ENGRO POLYMER &

CHEMICALS LIMITED
HOSPITAL WASTE
MANAGEMENT

TERMS OF
REFERENCE
MBA PROJECT 2014

Group Members
Sadaf Ijaz
SharjeelAwais
AimunShahab
MujtabaMansoor
M. Usman Kamran

Table of Contents
Introduction......................................................................................................................................2
Engro Polymer & Chemicals Limited.........................................................................................2
Purpose of the Research...............................................................................................................2
Plastic Recycling Industry...........................................................................................................3
Objectives........................................................................................................................................5
Phase 1: Local Market Analysis.................................................................................................5
Phase 2: International Best Practices and Benchmarking...........................................................6
Phase 3: Conclusions & Recommendations................................................................................7
Methodology....................................................................................................................................8
Phase 1: Local Market Analysis.................................................................................................8
Phase 2: International best practices and benchmarking............................................................8
Phase 3: Recommendations.........................................................................................................8
Project Timeline...............................................................................................................................9
Additional Clauses.........................................................................................................................10
Expectations & Responsibilities................................................................................................10
Project Budget...........................................................................................................................12

Introduction
Engro Polymer & Chemicals Limited
Engro Polymer & Chemicals Limited started off a joint venture between Engro Chemical (50%),
Asahi Glass Company (30%) and Mitsubishi Corporation (20%).In 2006, Asahi Glass divested
its share from the business and Engro Chemical acquired its shareholding. The name of the
company was changed to Engro Polymer & Chemicals Limited.
Engro Polymer & Chemicals Limited owns the only fully integrated Chlor-Vinyl chemical
complex in Pakistan. It is involved in the manufacturing, marketing and distribution of quality
Chlor-Vinyl allied products and PVC under brand name SABZ. Other than producing Caustic
Soda, Sodium Hypochlorite, EDC and VCM, Engro Polymer & Chemicals Limited is also the
sole manufacturer of PVC resin in Pakistan.

Purpose of the Research

CoreObjective
To study the informal and formal hospital waste management practices in Karachi, understand
current recycling practice of hospital plastic waste in particular and recommend best practices
for the clean disposal of hospital waste and recycling options for hospital plastic waste.
The primary product of Engro Polymer &Chemicals is PVC suspension resin and is an essential
raw material for manufacture of PVC plastic. Recycling of scrap plastic (both imported and
local) to extract vinyl chloride reduces the demand for Engros resin.
According to Pakistan Renewable Energy Society website, the country generates 20.024 million
tons of solid waste per year (2012). Environmental Protection Agency, according to 1996
estimates, claims that roughly 4-8% of the solid waste comprises of plastic waste generated from
households, hospitals and industries. Numerous newspaper reports have cited the usage of
hazardous, infectious hospital plastic waste such as syringes and IV bags to manufacture cheap
plastic products, thus endangering the lives of ordinary humans and workers.

The objective of this research can be divided into following:

Estimate the amount of hospital waste generated and its composition

Study the current hospital waste management techniques practiced in state owned and

private hospitals
Study the recycling process of the informal hospital plastic waste
Study the capability of the current incineration facilities and suggest financially feasible
alternatives to reduce illegal recycling of hospital waste by studying global best practices

With the help of concrete facts and insights from this study, Engro Polymer hopes to work with
the government to tighten and enforce the rules and regulations dealing with hospital waste
management in Pakistan thereby not only reducing the amount of infectious hospital plastic
waste being sold and recycled but also increasing the demand for Engros resin products.

Plastic Recycling Industry

Plastics are an important part of modern life. From household kitchen utensils to hospital
instruments and even automobile parts, plastics dominate our lives. Pakistanis consume 3.1 kg
plastic per annum per capita (2013). Pakistan's plastic industry is thriving at an average annual
growth rate of 15% (2013).
There are around 6,000-7000 plastic products manufacturers in the country out of which 700 are
organized companies engaged in plastic manufacturing, whilst the remaining 5000 are small and
medium enterprises engaged in production of cheap, low quality plastic products through the use
of scrap plastic(2013).

In Pakistan, recycling of plastic largely belongs to the informal sector of the economy. It is
estimated that 30-40% plastic waste generated in the country is collected and recycled (2012). It
primarily thrives on thousands of scavengers or rag-pickers who pick and sort out waste plastic
items from household, industrial and hospital waste dumps and land fill sites. In the absence of
formal waste management practices and over utilization of municipal machineries, such activities
have been expanding unchecked. It has been reported that municipal authorities, landfill site
managers and police themselves are involved in hiring these rag pickers and charging them on a
daily basis for permits to scavenge in their areas The rag pickers then sell the plastic waste to
wholesale scrap markets such as Shershah, Karachi and Shahdara Market in Lahore and the SME
plastic product manufacturers procure the scrap plastic for their manufacturing process.
According to an article in Pakistan Today (Feb 2012), 800 manufacturing units purchase used
syringes and discarded plastic bags and after reprocessing sell it to suppliers for a handsome
profit.
Additionally, Pakistan has become a dumping ground for hazardous plastic scrap and waste from
around the world mostly Middle East and European countries. According to an article in Daily
Times (Nov 2013), 92000 tons of plastic scrap has been imported and dumped into Pakistan
between 2011- Oct 2013.Imported scrap plastic includes sewerage pipes, medical and clinical
plastic waste, cable linings, bottle and food containers. This hazardous and toxic plastic is
recycled and used to manufacture water pipes to supply water to households and other daily use
products thus putting lives of citizens at risk.
In 2013, Ministry of Commerce convened a meeting under the orders of Lahore High Court with
Environmental Protection Departments of Sindh and Punjab Governments, Federal Board of
Revenue, Engro Polymer & Chemicals Ltd and Polymer Waste Importers and Recycler
Association to work on tightening the rules and regulations on plastic imports. Considering the
gravity of the situation, FBR decided to allow import of scrap plastic according to a fixed quota
and only for those companies which are registered with Pakistan Standards and Quality Control
Authority (PSQCA) and also with the Environmental Protection Agency, upon the permission of
the Ministry of Climate inspection team.

Objectives
Phase 1: Local Market Analysis
The first objective of our study would be to conduct a local market analysis on hospital waste
specifically plastic waste and its management. This analysis will include the following:

Identification of size/ volume of hospital waste

Research will be carried out to identify the size/volume of the total solid waste generated in
Karachi, Pakistan. The solid waste is generated through multiple sources including residential,
industrial, institutional, commercial, municipal services etc.
This solid waste will then be narrowed down to the hospital waste. A broad classification of solid
waste generated from hospitals has been made with respect to general and infectious waste.

General waste include kitchen waste, food leftovers, garden waste, debris, sweepings of

the premises, paper, packing, cardboard, tins, glass, X-ray sheets, plastic bags, caps etc.
Infectious waste include disposable syringes glucose/dextrose bags, plastic bottles, glass
bottles, glass culets, urine bags, bloods bags, infusion sets, bandages, dressings, blood,
pus, tissues, organs, empty glass vials/ampoules/needles, expired and unused medicines
etc.

Type of plastic waste

As far as our project is concerned we will determine the quantity and character of hazardous
medical wastes generated by hospitals and clinics particularly plastic waste. This plastic waste
includes syringes, plastic bags consisting of blood bags, glucose bags, urine bags and other
drips/medication. With the bags, the accessories include plastic tubing, control switches,
catheters, etc. Generally this waste is not segregated from other waste and is put in the litter box.
The sanitation staffs segregates and collects this waste and sells it to the hawkers when
accumulated in good quantity. The plastic bottles in good condition are washed and reused. The
plastic bottles are often reutilized or bought by the small vendors/manufacturers/suppliers that
fill their own product with a new sticker/label. The broken or damaged plastic bottles are
crushed/shredded and 'dana' (bead/resin) is made which is then sold to companies that are
involved in making PVC pipes.

Current usage/ disposal techniques

Furthermore, our project will also cover the current usage and disposal techniques and the
consequences that each of these disposal technique has on health as well as environment. A
common practice by the hospitals is to dump their waste openly inside or outside the hospital
premises prior to off-site transportation by the municipality vehicles, which is on daily or weekly
basis. According to a study, Hospital Waste Management in the Teaching Hospitals of Karachi
conducted in May 2005, only two hospitals had properly designed storage areas and proper
locking system and only two hospitals were providing essential protective gears to its waste
handlersfor handling the potentially dangerous waste. Incinerators were used by five institutions,
and two were putting hazardous segregated waste in the incinerators. Only two hospitals have
well documented waste management plans as well as waste management teams.

Local laws for disposal / recycling of PVC

Local laws for the disposal techniques and recycling of PVC will also be a major part of the local
market analysis. The legislation regarding Healthcare waste covered under Pakistan
Environmental, Protection Ordinance (PEPO), 1983, PEPO 1997, provincial legislation and local
laws, regulations of KMC and the National Environmental Quality Standards (NEQs) that
govern the discharges and emissions into the environment will be reviewed.

Phase 2: International Best Practices and Benchmarking

In Pakistan, municipal governments are usually responsible agency for solid waste collection and
disposal, but magnitude of the problem is well beyond the ability of any municipal government.
Under the local government system, the Town Municipal Administration is responsible for the
solid waste collection, transportation and disposal. However, TMAs are unable to cope with
continuously increasing volumes and municipal waste due to inadequate funds, equipment, rules,
regulation and expertise.
There are several non-government and associations such as International Solid Waste
Association(ISWA) that are working to provide trainings and technology for disposal of waste
according to international standards.
In developed countries, scrap/recycle market is well-regulated and significant amount of budget
is spent on awareness, trainings and use of advanced technology for the needed purpose.

In order to better understand the needed practices, rules and standards, a good understanding of
internationally implemented regulations and standards for benchmarking is very important.

Costs of hazardous waste disposal

It is important to differentiate the types of waste that are being produced in the country. As
studies suggest, not every waste is harmful and can finely be recycled for future use. Ministries
of Environment of both developed and under developed countries have drafted policies that talk
of segregation of hazardous and non-hazardous waste, rules to process each, procedures of
disposal and limits on the recycling as well as import of hazardous waste.
As mentioned earlier, Pakistans scrap market is un-regulated and several recyclers are involved
in the business without any active governing body overseeing their operations as watch dog. This
has led to a very dangerous situation since all kinds of scrap are being recycled instead of proper
disposal which includes huge amount of hazardous waste.
Therefore, it is important to study all direct and indirect outlays associated to limit the current
situation. Likewise, we need to look into the methods adopted globally and analyze both
financial and non-financial costs at each level of implementation of the required plan.

Phase 3: Conclusions &Recommendations

Detailed recommendation based on secondary and primary research conducted by our group will
be incorporated in the report. Recommendations will be based on following segments:

Methods for safe and effective disposal of hospital plastic waste as per local laws and

international standards
Cost Benefit Analysis of disposal of hospital plastic waste safely

Methodology
Phase 1: Local Market Analysis
Both primary and secondary research will be conducted to do the local market analysis.

Secondary Research

Collection and review of data, information and published research reports available on

the internet
Collection and review of newspaper articles on hospital waste management

Primary Research

Site visits to hospitals in the different areas of Karachi

Interviews of personnel related with health care waste management system, recyclers,
middle and main dealers, municipality etc.

Sampling Design
Target population: The target population would include personnel related with hospital waste
management working at different hospitals of Karachi.
Sample Size: The sample size would be30 hospitals. The hospitals to be visited will be divided in
bands of different bed sizes but different regions of the city will also be kept in mind while
making the visits to make sure that the sample is representative of the whole city.

Phase 2: International best practices and benchmarking

Secondary Research
The report will aim to cover all the aspects in greater detail through secondary research and
analyze the collected material for better implementation at local levels. The methodology will
include referring to several journals published by World Bank, United Nations agencies and other
environmental associations.

Phase 3: Recommendations
Phase 3 will be carried out post completion of prior phases via analysis of results and feedback
from Phase 1 and 2.

Project Timeline
S
#

TASK

PLANNE

PLANNE

D START

D END

DATE

DATE

1
2
3

TOR Finalization
TOR Presentation & Approval
Phase 1: Local Market Analysis

5-Aug-14
1-Sep-14
11-Sep-14

31-Aug-14
10-Sep-14
15-Nov-14

(Primary + Secondary Research)

Phase 2: International Best Practices

16-Nov-14

15-Dec-14

5
6
7
8

(Secondary Research)
Interim Report & Presentation
Phase 3: Recommendations
Draft Submission
Final Report & Presentation

16-Dec-14
1-Jan-15
16-Jan-15
26-Jan-14

31-Dec-14
15-Jan-15
25-Jan-15
15-Feb-14

Additional Clauses
Expectations & Responsibilities
IBA

The Project Team would keep all information confidential, only to be shared with Project

Coordinator/ Advisor and the Client.

The Project Team would be responsible for identification, collection, aggregation and

analysis of data in consultation with the Client and the Project Coordinator/ Advisor.
The Project Team would keep all commitments with regards to meetings and deadlines. Any

delays or cancellations would be communicated in advance.

Reporting and presentation on the progress of the Project and all significant developments

related to the project would be made to all the concerned parties.

The Project Team would submit all deliverables via agreed upon formats (email/hard
copy/presentation) on the established deadlines to the Project Coordinator/ Advisor and the

Client.
The Project Coordinator/ Advisor will be responsible for guiding and advising the Project

Team and helping them with all issues with the Project as and when they may arise.
The Project Team will share an Interim Project presentation with the Project Coordinator/

Advisor and theClient by the agreed timeline.

The Project Team would make the Final Project presentation to the Coordinator/ Advisor and
the Client bythe agreed timeline.

Client Organization

All information regarding the Engro Polymer business will be provided by the Client.
The Client would be responsible for providing guidelines, information, contacts and

technicalspecifications of the project.

The Client will nominate relevant personnel for coordinating with the Project Team for
allphases of the project. In case the contact person is unavailable, a substitute contact should

beidentified in advance to minimize delays.

The Client will bear all related expenses incurred during the course of the Project subject

toprovision of receipts and justification by the Project Team.

The Client will agree to meet the Project Team as and when required on prior notice.

Constraints

The Projects geographic scope for primary research is purely restricted to Karachi.
However,secondary research may be used to draw parallels between Karachi and other

similar cities.
Limitations of sources of information, especially from public offices may pose a constraint

on thegroup and its pace of doing activities.

Unavailability of contact persons in the Client organization can be a constraint; a

substitutecontact should be identified in advance to minimize the possibility of delays.

The Project Team lacks technical knowledge regarding plastic recycling process. The Project
Team will coordinate with the relevant peopleto understand the technicalities; and will share

any limitations with the Client.

The Project Team Members are enrolled as fulltime MBA students. There may be constraints
ontime due to assessments and exams. However, the constant correspondence between
theProject Team and the Client will ensure that work does not suffer and all deliverables are
readyby the agreed upon timelines.

Project Budget
A preliminary estimate of the budget is highlighted in the table below. These amounts are
tentative and subject to change as the project progresses. We will try to provide invoices where
applicable.
Expense Head

Cost
(PKR)

Travelling Expense - Hospitals*

9,000

Travelling Expense Recyclers etc.

Call Charges

5,000
10,000

Printing, Binding, and Related Expenses

Misc. Expenses

5,000
10,000

Total

39,000

*Breakup of Travelling Expense

Travelling Expense
Expected No. of Hospitals to be visited

30

Average Distance in Km

25

Expected Distance to be covered (KM)

Rate/Km
Total (PKR)

750
12
9,000