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Medical waste Management in Dhaka south city Corporation

Article · January 2017

DOI: 10.12944/CWE.7.l.l8

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 Journal of the Institute of Bangladesh Studies
Volume 40 (2017)

Medical waste Management in Dhaka south city

Corporation
Sanjia Mahiuddin,. Mallik Akram Hossain **

Abstract: Mismanagement of medical waste poses serious

consequences on urban environmental health causing diseases to the city
dwellers. The objectives of the study were to inves-tigate the existini
medical waste management and to identiflz the factors affectin[
medical waste management (MWM) of health care establishments
(HCEs) of Dhaka South City Corporation. Both qualitative and
quantitative data were used in this study. The study was conducted
in four public hospitals, fourteen private hospitals, for. clinics and
eight diagnostic centers of Dhaka South City Corporation. The
result of the study unveils an unsatisfactory management system in
the surveyed HCEs. The study also reveals thai medical waste
management is constrained by lack of skilled manpower, insufficient
collection_ and storage facilities, inadequate tiansportation and
disposal facilities. The finding also demonstrates that segregation
practices are not satisfactory in public and small HCEs. To achieve
an efficient medical waste management system, arrangement of
training and awareness program, appropriate plan, skiltea staffs,
proper storage facilities and a strong coordination among the
associated organizations would be needed.

1. Introduction
Medical care is essential for our life and health, but the waste generated
from
medical care activities creates a serious problem for human and thEir surrounding
environment. Medical waste management has recently emerged as an
issue of
major concern worldwide for the policy makers. Pooi .unu!"rent of rnedical
waste can directly impact the health risks to both human and environmental
health. lnefficient management of waste generated from health care
establishments also poses a direct health impact on the health care
workers and

Department of Geography and Environment, Jagannath University, Dhaka,

Bangladesh-
Professor, Department of Geography and Environment, Jagannath University,
Dhaka, Bangladesh.
94 Journal of the Institute of Bangladesh Studies, Volume 40

tlre community people. Every day, comparatively large amount of potentially

infectious and hazardous waste are generated in the HCEs around the world.l
Medical waste causes serious threats to environmental health and requires
specific treatment and management prior to its final disposal.' It can create health
risk for the waste generators and operators and also for the general community
including children who play adjac'ent to disposal areas.3 Poorly managed medical
waste causes diseases like hepatitis B/C and AIDS (HIV), infections to the health
care workers and waste handlers and may damage the environment.a Globally
over five million people every year, including four million children die from the
diseases caused by the exposure of the medical waste.s To achieve efficient
medical waste management, which is environmentally friendly as well as
economically viable for the developing countries like Bangladesh is now the
prime concern. According to WHO, any formulation of objectives and planning
for their achievement are necessary for improving medical waste management at
the regional, national and local level.6 Lack of appropriate policy and awareness
and lack of enforcement of law regarding medical waste management have made
the situation worst. In Bangladesh, the safe disposal process of rnedical waste has
been ignored for long.7 Bangladesh is experiencing rapid growth of urban
population. Because of heavy influx of migrants, the growing numbers of
hospitals, clinics, dental clinics, diagnostic centers and pathology services have

I Praveen Mathur, Sangeeta Patan, and Anand S. Shobhawat,

"Need of Biomedical
Waste Management System in Hospitals - An Emerging Issue - A Review," Current
World Environment'1, no.l (2012):1l7.doi: http://dx.doi.org/10.12944/CWE.7.l.l8
' M. M. Hassan et al., "Pattern of Medical Waste Manigement: Existing Scenario in
Dhaka City, Bangladesh," BMC Public Health, (2008): l -l0.doi:
httpsj//doi .orgl 10. I I 86/ I 47 I -2458-8-36
'Zarook M. Shareefdeen, "Medical Waste Management and Control," Journal of
Environmental Protection 3, (2012): 1625-l628.doi:
http : //dx. d o i . org/ I 0 .423 6I jep .20 12.3 12 1 7 9
'
Nasima Akter, AMR Chowdhury, and NM Kazi, Hospital l{aste Disposal in
Bangladesh with Special Reference to Dhaka City and its Environmental Evaluation,
(Dhaka: Association for Rural Development and Studies; BRAC, Research and
Evaluation Division, 1998), http://research.brac.net/new/ebook/Publication/354-special-
Reference-to-Dhaka-C ity-and- its-Envi ron mental-Eval uation# pageI 1
s Li Nie, 'Zhong guiao, and Huan Wu, "Medical Wast. tlunug.ment in China: A
Case Study of Xinxiang," Journal of Environmental Protection, 5, no.l0 (2014):803-804.
d o i : http : //dx.do i. o rg I 1 0.423 6 I jep.20 I 4. 5 I 0082
u
Tarannum Dana. "llospital Waste Management: Bangladesh," OIDA International
.lournal ,l Sustainable Development 2, no. I (201 I ):33, Retrieved from
http://www.ssrn.com/link/OIDA-lntl-Journal-Sustainable-Dev.html, accessed on
Decenrber 21,2016.
7 Nasima
Akter. AMR Chowdhury, and NM Kazi, "Medical Waste Disposal in
Dlraka City: An Environmental Evaluation," lnlernationol Center /br Diarrhoeal Disea.se
Research. Special Publication No.87, ( 1999)
 Medical waste Management in Dhaka South
city corporation 95

become an emergent feature of HCEs.

But the facitities provided by HCEs for
waste management cannot cope. up
h the growi,g demands.;in"L';;;;r"
than 1200 HCEs situated in Diraka c
waste every day and 40 tons of wlric
of MWM is serious especially in
increase of hospitals, clinirr, d
tremendous pressure on human
medical waste may
transmitted to huma
toxic and hazardous
produces 4,500-5000 tons of solid
clinical and bio-medical waste. T

, by reviewing the current status of

the Dhaka city, this study has tried to
n urban health and identify the factors
responsible for poor medical waste management in r'r u"c
Dhaka South citv
Corporation (DSCC) area. )
96 Journal of the Institute of Bangladesh Studies, Volume 40

2. Objectives
The aim of this research is to study medical waste management in DSCC area.
The specific objectives of the study are:
. To evaluate the impact of medical waste on urban health in DSCC area;
. To review the current status of medical waste handling practices (e.g.
storage, collection, transportation and disposal) in the Health Care
Establishments (HCEs) of the study area;
r To identity the factors affecting the medical waste management in the
study area;
. To provide recommendations for the improvement of medical waste
management.

3. Study Area
Dhaka is located in the central part of Bangladesh at 23"43'0"N latitude and
90"24'0"8 longitude, on the eastern banks of the Buriganga River.r' Dhaka
Metropolitan Area spreads over a total area of 1530 k.', it consists of both
Dhaka North City Corporation (DNCC) and Dhaka South City Corporation
(DSCC) area. For this study, Dhaka South City Corporation (DSCC) is selected
as the study area. Dhaka South City Corporation is divided into five zones, and it
includes 57 wards. There are more than 1200 HCEs situated in Dhaka city, where
approximately 317 HCEs are located in different zones of Dhaka South City
Corporation. The number of HCEs in DSCC is highly concentrated as compared
to DNCC. The HCEs continue to increase in DSCC, which leads to poor
management system of medical waste in this area. Five zones of DSCC areawere
selected for the field survey. This area is densely populated and the generation
of medical waste in this area is also higher than other parts of Dhaka city.t
Most of the largest public hospitals such as Dhaka Medical College Hospitals
(DMCH), Sir Salimullah Medical College Hospitals (SSMCH), and
Bangabandhu Sheikh Mujib Medical University Hospital (BSMMU) are located
in this area and the large amount of medical wastes are generated from these
HCEs. Considering above reasons, the DSCC area is selected for this study.

4. Materials and Methods

There are 347 HCEs under medical waste management program of DSCC. Both
public and private HCEs such as clinics, hospitals, diagnostics center were
selected for the survey. Out of 347 HCEs in five zones of DSCC area,30 HCEs
have been selected by using propoftionate stratified random sampling, in which
thirteen HCEs are from zone-I, four HCEs from zone-2, four from zone -3, three

'' Arif Uddin Ahmad, "ldentification of Urban Traffic Accident Hotspot Zones and
Unsafe Bus Stops Using GIS" (M.Sc Thesis, Jagannath University,2015)
ra
Aysha A. Rumi, "Medical Waste Management in Dhaka City Corporation: South,
Bangladesh" (M.Phil. Thesis, University of Dhaka, 2014),19.
 Medical waste Management in Dhaka South city corporation 97

from zone-4 and six from zone-5 (Table l). The required data for
this study was
collected from primary and t..oriury data sources. primary data was
-both
collected through questionnaire survey, while Secondary
data was .oil..t.J rro,
various published and unpublished sources. Two sets of
semi-structured
questionnaires and a checklist were used to know
about the current handling
practices of medical waste and its management system.
Data collection was carried
out from August to September,20lT .

Iglle l: The LocationNOTSU

of S rveyed HCEs in Different 7,one of fisf-f
Zone No. of Surveyed Location
number HCEs
Zone-l l3 Panthapath, Green Road, D@
Chankarpool
Zone-2 4 Mugda, Golapbagh, Outert ircular Roidl
Motijheel
Zone-3 4 Lalbagh, Azimpur, Atimkhani
Zone-4 3 Mitford Road, Patuatuli, SaAarghat
Lone-5 6 Tikatuli, Wari, Gandaria, SutrapurJatEbari
Source: Field survey, 2Ol7

The interviews and observations were also conducted

to gather first-hand data.
The interviews 112 respondents directly or indirectly eniaged in
9f
taken on the basis of simple random rurnpiing. Among
MWM were
i rz i.rlpondents, 69 waste
management workers a rd 43 administrative personnel
were interviewed.
collected data were properly checked and processed with
caution. GIS software
was used to show the spatial distribution of HCEs
in the DSCC. Collected data
was analyzed and incorporated in the analysis and
shown in tables and graphs
accordingly.

5. Results and Discussion

5.1 Impacts of Medical Waste
According to Q0l5), all individuals exposed to medical waste are
YH9
potentially at risk of being injured or infected (Figure z). wasi management
is
needed to protect the healt[care] workers and it
indirect--impacts caused by medical waste.it In " dpui;io, and minimize
Bungladesh, most of the HCEs
government HCEs ar.e in poor condition, they
::f.::illl 11.
envlronment with high toxic substanies generated are poluting the
Therefore, management of hazardous medicai
from medical waste.
waste is a growing concern in
Bangladesh'16 Many researchers suggest that
waste management workers who

'' Yves Chartier et al.,.2nd ed.s., "Safe Management

of Wastes from Health-care
Activities," world Hearth organization (20r5), Gen&a,
switzerrand.
'u Dana, "Hospital Waste"Management: Banglade sh,,, 29.
 98 Journal of the Institute of Bangladesh studies, volume 40

lrandle hazardous medical waste are mainly at risk of contagious diseases like
diarrhea and dysentery, blood-transmitted ._ infectious diseases,
gastroenterological, respiratory and skin infections.rT In Dhaka city, it is a
common scenario that poor scavengers, waste recyclers, women and children
collect syringe-needles, saline bags, blood bags etc. for reselling, regardless of
the serious healtlr risks. Worldwide, an estimated of l0 to 20 million infections of
Hepatitis B/C and HIV occur annually from the reuse of discarded syringe-
needles without prior treatment. Many incidents of injury occurred iue-to
exposure to this kind of wastes inside oroutside of HCEs.'t Medical wastes that
are disposed in common dustbins in the city are hazardous and toxic.t' The
laboratory analyses of medical wastes by the International Center for Diarrlroeal
Disease Research, Bangladeslr's (ICDDR, B) found the presence of infectious
wastes leading to risk of severe pollution of the environment (Akth er, 2003).20
Runoff from untreated hazardous wastes or human body parts dumped o,-, ih.
land may pollute surface and ground water exposing the urban dweilers to the
risk of diseases and parasites. In addition, uncontrollei burning of medical waste
pollutes tlre air with acid gases, furans, dioxins, and heavy metals, which may
lead to urban health problems.2r

5.2 Medical Waste Management Practices in DSC Area

5.2.1Composition of Medical Waste
According to the field survey, the respondents state that pathological waste

t7 Natalija
et al., "Management of Hazardous Medical Waste in
Marinkovic'
croatia." waste Management 28, no.6 (200g): lo4g-1056. doi:
hups://doi.orgll0.l0l6/j.wasman.2007.0l.O2l; PRISM Bangladesh Reporr, Survey on
Quantitative and Qualitative Assessment of Medical l(aste Generation and Managiment
in Dhaka North City Corporation and Dhaka South City Corporation. (Dhaka: FruSHA
Bangladesh, 2013)
r'6
Biswas et al., "Medical Waste Management in the Tertiary Hospitals of
Bangladesh: An Empirical Enquiry," 149-150; Dana, "Hospital Wasti Manigement:
Bangladesh," 32.
le Nasima
Akter, AMR Chowdhury, and NM Kazi , Hospital Waste Disposol in
Bangladesh with Special Reference to Dhaka City and its Environmental Evaluation,22;
Nasima Akter, Medical l(aste Management: A Review, (Thailand: Asian Institutl of
Technology,' 2000), Retrieved from hffp://www.eng-consult.com/ben/papers/paper-
anasima.odf
20
Nasima Akter, "Appropriate Management Options for Developing Countries (the
Case of-Bangladesh and Thailand)" (Ph.D.IAriun Institute of Technotogy,2003)
'' World Bank, Healthcare Waste Management Guidance Note,l-Washington DC:
world Bank, 2000), available at: http:/www.bisde.ops-
oms.org/foro hispano/BVS/bvsacd/cd49lcarewaste.pdf, accessed on September 21,2017;
Nasima Akter and Josef Triinkler, "An Analysis of Possible Scenarios of Medical
Waste Management in Bangladesh", Management of Environmental eualitv: An
lnternational Journal 14, no. 2, (2003): 242-
25 5. https / / doi.orgl I 0. I I 08/ I 47 7 7 B3O3 I 047 0459
:
 Medical waste Management in Dhaka South city corporation
99

\46'!%) is generated in large amount in the surveyed HCEs. Besides, about

31.9% is general waste, 13% is pharmaceutical, 5.g
is sharps, and only 2.g%
is chemical waste, which are presented in Table 2.

Figure 2: Health Risks of persons Associated with Medical

waste.

Table 2: Com ition of

o Medica Waste
Types of MW Frequency Percentage (r/r)

General waste 22 3 1.9

Pathological waste 32 46.4

Sharps Waste 4 58
Pharmaceutical waste 9 13.0

Chemical waste 2 2.9

Total 69 100.0
Source: Field survey, 2On

5.2.2 segregation, collection and Storage of Medical

waste
te handling process. It mainly takes
d laboratory in the surveyed HCEs
aste by suitable color_coded bins or
nanagement. In the field survey, it was
CEs used different types of containers
stic or metal containers to collect and
ed HCEs, 24 HCEs were found to use
al containers for collecting their wastes.
ers has been introduced by PRISM
Bangladeslr mainly for cotlecting__the segregated
hazardous wastes including
radioactive wastes. only a few HCEs *.i. i'oticed
using cardboard boxes as
containers for collecting their general wastes.
 100 Journal of the Institute of Bangladesh Studies,
volume 40

m Operating roorn
l Laboratory

'r Ward floor

Place of Segregation in Su.veyeO frcffi

Source: Field survey, 2017

morning and the PRISM Bangladesh col

All of the surveyed HCEs has tempora
open space inside or outside in the H-CEs,
but the system is inappropriate.

isposal Facilities for Medical Waste

o treatment and- disposal facilities for
on DSCC and pRISM Bangladesh for
ste transportation. It is evident from the
erator for treatment of infectious waste
te. A few HCEs has their own vehicles

Table 3: Tra rtation of M edieq I/qsf

Transportation Methods Frequency Percentage (%)
of MW (N:69)
On-site Manual 22 31.9
 Medical Waste Management in Dhaka South City Corporation l0l

Transportation Trolley 44 63.8

Wheelbarrow J 4.3
Off.site DSCC van l5 21.7
Transportation PRISM van 5l 73.9
Both (DSCC & J 4.3
PRISM van)
Source: Field survey, 2017

The survey result demonstrates that on-site disposal of medical waste carried
out by HCEs includes municipal landfills (46.4%), open burning (10.1%),
incineration (8.7%) and buried in hospitals ground (5.8%). DSCC use
dustbin (15.9%) and waste treatment plant (11.6%) for final disposal of
general waste. [t is noted that PRISM Bangladesh considers medical waste
treatment plant (72.5%) as their dump site for final disposal of medical waste,
which is located at Matuail, outskirts of Dhaka (Table 4).

able 4: of Medical Waste

Disposal of Places Frequency Percentage (o/o)
MW (N:69)
Municipal Landfill 32 46.4

On-site Disposal Buried on Hospital 4 5.8

Ground
Incinerated 6 8.7
open Burned 7 l0.l
DSCC Dustbins ll l s.9
Off-site Plant by PRISM 50 72.5
Disposal Plant by DSCC 8 I 1.6
Source: Field survey, 2017

The medical waste management at the HCEs of the study area is managed by a
national NGO named PRISM Bangladesh with the co-ordination of Dhaka
South City Corporation (DSCC). During the survey, the practices of medical
waste management in surveyed HCEs are observed. The existing MWM
framework of DSCC is shown in the Figure 4.

5.3 Factors of Medical Waste Management

MWM Plan and Guideline: Management plan is an important part of
conducting a system properly. The survey result indicates that majority of the
surveyed HCEs (86%) have no medical waste management plan; they only
follow instructions given by PRISM Bangladesh about MWM. There are only
14%HCEs that have followed their own management plan for MWM (Table 5).
 102 Journal of tlre Institute of Bangladesh Studies, volume 40

Mcdlc.l W.tt. Mlnlgcmcnt ln DSGC Araa

Source: Field survey, 2017

Figure 4: Current MWM Framework of DSCC for HCEs under MWM program

Management Committee: Absence of proper monitoring facilities and lack

of
responsibilities are the main reason of poor rnedical *utt. management.
More
than lralf of the HCE,s (51%), especially small HCEs have no management
team
for supervision or monitoring the waste handling practices. private HCEs have
supervision committee and team members for waste management team,
but it is
not sufficient for proper management. Only 49% HCEs constituted management
team for monitoring the MWM process (Table 5).

Table
aole 5: Ma.ior
M Factors Affecting MWM in the S urveved HCEs
Factors Responses Frequen Percentage
cy (%)
(N:43)
MWM plan Yes 6 t4

No 37 86
MWM team Yes 2t 49

No 22 5l
Arrangement of Yes 22 5l
MW Training
No 21 49

Source: Field survey, 2017

Training and Awareness program: In terms of training of MWM

healthcare personnel opine that they arrange training f; staff , 5ro
on waste
management and 49% do not arrange any training foi their
staff. Training
program for MWM is mainly carried out by the PRISM Bangladesh
and only I
 Medical Waste Management in Dhaka South City Corporation 103

few HCE, authorities arrange trairring for their waste management staff (Table 5).
Lack of awareness is noticed at all levels in the surveyed HCEs.

protective Equipment for MWM: All of the waste management staffs are
instructed to ,t" protective equipment like clothing, gloves, mask, gumboot
etc (Figure 5). But in reality, most of the workers of public hospitals and clinics
do not use any protective equipment while working with the infectious medical
wastes. Majority of the waste handlers (83%) did not face any problems due to
use of protlctive equipment in waste handling and collection. Only lTYo stated
that they faced problems in handling waste such as needle injury, virus infection
etc.

70
60
o5O
EO

€oo
9so
o
c20
10
o
I
Clothing Glovcs Mask Garnboot
I
Protective Equipment
t
L_
Source: Field survey, 2017
Figure 5: Use of Protective Materials by waste Handlers

Resources for MWM: In the only 48.8% healthcare personnel

surveyed HCEs,
lrave opined that they have enough manpower for waste management, while
5l.Z% mentioned thatthere is lack of skilled manpower in the HCE. As regards
to waste transportation, most of the health care personnel (74.4%) state that they
have no vehicles for general waste transportation; only 25.6% have claimed that
they have vehicles for transpoftation of waste (Table 6).

Table 6: Resources for MWM in the Surveyed HCEs

Resources Responses Frequency Percentage
(N:43) (%l
Skilled Yes 2l 48.8
Manpower for
No 22 51.2
MWM
Own Vehicles Yes lt 25.6
for MW 74.4
No 32
Transportation
Source: Fietd survey, 2017

Budget Allocation for MWM: Economic constraints are one of the prime
104 Journal of the Institute of Bangladesh Studies, Volume 40

obstacles to develop a better MWM. Without sufficient financial support,

improvement in the medical waste management is not possible.zz The present
study also noticed that private HCEs are not getting any financial suppolt
from public and private organizations for management of medical waste. There
are no investment paftners in this sector. It is found that small HCEs have no
budget plan for management of medical waste. ln each month, they have to pay
an amount to PRISM Bangladesh for medical waste collection, treatment,
transportation and disposal. Small HCEs such as clinics, diagnostics centers paid
tk. 1200/-to24001- and large HCEs paid tk. 10,000/- to 20,0001-per month for
transport and disposal of medical waste, which depend on numbers of patients
and beds of the HCEs. The off-site transport costs are included in the total
disposal cost paid by the HCEs (Figure 6).
("" -"- --"'--' -- "' -"--'
I

7m000

I sooooo
E sooooo

I o**o
8 gooooo
o
H zmmo

I rooooo
Governmert Priva[e Private Cl'n,cs Dragonist c

Fospitals hospitals Centers

Health Care Establishments

Source: Field Survey, 2017

' Figure 6: Transportation and Disposal Cost of HCEs

Co-ordination among Agencies: The field survey finds that poor coordination
among different organizationfor example, Department of Environment (DoE)
(under the Ministry of Environment and Forest, MoEF) and the DSCC, has
slowed down medical waste management. The DSCC mainly oversees the

22 Rumi, "Medical Waste Management in Dhaka City Corporation: South,

Bangladesh," 60; Dana, "Hospital Waste Management: Bangladesh," 35-37.
 Medical Waste Management in Dhaka South City Corporation r05

operation of medical waste management, while the DoE is entrusted for ensuring
the environmental law to be implemented. A good coordination between the two
agencies is badly needed.

5.4 Conclusion and Recommendation

The number of health care establishments is constantly increasing in Dhaka city. This
leads to an increase in the quantity of medical waste, which causes significant threat to
urban health and environment. It is found that a total of 347 HCEs of DSCC are
provided training by PRISM Bangladesh once or twice in a year, which is not
sufficient. Inappropriate handling practices and disposal of medical waste pose
urban health risks. The medical waste management of the public hospitals and
small HCEs was found very poor. There is lack of skilled manpower, insufficient
collection and storage facilities, inadequate transportation and disposal facilities.
In terms of segregation practice, the perforrnance of public hospitals and small
HCEs was not satisfactory. The study findings indicate that there are no
guidelines and monitoring facilities for MWM in the surveyed HCEs. The
existing medical waste management system currently serves a limited number of
HCEs of DSCC. The government and the private HCEs should take necessary
initiatives for improvement of the medical waste management system of the
study area. Based on the study findings, the following recommendations are
presented here in order to improve the medical waste management of DSCC area.

o Training and awareness program should be arranged for medical and

non-medical staff of the HCE. Raise awareness amongst the public about
risks of medical waste.
. Develop a national plan or policy and long term strategic framework of
MWM based on a renewed understanding of the environmental situation
in Dhaka.
. There must have wriffen rules and guidelines with proper instructions
for all waste management staffs of HCE.
. HCE authorities 5hould have a good management team for supervision
and monitoring the MWM system.
o HCEs should have enough skilled manpower to ensure proper handling
practices of medical waste.
o Proper storage facilities for hazardous waste should be available in the
HCEs.
. Provide sufficient vehicles for medical waste transportation in the HCEs.
. Ensure practices of recycling of medical waste prior to its final disposal.
o Allocate an adequate fund for proper medical waste management.
Government should allocate a budget for this sector.
 106 Journal of the Institute of Banglad'esh Studies, volume 40

Establishment of ETP in both public and private HCEs for,treatment of

liquid waste.
Develop a strong co-ordination among the Ministry of Health and family
welfare (MoHFw), Ministry of Environment, city Corporation, Local
autlrorities and NGOs.23

" The authors acknowledge the financial support provided by the Ministry of
Science and Technology (NST Fellowship,20ll-Zol8) for this.research. The
authors would like to thank DSCC, PRISM Bangladesn
6CO) and the personnel
of the studied HCEs for their cooperation and uriirtun.e'in conducting tiris study.
we are grateful to Arif Uddin Ahmad and Md. Mainuddin ekaJh for their
generous support in completing our research work.

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