. Separate budget line for HCWM under 2014
Environmental & Occupational Health
Unit
iii. Infra- Structure developed for 2016
Environmental & Occupational Health
Unit
3 Develop a standard i. Standard template for hospital specific 2014
template/form for HCWM HCWM plan developed.
plans for medical institutes ii. Standard template for Provincial HCWM
and for PHS. If plan developed
necessary, prepare
iii. Technical guidelines developed and
additional guidelines
adopted
consisting of basic steps
for the preparation of
HCWM plans.
Chapter 5: Implementation and monitoring arrangements for HCWM under the Second
HSDP
5.1 : Project Institutional and Implementation Arrangements
As a sector assistance program, the implementation of the 2nd HSDP will be the
responsibility of regular implementing divisions/units in charge of the subject matter under
the leadership of the MOH and the PHS. The actual project implementation will involve
central and district level administrative and technical staff, health workers and technicians.
The project Management team of the D E & OH unit will be responsible for the following key
tasks:
i. Operating the Project Account;
ii. Reviewing the DHPs and the plans and budgets for approval by the PCT;
iii. coordinating the elaboration of operational documents, including:
iv. Preparing TORs and contracts for technical assistance (e.g. capacity building of
PMUs, Health Forum organization, annual audits);
v. Consolidating reports necessary for documenting use of IDA funds and
implementation progress and results;
vi. Reporting on procurement documents for large items;
vii. Managing capacity building activities. In particular, with the support of
consultancy firms, it will develop training programs in the areas of
planning/monitoring and procurement/financial reporting for the districts;
viii. Coordinating monitoring and evaluation activities;
ix. Communicating to key stakeholders the nature, progress and outcome of the
Program;
x. Liaise with international agencies such as IDA, JICA, WHO, and other partners to
ensure that all sector activities are well coordinated.
The project management team will also be supported by a Project Steering Committee
(PSC) appointed by the MOH who will oversee implementation of program activities.
More specifically, the role of the PSC will be to (i) monitor the achievements of project
objectives, (ii) provide policy direction, general project oversight and take necessary
decisions to address implementation issues which may arise during the life of the project.
The relevant division of the MOH and the will ensure that the PSC recommendations to
resolve project implementation issues are satisfactorily implemented.
With technical assistance, the project management team will set up a management
information system, for all project activities (provincially and centrally managed
components), that links financial and procurement management information to the
physical progress of the project. With this tool, the project management team will
supervise, monitor, and report on project activities to the PCT and to the Bank, and will
ensure that implementation of the various project components are implemented in
accordance with the rules set out in the Operations Manual, and that annual audits are
carried out as stipulated in the Grant Agreement.
At the Provincial level, under the technical and policy guidance of the MoH, the Local
Government and the Provincial Councils will serve as the coordinating and monitoring
agencies responsible for overseeing the implementation of the district programs. Actual
implementation of project activities will be the responsibility of the District health
authorities (2 to 3 Districts in each Province) and their divisional staff responsible for
planning, executing and monitoring their District Health Plan. Districts will continue to
receive considerable technical assistance and on-the-job training to strengthen Program
Management Centers (PMCs) capacity to implement the project, the core operational
body to implement the Program under a Performance Based approach.
The Second Health Sector Development Project will basically support the
implementation of the National Health Development Plan through the programs of the
MOH and the 9 provincial MOHs. As the program is designed to be implemented
through the regular health institutional structure, responsibility of implementing and
monitoring results related to HCWM will lie with the relevant divisions/units of the
MOH, PHS and the medical institutions.
Hospital Major HCFs Every hospital is legally responsible for the proper management of
Level the waste that it generates until final disposal. Directors of every
HCF will take the responsibility to implement safe HCW
procedures in their institutions. Therefore, all major hospitals will
take the responsibility of establishing HCWM plans for the
institution and implement accordingly.
MOH/PHS The EOHD of MOH and the PHS should (i) co-ordinate efforts to
ensure that HCWM plans are annually set up in the entire major
hospitals, (ii) provide technical services and (iii) supply adequate
resources.
As there is ample literature produced by various organizations11 including the WHO on guiding
medical institutions in selecting the most appropriate treatment and disposal technology,
depending on the types and quantities of waste produced and other specific local conditions, this
chapter will be limited to providing a broad technical overview of the options only. The table
below presents suitable treatment and disposal technologies according to the different categories
of HCW and has been sourced from the Guidance Manual for Preparing a National Health Care
Waste Management published by the WHO12.
11
The “Technical Guidelines on Environmentally Sound Management of Biomedical and Healthcare waste” (2002) adopted by
the Conference of the Parties to the Basel Convention;
• Safe management of wastes from health-care activities, WHO (1999);
• Teacher’s Guide: Safe management of wastes from health-care activities, WHO (1998);
• (Draft) Guidance for the development of National Action Plans, WHO (2002);“Basic Steps in the Preparation of Health Care
Waste Management Plans for Health Care Establishments”, WHORegional Office for the Eastern Mediterranean (CEHA) (2002).
12
Guidance Manual for the Preparation of National Health Care Waste Management Plans in Sub-Saharan Countries, World
Health Organization and the Secretariat of the Basel Convention
quantities
with
encapsulation
Pharmaceutical Yes Small No No No No No
waste amounts
Cytotoxic Yes No No No No No Small
waste Yes for quantities
modern with
ones inertization
Infectious Yes Yes Yes Yes Yes Yes
waste
Highly Yes Yes Yes Yes Yes Yes but only
Infectious after pre-
waste treatment
Radioactive No No No No No No Yes but need
waste to be
specially
designed
Other Yes No No No No No No
hazardous Yes if
waste specially
designed
Table 13 - suitable treatment and disposal technologies according to the different categories of
HCW
The section below is a comparison of the alternative technologies available to treat hazardous
HCW and has been adopted from the Situation Analysis report of 2001 (MOH) and relevant
Who guidelines13.
6.2: Incineration
Incineration is the only technology that can effectively treat most types of health care waste. It
involves a high-temperature dry oxidation process that reduces organic combustible waste to
inorganic incombustible matter with a resultant significant reduction in the waste volume and
weight. Incinerators can range from extremely sophisticated high-temperature operating plants to
very basic combustion units that operate at much lower temperatures. Broadly, they can be
categorized as (i) Double chamber pyrolotic incinerators (ii) single chamber incinerators and (iii)
rotary kilns. One of the main drawbacks of this technology is the gaseous emissions the process
yields, particularly toxic substances if the waste material contains cytotoxic drugs, chemicals,
halogenated material or waste with high contents of heavy metals (such as batteries and broken
mercury thermometers etc). Higher operating temperatures and treatment of flue gases limit
potential for atmospheric pollution and odors caused by the incineration process.
Therefore, selection of the incineration equipment is important and should be carefully evaluated
on the basis of available resources, local conditions and of public health benefits against the
potential risks of air and groundwater pollution caused by inadequate destruction of certain toxic
13
wastes. It is recommended that incinerators designed especially to treat HCW should operate at
temperatures between 900°C – 1200°C. To achieve optimal results from incineration, the waste
should meet certain criteria such as having a low heating value, high content of combustible
matter, very low content of incombustible matter , low moisture content etc.
Capacity (per hour) 50Kg to several metric tons or 200Kg – 10 tons per day
6.3: Autoclaving
Autoclaving is the process of exposing infectious waste to high temperature, high pressure steam
in an enclosed container, similar to the autoclave sterilization of medical equipment. It
inactivates most types of micro-organisms, if properly operated with sufficient temperatures and
contact time, and once disinfected the output can be considered non-hazardous which can be
land-filled with general municipal waste. Autoclaving requires shredding of wastes and sharps
prior to loading to the equipment in order to increase disinfection efficiency. This method is most
appropriate for infectious and sharp wastes and not for certain types of wastes such as
anatomical, pharmaceutical, chemical wastes. The equipment requires to be operated and
maintained by adequately trained technicians and the effectiveness of the disinfection process
has to be routinely checked using a bacterialogical test.
Description Minimum contact times and temperatures will depend on several factors such
as the moisture content of the waste and ease of penetration of the steam.
Research has shown that effective inactivation of all vegetative
microorganisms and most bacterial spores in a small amount of waste (about
5– 8kg) requires a 60-minute cycle at 121°C (minimum) and 1 bar (100kPa);
this allows for full steam penetration of the waste material.
Advantages Relatively simple to operate
Low environmental impact
Autoclaving is commonly used technology in the country for sterilizing medical equipment as
well as infectious HCW. The HCWM system implemented for the public hospitals in the GCA
comprises of two semi-centralized steam sterilizers located in two strategic locations which
disinfects waste generated in 3 major HCFs in the said area.
tests. As the process is powered by electricity and does not involve the application of steam,
generation of gaseous emissions and wastewater are minimal compared to incineration and even
autoclaving, which can require combustion of fuel for the generation of steam.
The microwave process is widely used in many developed countries. However, it’s not very
popular in developing countries due to the high initial cost and maintenance involve. At the
moment the technology is not popular in Sri Lanka as a suitable solution for treating HCW.
Description Chemicals that are used are mostly strong oxidants such as chlorine
compounds, ammonium slats, aldehydes, phenolic compounds etc)
In the absence of sanitary landfills, a controlled dump site which fulfills minimum requirements,
such having certain engineering work completed to effectively retain waste and an established
system for rational and organized deposit of waste, could be used. It is further recommended that
HCW be deposited using one of the following techniques; (i) bury in a shallow hollow excavated
in mature municipal waste at the base of the working face and cover with a fresh layer of
municipal waste (ii) bury in a excavate deep pit in mature municipal waste and backfill with the
removed municipal waste or (iii) design and dedicate a special cell in the landfill where only
HCW will be received.
In smaller HCFs with means for minimal HCW management programs, especially in remote
areas or areas with severe hardships, safe burial in a specially constructed burial pit may be the
only viable option. As a minimum, the hospital should follow certain basic rules in managing the
burial pit such as lining the pit with a material of low permeability, restricting access to the site
to authorized personnel only, covering HCW with a layer of soil after each load and with lime if
ordour has to be suppressed, bringing only hazardous waste to the site to optimize the space
available in the pit etc,. Once filled, the pit should be sealed off.
Sri Lanka does not operate fully engineered sanitary landfills. However, the Nuwera Eliya
Municipal Council operates a semi-engineered small landfill which is used by the Nuwera Eliya
General Hospital to dispose of its hazardous HCW. Ampara has land fill sites developed by
UNOPS. All other landfills used by local authorities are unsafe dump sites and hence is not safe
for the disposal of infectious HCW.
Chapter 7: Safeguard requirements for infrastructure development work under 2nd HSDP
The second HSDP may invest in the development of health infrastructure, mainly buildings to
improve/expand health care services. Environmental impacts of such construction, which would
in most cases take place within the existing premises, are likely to be localized, relatively small
scale, spread in different locations of the country and confined to the construction site. However,
the hospital management and health authorities should take precautions to minimize any
potential adverse impacts caused by civil works and also to ensure that environmental friendly
practices are employed when planning and designing the sub-project.
It is very unlikely that infrastructure development undertakings of the project would belong to
any of the prescribed categories mentioned above, however, in the unlikely event it does an
application need to be submitted to the CEA using the Basic Information Questionnaire available
on its website. Based on the application the CEA will make a determination on the level of
assessment required and instruct the relevant authorities of the requirements that need to be met
in obtaining EIA clearance.
When new sites are developed, the project should give strong consideration to proper site
selection criteria such as (i) accessibility (ii) availability of services such as water supply
and other infrastructure essential for development of a health care service (iii) availability
of space for waste management activities (iv) proximity to ecologically sensitive areas (v)
minimum interference with local hydrology (vi) minimum potential impact on the
surroundings of the health premises (vii) areas known to be vulnerable to natural disasters
etc
Spatial planning within the health premises should also give priority to potential for
creating green areas and other facilities for visitor/resident comfort.
Designing
The design of health facilities should give due consideration to the comfort of users and
needs of patients, children, disabled and the old.
The design of the buildings should also ensure adequate ventilation and lights and should
give priority to making the most of the potential of natural systems and renewable energy
sources.
The health facility should have adequate safe water supply and sewage/wastewater
disposal systems.
The building design also should make ample spaces and provisions for collection,
storage, transfer, treatment and disposal of HCW generated by the facility during the
operational phase. If the type of treatment facility (such as incineration) is determined the
design should incorporate the infrastructure needed to support its functioning.
Construction
Protection of Ground Cover and Vegetation
Removal of existing green cover including trees should be limited to the bare minimum.
Soil Erosion
The contractor should be instructed to take all steps necessary to ensure the stability of
slopes including those related to temporary works.
Work that will lead to heavy erosion shall be avoided during the raining season. If such
activities need to be continued during rainy season prior approval must be obtained from
the hospital authority by submitting a proposal on actions that will be undertaken by the
contractor to prevent erosion.
The work, permanent or temporary shall consist of measures as per design or as directed
by the Engineer to control soil erosion, sedimentation and water pollution to the
satisfaction of the Engineer. Typical measures would include grass cover, slope drains,
retaining walls etc.
Noise
All noise generating machinery used during construction should be fitted with noise
control devises and comply with the standards stipulated by the CEA for sensitive
environments. The use of noise generating machinery should be limited to day time hours
and cause minimum disturbance to patients if in-patient care facilities already exist within
the premises.
Labour Camps
If labour camps are established, they should be provided with adequate and appropriate
facilities for disposal of sewerage and solid waste. The sewage systems shall be properly
designed, built and operated so that no pollution to ground or adjacent water
bodies/watercourses takes place. Garbage bins should be provided in the camps,
regularly emptied and disposed off in a hygienic manner, to a designated site by the Local
Authority.
The labour camps should be monitored for cleanliness and hygiene and necessary
measures should be taken to prevent any breeding of vectors.
The labour camps must be removed from the site after its need is over along with septic
tanks, garbage and other construction debris and clean. The area should be restored back
to its former condition before handing the site over.
Dust Management
To prevent dust pollution during the construction period, regular watering of the
construction site must be carried out and all material stocks onsite must be covered to
prevent dust and other particles getting airborne.
All vehicles delivering materials shall be covered to avoid spillage and dust emission.
Annexes
1. Hospital Information
a) Name of the Hospital :………………………………………
b) Bed Strength:………………………………………………...
c) Bed Occupancy Rate:……………………………………….
d) Number of wards:……………………………………………
e) Number of Staff:…………………………………………….
f) Doctors/ Nurses/ / Paramedics/ Minor Staff ………………..
2. Does the hospital have a approved Health Care Waste Management Plan? Yes
No
…………………………………………………………………………………………………
………………
Infectious waste
Chemical waste
Pharmaceutical waste
Sharps
Radio-active waste
Plastic/ polythene
Paper
Other
4.1 Details on waste segregation – into which categories are HCW separated?
4.2 What type of containers are used to segregate waste (bags, cardboard boxes,
plastic/metal containers)
………………………………………………………………………………………………
………………………
………………………………………………………………………………………………
………………………
4.3 What type of labeling and color coding is used for marking segregated waste?
………………………………………………………………………………………………
………………………
………………………………………………………………………………………………
……………………
4.5 Do sanitary laborers use protective clothing like masks, boots, gloves and aprons?
Yes No
4.6 What types of containers are used for collection and internal transport of waste?
(Bins, bags, boxes, trolleys, wheelbarrows etc)
………………………………………………………………………………………………
………………………
………………………………………………………………………………………………
………………………
4.7 Where is segregated waste stored while awaiting removal from the hospital or
disposal? Is this area secure?
………………………………………………………………………………………………
………………………
………………………………………………………………………………………………
………………………
4.8 Is there off-site transportation of HCW involved prior to disposal? If yes, please
provide details of the following:
………………………………………………………………………………………………
………………………
………………………………………………………………………………………………
………………………
………………………………………………………………………………………………
………………………
………………………………………………………………………………………………
………………………
………………………………………………………………………………………………
………………………
………………………………………………………………………………………………
………………………
………………………………………………………………………………………………
………………………
………………………………………………………………………………………………
………………………
………………………………………………………………………………………………
………………………
4.10 Is there a waste treatment facility available within the hospital? (incinerator/steam
sterilizer)
…………………………………………………………………………………………………
……………………
…………………………………………………………………………………………………
……………………
or
4.11 Has the hospital outsourced HCW treatment to third party? If so, does the
organization offer satisfactory services?
…………………………………………………………………………………………………
………………
…………………………………………………………………………………………………
…………………
…………………………………………………………………………………………………
……………………
…………………………………………………………………………………………………
……………………
…………………………………………………………………………………………………
……………………
…………………………………………………………………………………………………
……………………
6.1 Is there a waste management team in the hospital with designated responsibilities?
Please provide a brief overview of how duties and responsibilities for HCWM is
organized.
…………………………………………………………………………………………………
……………………
…………………………………………………………………………………………………
…………………
…………………………………………………………………………………………………
……………………
…………………………………………………………………………………………………
……………………
…………………………………………………………………………………………………
……………………
Yes No
8 Status of obtaining Environmental Protection License and Scheduled Waste License from
the Central Environmental Authority
…………………………………………………………………………………………………
……………………
…………………………………………………………………………………………………
……………………
9 Do you think the current practices of waste handling, storage and disposal offer sufficient
security and protection against risks posed by hazardous HCW
…………………………………………………………………………………………………
………………
…………………………………………………………………………………………………
…………………
…………………………………………………………………………………………………
……………………
…………………………………………………………………………………………………
……………………
…………………………………………………………………………………………………
……………………
…………………………………………………………………………………………………
……………………
Name Bed Bed No of Quantity of solid Quantity Method Method of Method of Method Method of Traini EPL/H
Streng Occupanc Staff waste generated of Waste of Waste Waste of Sewerage ng on WL
th y rate ( Category wise) Water Waste Transportati Treatment Waste Treatment HCW obtained
generated segrega on and & Disposal water M
-tion Storage treatme
nt
1. 3300 82% 6750 Infectious 500 Used – NCC Storage Steam Connect - Trainin Pending
NHSL Kg 3750 units available Sterilization ed to g licenses
Sharps 100 Kg Disposal by main conduc
Chemical 25liters CMC sewer ted
Pharmaceutical
waste 10Kg
Radio active – 2
Kg
E waste 100Kg
per year
Mercury – 5Kg
per year
2.TH- 485 89.66% 1042 Infectious – 50m3 – As per Carts, storage Steam Chemic No Trainin Yes
CSHW 160Kg 100m3 the available sterilization al –( treatment g
Sharps – 9Kg Nationa & shredding TCL) conduc
Chemical – 7.5l l Colour ted
Code CMC –
recycling
paper, plastic
general
waste
3..Lady 901 78.4 2220 Infectious waste – Water NCC Waste Steam No No yes Applicati
Ridgeway 125Kg usage transportation sterilization ons
Hospital Sharps – 15 Kg 675.6 m3 –by Carts and submitted
Storage shredding at
08 Kg per 2 available CSHW
weeks
10 tube light
bulbs
4TH- 1093 83% 1990 Infectious- 200kg 791.40 NCC Storage Treatment – No - yes Applicati
Colombo Sharps – 100Kg litres available outsourced ons
South Placenta body Bio submitted
Name Bed Bed No of Quantity of solid Quantity Method Method of Method of Method Method of Traini EPL/H
Streng Occupanc Staff waste generated of Waste of Waste Waste of Sewerage ng on WL
th y rate ( Category wise) Water Waste Transportati Treatment Waste Treatment HCW obtained
generated segrega on and & Disposal water M
-tion Storage treatme
nt
parts( 350kg per degradable-
week) local
authority
Other
recycled.
5.TH- 954 72% 1789 Infectious – 180000 l NCC Storage room Out sourced Connect Sewerage yes
Peradeniy 125Kg ed to treatment
a Sharps – 50% sewer plant
Chemical – 65
litres Chlorination
Radio active
600ml
6.De 343 86.67% 850 Infectious – 100 100 m3 NCC Storage Room Out sourced no No yes Applicati
Soyza Kg ons
Maternity Sharps – 5Kg prepared
Hospital
7. 876 1199 Infectious – - NCC No Out sourced No Sewerage yes Applicati
National 177Kg treatment on
Cancer Sharps – 74Kg plant Submitte
Institute Plastic Cytotoxic d
75Kg
Glass Cytotoxic –
25Kg
8.T H - 1606 85.7% 2571 Infectious – 25 liters NCC Storage Incinerator yes Applicati
Karapitiya 175Kg Rooms available – ons to be
Sharps 30Kg not adequate submitted
.
9.TH – 671 - 423 Infectious – 80 275 m3 NCC Storage – not Incineration Waste yes NO
Chest Kg satisfactory – not water
Hospital Sharps – 6kg adequate treatme
Chemical – 5Kg nt plant
10.TH- 115 89.15% 355 Infectious -08 Kg - NCC No - storage Open Waste yes Not No
Name Bed Bed No of Quantity of solid Quantity Method Method of Method of Method Method of Traini EPL/H
Streng Occupanc Staff waste generated of Waste of Waste Waste of Sewerage ng on WL
th y rate ( Category wise) Water Waste Transportati Treatment Waste Treatment HCW obtained
generated segrega on and & Disposal water M
-tion Storage treatme
nt
Sirimavo Sharps – 5Kg burning water adequa
Bandarnai connect te
ke CH ed to
sewer
11.TH _ 1228 90& 1104 Infectious 165,000 NO Waste yes Not Preparati
Jaffna 1000Kg gallons Disposed by water adequa on for
Local connect te Submissi
Sharps 150Kg authority ed to on
Cytotoxic 1800Lg sewer
per year
12.TH – 1650 87% 2725 Infectious – 250m3 NCC Under Incineration No No yes No
Kurunegal 2000Kg ???? construction Not adequate
a Sharps – 79.5%
13.Nation 1514 62.81% 1052 Infectious – 13 - NCC Storage area Out sourced No Available yes Applicati
al Institute Kg available not ons
of Mental Sharps – 1.5 Kg functioning submitted
Health
14. Sri 1046 66% 1608 Infectious – - NCC Storage Incineration yes yes yes Licenses
Jayawarde 100Kg Available obtained
napura G Sharps – 15Kg
H Chemical –
100Kg
15.TH - 2286 81% 4672 Infectious – NCC Storage Out Sourced No Yes Yes Licenses
Kandy 470Kg Available Obtained
Sharps – 71Kg
Placenta – 60Kg
Cytotoxic Waste –
600Kg
16.TH – 252 95.54% 758 Infectious – 55Kg 20m3 NCC Demarcated Steam No No No Applicati
Mahamod Sharps – 4-5 storage area Sterilizer ons
ara - Galle boxes submitted
17.TH- 1405 2103 Infectious – - NCC Demarcated Incinerator No No yes
Colombo 120Kg Area +
North Sharps -24Kg Out Sourced
Name Bed Bed No of Quantity of solid Quantity Method Method of Method of Method Method of Traini EPL/H
Streng Occupanc Staff waste generated of Waste of Waste Waste of Sewerage ng on WL
th y rate ( Category wise) Water Waste Transportati Treatment Waste Treatment HCW obtained
generated segrega on and & Disposal water M
-tion Storage treatme
nt
18.TH - 746 83% 1405 Infectious – - NCC yes Burning and Connect yes yes No
Kegalle 327Kg buring ed to
sewer
Sharps – 76.5Kg
Chemical Waste -
54 liters
19.IDH 200 220 Infectious – 8 – NCC Secure Area
10 Kg
Sharps - 01Kg
Chemical 1-2Kg
20. DGH- 708 73.83% 979 Infectious – 90Kg 03m3 NCC Separate Huts Incineration Drafted NO
Gampaha Sharps – 10Kg Available a
project
prposal
21 259 72.5% 322 Infectious – 20Kg 240m3 NCC No Clinical Collecte No Applicati
Rehabilitat Waste – d in a ons
ion Sharps – 4Kg transported closed Submitte
Hospital _ to NCTH - pit d
Ragama Ragama
22. DGH - 300 1367 Infectious – 30 000 NCC Storage room Open Connect Yes Applicati
Kalutara 300Kg liters available not burning of ed to ons
Sharps -10Kg adequate infectious Sewera submitted
waste ge
System
Sharps – out
sourced
23.PGH 1010 78% 1847 Infectious – 500000L NCC Storage and Incinerator. No Sewerage yes No
Ratnapura 1000Kg demarcated method system
Sharps – 50Kg Water area available.
Pharmaceutical usage- available.
waste – 20Kg 1200000L
Cytotoxic waste –
30Kg per year
Name Bed Bed No of Quantity of solid Quantity Method Method of Method of Method Method of Traini EPL/H
Streng Occupanc Staff waste generated of Waste of Waste Waste of Sewerage ng on WL
th y rate ( Category wise) Water Waste Transportati Treatment Waste Treatment HCW obtained
generated segrega on and & Disposal water M
-tion Storage treatme
nt
Mercury waste –
50 l x12 per year.
24..PGH 1375 78% 1807 Infectious – 1,10,000l NCC Storage incineration Adding Sewerage yes Applicati
Badulla 1500Kg available TCLfilt system ons
Sharps -75Kg eration available. submitted
Chemical 90 100 l Connect
Cytotoxic 10Kg ed to
per year sewerag
e
25. DGH 530 80% 930 Infectious -175 - - NCC Demarcated Incineratorav Waste - yes Applicati
– Ampara 200Kg area available ailable – not water ons
Sharps – 50 -70 adequate treatme Submitte
Kg nt d
system
availabl
e
26. DGH 676 - 873 Infectious – - NCC Yes Open Connect yes No No
_ 400Kg burning/ ed to
Negambo Sharps – 300Kg burring Sewera
ge
System
27. DGH 427 90% 617 Infectious – 50 10 liters NCC Storage Disposed at Connect yes yes No
– Nuwara Kg Available the land fill ed to
eliya Sharps- 05Kg Sharps – sewerag
Sharp pit at e
the land fill System
28.DGH – 526 69.3% 567 Infectious – 25- 4000- NCC yes Buring Connect Yes – needs yes Applicati
Nawalapiti 30Kg 6000 liters burning ed to repairs ons
ya sewerag submitted
Sharps – 12-15Kg e
29.DGH - 737 60.62% 22 Infectious 250 Kg 2500 liters NCC yes Incineration Connect Sewerage conduc Applicati
Matale Sharps 10Kg ed to system ted ons
Pharmaceutical Sewera available submitted
Name Bed Bed No of Quantity of solid Quantity Method Method of Method of Method Method of Traini EPL/H
Streng Occupanc Staff waste generated of Waste of Waste Waste of Sewerage ng on WL
th y rate ( Category wise) Water Waste Transportati Treatment Waste Treatment HCW obtained
generated segrega on and & Disposal water M
-tion Storage treatme
nt
waste -650 mg ge pit .
Chemical – 10
liters
Mercury – 120 g
per year
Name Bed Bed No of Quantity of solid Quantity Method Method of Method of Method Method of Traini EPL/H
Streng Occupanc Staff waste generated of Waste of Waste Waste of Sewerage ng on WL
th y rate ( Category wise) Water Waste Transportati Treatment Waste Treatment HCW obtained
generated segrega on and & Disposal water M
-tion Storage treatme
nt
waste – 3kg
E waste 01 Kg per
year
Cytotoxic waste
0.5l per year