India’s population is estimated to be 1.3 billion, however, its hospital bed capacity is approximately only 2.02 million—a number barely covering 1.5% of our population. Worst still, the number of ventilators and intensive care units are further scarce . If such is the state of affairs of our healthcare system, one cannot even imagine in what state our bio-medical waste management system is in.
India currently generates about 550.9 tons of medical waste per day with a compound annual growth rate of 7%. It is estimated that by 2022, the waste per day generated will be 775.5 tons. We already face a lapse in bio-medical waste management as there is not enough waste treatment infrastructure such as CBWTFs (Common Bio-medical Waste Treatment Facilities) to cope with the existing medical waste generated by health facilities. Throughout the nation, there are only 198 CBWTFs in operation with 28 more under construction. Only 1,31,837 health care facilities (HCFs) come under CBWTFs and approximately 21,870 HCFs have their own treatment facilities on-site.
Other issues plaguing bio-medical waste management are lack of awareness among medical staff on proper waste disposal, mixing of hospital waste with general waste, health care facilities operating without proper authorization, health facilities under-reporting their generated medical waste and avoiding investing in systems of waste disposal. This in turn affects the effectiveness of CBWTFs as they are unable to operate at optimum capacity, suffer financial losses due to lack of payments, and find it difficult to do safe and proper disposal of waste which is mixed.
It is imperative to treat medical waste as it poses a huge health and environmental risk. Improperly disposed medical waste can lead to transmission of diseases such as cholera, AIDS and hepatitis through contaminated syringes, cotton swabs, etc., as well as act as a breeding ground for rodents, insects, worms and the like. Sanitation workers too are at risk as they come in direct contact with such waste.
In such a situation, with the coming in of COVID-19, things look grim. As medical waste is an equal source of spreading COVID-19, if not more than an infected person, its proper disposal is paramount. The government has recently issued guidelines regarding proper disposal of COVID-19 medical waste. But the question remains, with an already flawed and faulty disposal system in place, how proper will COVID-19 waste disposal be?
The problem becomes even more complex with COVID-19 patients undergoing treatment at home. With waste segregation limited to certain Indian cities and mixing of different types of waste being a common practice in most cities. Unsegregated medical waste generated at home, which includes items like face masks, tissues and sanitizers, further aggravates the spread of COVID-19. Such type of medical waste poses a health risk to anyone who comes in direct contact with it, especially sanitation workers and rag pickers.
To solve the problem of bio-medical waste, intervention is needed at multiple levels. The first and the most crucial step is to segregate medical waste at source. As mandated by the Bio-Medical Waste Management Rules 2016, health care facilities (HCFs) need to do 4-way segregation of their waste. To achieve the same, hospital staff and medical professionals need to be given training on proper segregation and disposal. Not only hospitals, but even at the household level, citizens need to segregate their medical waste from their household waste. At the same time, the municipal corporations too need to have tie-ups with medical waste treatment facilities to ensure proper disposal of such waste.
The key lies in ensuring the chain is not broken at any point starting from segregation and collection to disposal. This can only be done if there is strict monitoring, enforcement and follow-ups by pollution control authorities like CPCB, SPCBs and health departments. It is imperative to create an ecosystem that helps build a culture of bio-medical waste segregation and waste segregation in general. Not only waste segregation, but waste reduction is essential. With the advent of disposables, bio-medical waste will continue to increase, therefore, it is important to look for alternatives which can be sterilized and reused.
COVID-19 has fully exposed the systemic faults in our cleanliness and waste management habits and practices. India is expecting COVID-19 infections in the range of hundred millions, which translates to COVID-19 waste too being easily in the range of hundred million kilograms (assuming 1 kg of medical waste per day per person). Also, the fact that 7 Indian states/UTs are yet to have CBWTFs, the COVID-19 waste situation looks even more alarming.
With so much awareness being done on hygiene and sanitation, equal emphasis needs to be given on proper waste management practices and building waste management infrastructure, if we wish for the problem of COVID-19 to truly go away.
About The Author: This piece has been written by Riddhima Karwa, who is an Alumna of the ISDM Class of 2019 from the 1 Year Post Graduate Program in Development Leadership. She works as a Program Coordinator for Do No Trash at Nature Science Initiative. Do-No Trash is an initiative aimed to resolve trash issues in homes, workspaces, campuses and communities.