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Another Crisis In The Making: COVID-19 And India’s Bio-Medical Waste

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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.

Growing problem of bio medical waste
India currently generates about 550.9 tons of medical waste per day with a compound annual growth rate of 7%.

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?

As medical waste is an equal source of spreading COVID-19, if not more than an infected person, its proper disposal is paramount.

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. 

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An ambassador and trained facilitator under Eco Femme (a social enterprise working towards menstrual health in south India), Sanjina is also an active member of the MHM Collective- India and Menstrual Health Alliance- India. She has conducted Menstrual Health sessions in multiple government schools adopted by Rotary District 3240 as part of their WinS project in rural Bengal. She has also delivered training of trainers on SRHR, gender, sexuality and Menstruation for Tomorrow’s Foundation, Vikramshila Education Resource Society, Nirdhan trust and Micro Finance, Tollygunj Women In Need, Paint It Red in Kolkata.

Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

Saurabh has been associated with YKA as a user and has consistently been writing on the issue MHM and its intersectionality with other issues in the society. Now as an MHM Fellow with YKA, he’s launched the Right to Period campaign, which aims to ensure proper execution of MHM guidelines in Delhi’s schools.

The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

Read more about his campaign.

Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

Her campaign #MeriMarzi aims to promote menstrual health and wellness, hygiene and facilities for female sex workers in UP. She says, “Knowledge about natural body processes is a very basic human right. And for individuals whose occupation is providing sexual services, it becomes even more important.”

Meri Marzi aims to ensure sensitised, non-discriminatory health workers for the needs of female sex workers in the Suraksha Clinics under the UPSACS (Uttar Pradesh State AIDS Control Society) program by creating more dialogues and garnering public support for the cause of sex workers’ menstrual rights. The campaign will also ensure interventions with sex workers to clear misconceptions around overall hygiene management to ensure that results flow both ways.

Read more about her campaign.

MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

With YKA MHM Fellow Vineet, Sabna launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society. As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Read more about her campaign. 

A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Find out more about the campaign here.

A native of Bhagalpur district – Bihar, Shalini Jha believes in equal rights for all genders and wants to work for a gender-equal and just society. In the past she’s had a year-long association as a community leader with Haiyya: Organise for Action’s Health Over Stigma campaign. She’s pursuing a Master’s in Literature with Ambedkar University, Delhi and as an MHM Fellow with YKA, recently launched ‘Project अल्हड़ (Alharh)’.

She says, “Bihar is ranked the lowest in India’s SDG Index 2019 for India. Hygienic and comfortable menstruation is a basic human right and sustainable development cannot be ensured if menstruators are deprived of their basic rights.” Project अल्हड़ (Alharh) aims to create a robust sensitised community in Bhagalpur to collectively spread awareness, break the taboo, debunk myths and initiate fearless conversations around menstruation. The campaign aims to reach at least 6000 adolescent girls from government and private schools in Baghalpur district in 2020.

Read more about the campaign here.

A psychologist and co-founder of a mental health NGO called Customize Cognition, Ritika forayed into the space of menstrual health and hygiene, sexual and reproductive healthcare and rights and gender equality as an MHM Fellow with YKA. She says, “The experience of working on MHM/SRHR and gender equality has been an enriching and eye-opening experience. I have learned what’s beneath the surface of the issue, be it awareness, lack of resources or disregard for trans men, who also menstruate.”

The Transmen-ses campaign aims to tackle the issue of silence and disregard for trans men’s menstruation needs, by mobilising gender sensitive health professionals and gender neutral restrooms in Lucknow.

Read more about the campaign here.

A Computer Science engineer by education, Nitisha started her career in the corporate sector, before realising she wanted to work in the development and social justice space. Since then, she has worked with Teach For India and Care India and is from the founding batch of Indian School of Development Management (ISDM), a one of its kind organisation creating leaders for the development sector through its experiential learning post graduate program.

As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

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A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

A Gender Rights Activist working with the tribal and marginalized communities in india, Srilekha is a PhD scholar working on understanding body and sexuality among tribal girls, to fill the gaps in research around indigenous women and their stories. Srilekha has worked extensively at the grassroots level with community based organisations, through several advocacy initiatives around Gender, Mental Health, Menstrual Hygiene and Sexual and Reproductive Health Rights (SRHR) for the indigenous in Jharkhand, over the last 6 years.

Srilekha has also contributed to sustainable livelihood projects and legal aid programs for survivors of sex trafficking. She has been conducting research based programs on maternal health, mental health, gender based violence, sex and sexuality. Her interest lies in conducting workshops for young people on life skills, feminism, gender and sexuality, trauma, resilience and interpersonal relationships.

A Guwahati-based college student pursuing her Masters in Tata Institute of Social Sciences, Bidisha started the #BleedwithDignity campaign on the technology platform Change.org, demanding that the Government of Assam install
biodegradable sanitary pad vending machines in all government schools across the state. Her petition on Change.org has already gathered support from over 90000 people and continues to grow.

Bidisha was selected in Change.org’s flagship program ‘She Creates Change’ having run successful online advocacy
campaigns, which were widely recognised. Through the #BleedwithDignity campaign; she organised and celebrated World Menstrual Hygiene Day, 2019 in Guwahati, Assam by hosting a wall mural by collaborating with local organisations. The initiative was widely covered by national and local media, and the mural was later inaugurated by the event’s chief guest Commissioner of Guwahati Municipal Corporation (GMC) Debeswar Malakar, IAS.

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