The Workshop on Medical Waste Management

And

Public Private Partnership

Venue: Hotel Pan Pacific Sonargaon, Dhaka, Bangladesh

Date: December 14, 2011

Organized by UNIDO and IFC

Prepared by Md. Anisul Kabir

National Expert on Medical and Hazardous Waste Management

UNIDO Bangladesh

Contents Event Page Number

Introduction:

Background information of the project and Objective of the

Workshop:

Description of the workshop:

Opening Session:

Technical Session 1:

Technical Session 2:

Appendix 1: List of participants:

Appendix 2: Workshop scheduleAppendix 3: Contents of the Presentations:

Introduction to Medical Waste:

Medical waste is being generated while providing healthcare services in hospitals, clinics,

diagnostic centers, pathological labs, dental units and other medical institutions. Generally,

medical wastes consist of all types of wastes include infectious, hazardous, radioactive and

other general wastes. In Bangladesh, a large quantity of healthcare waste is generating each

day from the government and non-government hospitals, private clinics, nursing homes,

diagnostic laboratories and from other small medical institutions situated in remote areas of

the country. There are two types of medical waste generating from healthcare activities. One

is non-hazardous or general waste and other one is hazardous in nature and very harmful to

the human health. Though, this specific waste is very small in quantities (10 to 25 percent)

among the total waste generating, but it can be mixed with the general waste making the

whole waste stream hazardous. Only Dhaka city is producing more than 250 tons of medical

waste per day. Amid, around 50 tons is hazardous wastes. Lack of proper segregation and

internal management system these untreated hazardous wastes are being dumped and

disposed outside the hospital premises or in the municipal bins along with the general

household waste making the total waste hazardous. Reusing of used syringe, needle and other

reusable things can be facilitated spreading contagious diseases like hepatitis B, hepatitis A,

Hepatitis C, HIV/AIDS etc. The concern ministries and other government and non-

government organization including development partners are being seriously concerned

about this issue and its life threatening consequences.

As Bangladesh is one of the most populated countries in the world and population of urban

areas is increasing day by day. The total population of Bangladesh is now around 160

million. In considering the total population, Bangladesh is the 7 th largest countries in the

World. Ministry of Health and Family Welfare and Directorate of Health Service is the

leading authority of health sector in Bangladesh. Government is always prioritizing this

sector as one of the most important sectors in Bangladesh. Government is largely providing

healthcare services throughout the country including capital city, divisional towns, city

corporation areas, district towns, upazillas and even in union level. Nowadays, a big private

healthcare sector is rapidly developing in urban areas, especially in big cities like Dhaka,

Chittagong etc. Some NGOs are also playing an important role in this sector. They are using

their widespread network for reaching healthcare service for the under privileged people.

Under Local Government Division, some projects have also been developed on urban

primary health care and development of public and environmental health issues.

As a part of health sector development activities, Ministry of Health and Family Welfare has

declared Medical Waste Management and Disposal is equally important as other

conventional healthcare services. They have approved an operational plan for “Improved

Hospital Services Management” for 2003-2011. And within this plan Medical Waste

Management is a prioritized activity.

Background information of the project and Objective of the workshop:

Bangladesh has become a Party to the Stockholm Convention since 2007, and its National

Implementation Plan submitted to the Convention articulates emissions of Persistent Organic

Pollutants (POPs) in the country and prioritized action plans to address the POPs risks

imposed on its citizens and workers in related sectors. Upon receiving a request from the

Government of Bangladesh, UNIDO has developed a project proposal to be funded by the

Global Environmental Facility (GEF) on environmentally sound management of POPs. The

objective of this project is to assist Bangladesh in fulfilling its obligations under the

Stockholm convention by (1) reducing the release of PCBs to the environment, and (2)

improving healthcare waste management in the country to reduce the emission of

dioxin/furan from disposal activities.

The main objective of this workshop was to share and discuss the project design on medical

waste disposal with major stakeholders including associated ministries, departments, NGOs

working on waste management, public and private hospitals, private companies, association

of doctors, association of clinics and diagnostic centers, development partners, potential

investors and waste operators. To explore the modalities of public and private sector

partnership operations in the area of medical waste disposal in Bangladesh.

Description of the workshop:

The workshop was divided into three sessions. One was opening session and two technical

sessions. The numbers of presentations were 7 (seven).

Participants of the workshop:

In the workshop, UNIDO and IFC have invited all the stakeholders related to the Medical

Waste Management in Bangladesh. All the key stakeholders, such as associated Ministries

(Ministry of Health and Family Welfare, Ministry of Local Government and Rural

Development, and Cooperatives, Ministry of Environment and Forest etc), associated

Government departments (Directorate General of Health Service-DGHS, Local Government

Division, Dhaka City Corporation, and Department of Environment-DoE, etc), relevant

NGOs (PRISM Bangladesh, Waste Concern, SAPNO, Innovation Seba Sangstha, etc),

Government Project such as Urban Public and Environmental Health Sector Development

Project, Urban Primary Health Care Project II, International Development partners,

International NGOs, Association of Doctors, Association of Private Clinic and Diagnostic

centers, private companies, waste operators and print and electronic media people have

participated in the workshop. A list has enclosed with the report.

Opening Session:

Duration of the opening session was 1 hour and 20 minutes. Opening session was facilitated

by Mr. Zaki-uz-Zaman, PhD, Head of Operation in Bangladesh, UNIDO. He announced the

name of speakers for delivering their speeches.

The session was attended by all the participants and facilitators, along with Prof. Dr. AKM

Ruhul Haque, MP and Honorable Minister, Ministry of Health and Family Welfare as Chief

Guest. Mr. Abdul Malek, Joint Secretary, Ministry of LGRD&C and Mr. Naim Ahmed

Khan, Joint Secretary and Project Director, Urban Public and Environmental Health Sector

Development Project were attended as Special Guests. Mr. Kyle F. Kelhofer, Country

Manager, IFC Bangladesh was the guest of Honor of the workshop. Key note speech was

given by Mr. Ayumi Fujino, Regional Director for South Asia, UNIDO. Mr. IINO Fukuya,

PhD, Program Manager, UNIDO presided the opening session and delivered his vote of

thanks to the workshop audience at the end of the session.

Ms. Fujino in her keynote speech as UNIDO Representative, explained the background of the

project which is going to implement in Bangladesh and highlighted UNIDO’s expertise on

POPs, especially medical waste management for the reduction of dioxins and furans, and

encouraged south-south cooperation with the ongoing project in India.

Mr. Abdul Malek, Joint Secretary, Ministry of LGRD&C in his speech as special guest, he

explained the importance of Medical Waste Management, and later he expressed his concern

about managing radio active wastes in Bangladesh.

Mr. Naim Ahmed Khan, Joint Secretary and Project Director, Urban Public and

Environmental Health Sector Development Project, in his opening speech, he said that

although few NGOs like PRISM Bangladesh, PRODIPAN, SAPNO etc. are jointly working

with City Corporations on Medical Waste Management in two three cities in Bangladesh. But

their coverage and progress in this sector is very low and a strong supervision and monitoring

system should be developed to supervise and motor the activities. He also described activities

of ADB funded project which is implementing in 6 cities of Bangladesh. The project will

develop 5 more sanitary land areas in 5 city corporation areas, 6 medical waste disposal

facilities and 6 modern slaughtering houses with waste management facilities 6 city

corporation areas in Bangladesh.

The Honorable Minister of Health and Family Welfare, Prof. A.F.M. Ruhul Haque, in his

opening address as chief guest, reiterated that the issue is a priority in the country and simple

but effective solutions are preferred. He said whenever any project for medical waste

managements were proposed in the past, always involving a big budget. Bangladesh

Government wouldn’t afford that much of money. It does not need a big amount of money as

basic works have already been done in the Medical Waste Management sector. The different

wings of the Government should work as one unit to improve the situation of Medical Waste

management in Bangladesh. He also commented that an electronic system would be

developed to monitor waste disposal activities.

Technical Session 1

The technical session 1 comprised with four presentations, an open discussion and a

concluding remarks by the chair at end of the session.

Chair: Mr. Md. AFM Saiful Alam Additional Director General, DGHS

Presentation 1: Ms. Tonilyn Lim, UNIDO

Title of the Presentation: The proposed Project and roadmap towards Project

Development/approval; issues to be resolved.

Topics discussed in the presentation:

Currently UNIDO and GEF are developing a project on Environmentally-Sound

Management of PCBs and Healthcare Waste (HcW) in Bangladesh. And Healthcare Waste

management is one of the bigger components. Through the 1st presentation Ms. Lim

discussed about the background and Rational, project proposal, issues defining the

partnership and co-financing and preparation status and roadmap of the project. She also

described the Objectives, Expected Outcomes, Outputs and References of the project.

Presentation 2: By Mr. Indranil Sarkar, IFC.

Title of the Presentation: Medical Waste Management: PPP Models.

Topics discussed in the presentation:

Mr. Sarker define healthcare waste PPP as “Under a PPP, government or /health insurer

contracts with a Private Partner (for-profit or not-for-profit) for a health care service and / or

facility.” All the way through his presentation, Mr. Sarker presented a clear outline on

establishing a Public Private Partnership models healthcare waste service in Bangladesh. He

portrayed few PPP concepts in healthcare waste management sector, such as Tipping fees,

The Concession Agreement etc. He described about the Medical Waste Management sector

of Bangladesh, including integrated medical waste management, benefit and challenges and

risk allocations of PPP, key issues for successful PPP etc. In his presentation he also

displayed a case study from Gujarat, India as an example of successful PPP in healthcare

waste management service. He displayed the detail procedures of Common Biomedical

Waste Treatment Facility (CBWTF), BOOT (Build, Own, Operate, and Transfer) followed

by Surat Municipal Facility (SMC). At the end of his presentation he provided a list that

portrayed ‘Lesson Learnt’.

Presentation 3: By Md. Ziaul Haque, Deputy Director (Technical), Department of

Environment, Bangladesh.

Title of the Presentation: For the workshop on Medical Waste Disposal and Public Private

Partnership.

Topics discussed in the presentation:

In the presentation, he presented major legal instrument related to the medical waste

management activities. He provided a list of related laws:

1. Bangladesh Environmental Conservation Act 1995 and its subsequent amendments

(recent amendment done in 2010).

2. Bangladesh Environment Court Act, 2010.

3. Bangladesh Environment Conservation Rules 1997 and its subsequent amendments.

4. Noise Pollution (Control) Rules, 2006.

5. Medical Waste (Management and Processing) Rules 2008.

He also informed that few other environmental laws will be promulgated in very short time.

Three laws are in the list:

1. Solid Waste Management Rules, 2011.

2. Hazardous Waste and Ship Breaking Waste Management Rules 2011.

3. E-Waste Management Rules, 2011

He also described the procedure of obtaining Environmental Clearance Certificate under

Environmental Conservation Act 1995 and the industrial category list under Environmental

Conservation Rules 1997. For the purpose of issuance of Environmental Clearance

Certificate, the industrial units are classified into four categories:

1. Green

2. Orange A

3. Orange B, &

4. Red

He also described the steps involved for obtaining ECC from Department of Environment

(DoE) under the ECA, 1995.

In the middle of his presentation he mentioned few key features of Medical Waste

(Management and Processing) Rules 2008. In the rules, Medical waste categorized in 11

types and recommends specific treatment for each type. Six color coding are recommended

for storage and disposal of different types of medical waste. It also describes the standard of

incinerator, emission, autoclaving, liquid effluents, micro-waving and deep burial of medical

waste and disposal of radioactive materials. The rules provide detailed instruction on

segregation, packaging, transport and storage and treatment of medical waste. As per the

rules, the waste generator shall be liable financially and legally to ensure proper handling and

treatment of medical waste. The rules provides various formats for the application of

licenses, approval of licenses, accident reporting, annual reporting, and appeal against the

authority’s decision.

Under the Rules three types of licenses are issued for medical waste management:

1. Medical Waste segregation, packaging, storing, disinfection and incineration license.

2. Medical Waste collection and transportation license.

3. Medical Waste Treatment, decontamination and disposal license.

Mr. Zia also presented national 3R strategy for waste management in his presentation. In his

last slide he described on DoE’s role in promoting PPP in waste management sectors. He said

that DoE is very much aware of its coordinating role in facilitating PPP on MWM for the

purpose of achieving environmental objectives of the country.

Presentation 4: by Engr. Syed Qudratullah, Superintendent Engineer and Additional Chief

Waste Management Officer, Dhaka City Corporation.

Title of the Presentation: Medical Waste Disposal – Role of Dhaka City Corporation

Topics discussed in the presentation:

Mr. Qudratullah started his presentation by providing an overview on Dhaka City

Corporation’s medical waste situation. Overview shown:

Present population of CC area: 16 million (app)

No. of Govt. Hospital: 13

No. of autonomous Hospital: 2

No. of Private HCF: 1200 (App.)

Total Soled Waste generation: 5000 Ton/day (App.)

Total Medical Waste Generation: 50 Ton/day (App.)

Total Hazardous Medical Waste Generation: 20 Ton/day (App.)

No. of HFC under MWMP: 325, including 8 nos. Gov. hospital & 1 No. autonomous

hospital (BSMMU)

Present capacity of MWMP: 8.5 Ton/day

Quantity of MW managing at present: 6 Ton/day (Avg.)

He described the role of DCC regarding Solid waste management and Medical waste

management separately. DCC signed a Memorandum of Understanding (MoU) with PRISM

Bangladesh in March, 2004. He displayed a slide with few inter-ministerial decisions for

operating medical waste management in every level of Bangladesh government. The

decisions are:

Medical Waste Management committee at Administrative level

In-house Management of Medical waste is the responsibility of MoH&FW

Management of waste outside the healthcare facility is the responsibility of Local

Government ministry.

MoH&FW will pay service charge to MoLGRD&C ministry.

Supervision & Monitoring by MoH&FW, MoEF and MoLGRD&C.

Four committees have formed to operate Medical Waste Management in Bangladesh. The

committees are:

A four members Advisory Committee

A twelve members management committee headed by CEO of DCC

A six members Technical Committee

A four members financial sub committee

Mr. Qudratullah depicted DCC’s achievements, problems and recommendation at the end of

his presentations.

Open discussions: After completing the presentations a vibrant discussion occurred among

the participants of the session. Few comments and questions raised by the participant

regarding proper management of Medical Waste in urban areas and the challenges for

implementing Public Private Partnership (PPP) model in Bangladesh. Representative from

Innovation raised the issue of building capacity for training and monitoring in Medical Waste

Management activities. Dr. A.K.M. Saidur Rahman, Deputy Programme Manager of

Improved Hospital Services Management of DGHS informed the workshop that a Training

Manual on Medical Waste Management has already developed, and it covers every aspects

and steps of Medical Waste Management system for the healthcare establishments and final

disposal and treatment facilities. Dr. Bhuyan, member of executive committee of Bangladesh

Medical Association (BMA) recommended that Government would transfer responsibilities

for issuing licenses of private hospitals and clinics to a separate institution other than

Directorate of Health Service (DGHS). Mr. Ziaul haque, Executive Director of SAPNO, an

NGO, involved in medical waste management in Bogra a northern district of Bangladesh,

claimed that Dhaka City Corporation should be in charge for carrying all the wastes

including municipal solid waste and medical waste separately. He also informed that local

authorities of Bogra is checking medical waste management status of healthcare

establishment before issuing licenses for clinic and diagnostic centers. Mr. Monir Alam

Chowdhury, Executive Director, Commitment consultant said that we have to find out the

prioritized areas where we should emphasize now. He expressed his despondency by saying

that things are not moving forward as though we already have 11 years experience in this

field. Mr. Shamsul Gafur Mahmud, from WHO asked Mr. Haque of DoE that what is the

main barrier for not implementing Medical Waste (Management and Processing) rules

properly. Mr. Ziaul informed that now DoE is checking Medical Waste management plan

while a new healthcare facility applying for Environmental Clearance Certificate (ECC) and

they are not getting utility facilities from the government if they are not complying Medical

Waste Management Rules. Consequently, Dr. Tariq-Bin-Yusuf, Waste Management

Specialist of Dhaka City Corporation asked what capacity you have to monitor the

compliance of Medical waste management status and issuing ECC to new healthcare

facilities? And what would be the modality for implementing Bangladesh Medical Waste

(Management and Processing) Rules 2008? Representative from Apollo Hospital

Bangladesh displayed a news paper cutting to the workshop audience that depicted a horrible

picture and an article that says 46 tons of untreated hazardous medical wastes are mixing

everyday with general municipal waste in Dhaka city. He said that we need 20 more PRISM

Bangladesh to cover the whole areas of Dhaka city.

Concluding remarks of chair:

Prof. Dr. AFM Saiful Islam, Additional Director General (Admin), Directorate General of

Health Service (DGHS), Ministry of Health and Family Welfare delivered his concluding

remarks after the open discussion session.

Technical Session 2

Chair of the session: Mr. Indranil Sarkar, Senior Investment Officer, IFC

Presentation 1: By Dr.A.K.M. Saidur Rahman, Deputy Project Manger, Improved Hospital

Services Management, Directorate General of Health Service (DGHS), Ministry of Health

and Family Welfare

Title of the presentation: Address the issue of HcWM as a priority, and parallel program of

DGHS and Opportunity for PPP

Presentation 2: By Mr. Tarit Kanti Biswas, Project Coordinator, PRISM Bangladesh

Title of the presentation: Medical Waste Management in Dhaka City; An Example of GO,

NGO Partnership (PPP) between DCC & PRISM Bangladesh

Presentation 3: By Dr. Hemanth Thampsey, Director- Health Care Waste Management Cell,

M. S. Ramaiah Medical College & MSR Hospitals

Title of the presentation: Medical Waste Disposal and Indian Experience

Open discussions:

After completing three presentations a lively discussion happened between presenters and

participants of the 2nd Technical session. Mr. Monir Alam chowdhury of Commitment

consultant asked Dr. Hemanth, how Ramaiah Medical College initiated Medical Waste

Management in 5 states and will the project sustain after completing the project period? Dr.

Hemanth explained that they had taken this project as a public health issue and Medical

Waste Management issue is being judged as prime concern of public health. He informed

that Ministry will take over the ongoing activities after completion of the project. Mr. Ullah

from ICDDR, B asked about the final disposal option for Radio Active Waste. He said Radio

active wastes should be sent to Atomic energy regulatory board or commission. Some other

topics came out from the discussions, such as how many beds would be needed if a private

operator wants to operate medical waste collection and treatment facility successfully? The

answer was ‘minimum 10,000 beds’.

Concluding remarks of chair: Mr. Indranil Sarkar, the chair of the session delivered his

concluding remarks by thanking all presenters for their excellent presentations and sharing

the practical experiences on Medical Waste Management in Government and Non-

government sectors in Bangladesh and India.

Key issues raised in the workshop:

If we compile all the comments and findings that participants had delivered in the workshop,

we may get a clear picture for developing Public Private Partnership model among concern

Ministries, departments, development partners, local government institutions, Non-

government organizations and private companies in Bangladesh. Now, we have to reconsider

some issues before establishing successful PPP model in Bangladesh.

The issues are:1. Coordination between different ministries, city corporations, and municipalities to

implement environmentally-sound management of medical waste, in consideration of

the number of guidelines/policies already issued:

Managing medical waste is the responsibility of three ministries. The ministries are:

1. Ministry of Health and Family Welfare 2. Ministry of Local Government, Rural

Development and Cooperatives, & 3. Ministry of Environment and Forest.

Ministry of Health and Family Welfare and its Directorate General of Health Service

(DGHS) are responsible for in-house healthcare waste management in government

hospitals and other healthcare establishments. Ministry of Local Government Rural

Development and Cooperatives and its local government division are responsible for

secondary transportation and final disposal of medical waste. Ministry of

Environment and Forest is acting as regulatory body here.

A strong coordination is needed among the three ministries and concern departments

to establish proper medical waste management in every corner of the country. For

this, we may need to prepare bylaws for existing guidelines and policies already

issued.

2. A strong monitoring system should be developed:

We received quite a few observations and recommendations regarding lack of

monitoring and supervisions in existing medical waste management activities and

developing a strong monitoring system in future. Successful PPP model always

requires a better monitoring and supervision system.

3. Capacity Development for hospital staff and medical waste service providers:

An extensive capacity development campaign is needed for hospital staff, city

corporation staff and medical waste service providers.

4. Strengthening the capacity of Department of Environment (DoE) for implementing

existing laws regarding Medical Waste management in Bangladesh:

There are few laws regarding Medical Waste Management existed in Bangladesh.

Medical Waste (Management and Processing) Rules 2008 is the main legal

instrument for regulating medical waste management in Bangladesh. But lack of

proper training and manpower restricts DoE for implementing these rules properly.

5. Nurturing new/upcoming medical waste operators in Bangladesh:

Only four NGOs are operating medical waste management service in 7 cities of

Bangladesh. For covering the whole country, we need to nurture new and upcoming

medical waste operator to serve un-met demand for this service in other areas in the

country. Big private companies would play a vital role in this sector as a CSR

(corporate social responsibility) activity.

6. Selection of Final disposal options:

The authority and waste operators both are pretty confused in selecting proper final

disposal options in the waste disposal facilities in Bangladesh. Availability of land,

energy supply and financial capacity are the main constraint for selecting final

disposal options in different areas in Bangladesh. So, transfer of technology and

upgrading the existing disposal facilities would be a priority.

7. Sustainability issue:

Till now, healthcare facilities are not providing adequate service charge to the waste

operators, and they are struggling to keep continuing the service. So, a national

service charge list should be prepared and circulated though out the country by Local

Government authorities for ensuring the sustainability of medical waste services and

for the operators.

Other meetings with key stakeholders:

Itinerary of meeting:

13th December, 2011: Meeting with Director General (DG) of Directorate General of

Health Services (DGHS), Ministry of Health and Family Welfare. And ICCDR, B.

14th December 2011: UNIDO/IFC workshop on medical waste management and

Public Private Partnership followed by a meeting with Innovation a medical waste

facility operator working in Chittagong and Comilla city corporation area.

15th December, 2011: Meeting with PRISM Bangladesh (an NGO operating the

medical management and disposal facility in Dhaka City corporation area),

Department of Environment (DoE), Project Director of the ABD funded project on

Urban Public and Environmental Health Sector Development Project (UPEHSDP),

Power Development Board (PDB), Rural Electrification Board (REB), and NGO

called Family Health International (FHI).

Meeting with DG of DGHS (2.30 PM, December, 2011):

Meeting was scheduled at 2.30PM, December 2011, at the office of DG of DGHS.

UNIDO mission team was reached at 2.25 at the meeting place and the meeting started at

3.00pm. Prof. Dr. Khondhaker Md. Shefyetullah, Director General, DGHS, Dr. Md.

Ruhul Furkan Siddique, Assistant Director (Coordination), DGHS, Dr. ABM Musa,

Deputy Director, DGHS, Mr. Zaki-Uz-Zaman, Head of Operation, UNIDO Bangladesh,

Mr. IINO Fukuya, Program Manager, UNIDO, Ms. Tonilyn Lim, Industrial Development

Officer, UNIDO and Mr. Md. Anisul Kabir, National Expert, UNIDO Bangladesh were

attended the meeting.

In the meeting Ms. Toni described the background and ongoing preparatory activities of

the UNIDO project. Mr. IINO explained the GEF co-financing procedure. Dr. Musa

described DGHS’s ongoing Medical Waste Management activities on future

development. He informed that Government is very committed about the sector, and

Ministry of Health is now providing training and logistics for all Government hospitals to

maintain in-house medical waste management in their premises. His team mentioned

their ongoing activities on the capacity building of healthcare establishments for proper

waste management and identified key people, from as high as the office of the Prime

Minister, who obtained specialized trainings and who can help in further advocating the

project.

Meeting with ICDDR, B Bangladesh (3.30 PM, December 13, 2011):

Meeting was scheduled at 3.30PM, December 2011 at ICDDR, B Dhaka premises at

Mohakhali, Dhaka. Mr. Kenneth Ford, Head of Bio-safety Quality Assurance, ICDDR,B,

Ms. Lutfe Ara, Head, Clinical Governance & Systems, ICDDR,B, Mr. Mohammad Ullah,

Professional Practice Leader – Nursing, ICDDR,B, Ms. Umme Sharmeen Hyder,

Manager Quality Assurance, ICDDR,B, and Mr. Zaki-Uz-Zaman, PhD, Head of

Operation in Bangladesh, UNIDO, Mr. IINO Fukuya, Program manager, UNIDO, Ms.

Tonilyn Lim, Industrial Development Officer, UNIDO and Mr. Md. Anisul Kabir,

National Expert, UNIDO Bangladesh were attended the meeting.

ICDDR,B personnel expressed their keen interest on UNIDO project and described

ICDDR,B’s existing activities on medical waste management and disposal. ICDDR, B

has a strong in-house medical waste management system and they have two incinerators

in their premises, one is in Dhaka and another one is in Matlab premises. Now they are

providing training on medical waste management and infection safety for their staffs in

all levels. ICDDR, B expressed their commitment to improve their final disposal system

by installing big autoclave unit and ETP at their premises in future.

ICDDR, B will share the report of third party evaluation conducted in their incineration

facility in Dhaka to give UNIDO an idea of issues faced in similar operations.

Meeting with Innovation (5.00 PM, 14th December 2011):

After the workshop on Medical Waste Management and PPP at Hotel Pan Pacific, a brief

meeting was conducted at workshop place with Innovation Waste Management Ltd. In

meeting Mr. IINO Fukuya, Tonilyn Lim and Md. Anisul Kabir from UNIDO and Mr.

Md. Motiur Rahman Khan, Managing Director, Innovation and his representative

attended the meeting.

Mr. Khan described the Innovation’s initiatives regarding Medical Waste Management

activities and their future plan for expansion. Currently they are working in two cities of

Bangladesh. Chittagong and Comilla. Most of the Healthcare establishments of those

cities are already included in their service and they have also installed final disposal

option in city corporation areas. They are using concrete pit for disposing medical waste

as final disposal option.

They had signed separate MoU agreement with Chittagong and Comilla City Corporation

for operating medical waste management in those areas. Primarily, they had invested

their own money to establish the operation. They had shown a keen interest to improve

their capacity on medical waste management service and build partnership with UNIDO

and other development partners. They informed that German Embassy would provide an

autoclave unit for them.

Meeting with PRISM Bangladesh (9.00 AM, December 15, 2011):

The meeting was scheduled at 9.00AM at PRISM Bangladesh office. In the meeting Mr.

Kh. Anisur Rahman, ED, PRISM Bangladesh, Mr. Tarit Kanti Biswas, Project

Coordinator, PRISM Bangladesh, Mr. IINO Fukuya, Program Manager, UNIDO, Ms.

Tonilyn Lim, Industrial Development Officer, UNIDO and Mr. Md. Anisul Kabir,

National Expert, UNIDO were participated.

The UNIDO mission team was briefed them about potential opportunities with regard to

participating in the project. PRISM Bangladesh described their medical waste

management activities and recent program progress they have achieved in this field. After

a brief discussion happened between two teams, some useful points came out regarding

Medical waste management and future progress of PRISM. Some points were:

A Medical Waste Operator association would be formed for ensuring better

coordination between Government institution/authorities and waste operators.

There are no facilities available to measure Dioxin and Furan in Bangladesh. This

kind of service is needed for measuring dioxin and furan emission from

incineration process in Bangladesh.

PRISM is monitoring the emission standard of their incinerators in complying

Bangladesh Environmental Conservation Act, 1995.

PRISM Bangladesh has intension to expand their medical waste activities in

Dhaka as well as to other cities of Bangladesh. But they need initial investment

to do that. If they would get money from Development partners or from financial

institution as lower interest loan, they will definitely expand the activities.

Meeting with DoE (11.00 AM, December 15, 2011):

The meeting was scheduled at 11.00AM at DoE office with Director General (DG) of

Department of Environment (DoE). As present DG was out of station, so, Mr. Md.

Shahjahan was presided the meeting. Mr. IINO Fukuya had spent almost one hour to

explain the project background and status to Mr. Shahjahan. The subject of the meeting

was about the review and approval of PIF document of environmentally sound

management of PCBs and healthcare waste project by UNIDO and GEF. But DoE

officers informed that they haven’t reviewed the document yet and UNIDO should update

the document again by incorporating few comments they had already given to the head of

operation, UNIDO in last meeting.

Meeting with Project Director, UPEHSDP (3.30 PM, December 15, 2011):

Urban Public & Environmental Health Sector Development Project is an ADB funded

project implemented by Local Government Division, Ministry of LGRD&C. A

spontaneous meeting had conducted between Project Director, UPEHSDP and UNIDO

team at UPEHSDP project office, Nagar bhaban, Dhaka City Corporation building,

Dhaka.

In the meeting, Mr. Naim Ahmed Khan, Project Director, Dr. Tariq-bin-yusuf, Waste

specialist, Dhaka City Corporation, Ms. Tonilyn Lim, Industrial Development Officer,

UNIDO and Mr. Md. Anisul Kabir, National Expert, Medical and Hazardous Waste

Management were attended.

At the outset of the meeting Mr. Naim had delivered a short speech regarding the project

background, objectives, activities and predicted outcome. The scope of the project

includes building and operating integrated waste management facilities (IWMF) in 6 city

corporations of the country including Dhaka City. These IWMFs will also include

sanitary landfills except in Dhaka where there is space constraint and already two landfill

sites existed. With the development, UNIDO’s proposed project could then focus on

optimizing the performance of one or two existing medical waste facilities to cater to un-

met demand, while reducing the emission of dioxins/furans through BAT/BEP. This

should demonstrate environmentally-sound management of Medical Waste for possible

replication in the ADB project.

Meeting with FHI (6.00PM, December 15, 2011):

The UNIDO mission team also visited an international NGO, Family Health International

(FHI), and gave a briefing to the Program Manager of its regional waste management

projects about the outcomes of the UNIDO/IFC workshop, and identified areas of

possible cooperation and co-financing.

Dr. M. Abul Kalam Azad, Manager Clinical Research and Laboratory Science, FHI, Mr.

IINO Fukuya, PhD, Program Manager, UNID, Ms. Tonilyn Lim, Industrial Development

Officer, UNIDO and Mr. Md. Anisul Kabir, National Expert, Medical and Hazardous

Waste Management, UNIDO were attended the meeting.

Summary findings and comments and opinions regarding future partners of the

project:

After receiving the comments and findings from workshop and following meetings, I think

we need to address few issues regarding medical waste management by the upcoming

project. The issues are:

Building coordination among three ministries related to MWM.

Enhance the capacity of monitoring and supervision of DoE or local government

division.

Prepare the bylaws for Medical waste (Management and Processing) Rules 2008 and

City corporation acts for facilitating implementation of these regulations.

A nation wide awareness campaign and a capacity building activities should be

conducted through Directorate of Health Service (DGHS) and Local Government

Division for building capacities of key stakeholders as well as general people of

Bangladesh.

A forum would be formed among all medical waste operators, which will strengthen

their capacity to deal Government and development partners in medical waste

management issues.

Create new medical waste operators in other areas where medical waste management

activities are absent.

Changing the final disposal option for reducing the emission of dioxin and furan.

During the project, establish a PPP model on medical waste management in

Bangladesh.

To address the above issues, the potential partner would be: Directorate of Health Service (DGHS), Ministry of Health and Family Welfare:

they are the responsible ministry for managing in-house waste management in

government hospitals. They have sufficient fund for training and capacity building for

Government hospitals, but they don’t have sufficient trainers to complete the training

activities. And from the co-financing point of view they are capable to work as a

partner of UNIDO/GEF project.

Urban Public and Environmental Heath Sector Development Project (an ADB

funded project by Local Government Division): The project has an extensive area

of activities with a component addressing medical waste disposal options. But they

don’t have activities related to awareness development and building capacity for city

corporation staffs on Medical waste management. UNIDO would fill the gaps of the

project and build the project a successful one.

PRISM Bangladesh: They are one of the most potential partners of the project.

Current, they are operating medical waste management in Dhaka city. They are

covering 327 healthcare establishments among the total 1200. Now they need to

enhance their capacity on collection as well as final disposal options. Another option

would be improving the quality of their incinerator or changing to non-burning

technologies.

Innovation/SAPNO: Two NGOs working in two regions of Bangladesh. SAPNO is

working in three cities of north western part of Bangladesh and Innovation is working

two cities of eastern part of Bangladesh. UNIDO project will facilitate them to

establish appropriate non burning disposal options and a model medical waste PPP.

ICDDR, B and FHI: Both the organizations goal is different then the other potential

partners and their activities mostly involved with research and in-house waste

management activities. UNIDO would help them to conduct research on specific

subject regarding medical waste management.

Category and strength and weakness of the organization:

Directorate of Health Service: Government organization, responsible for all government hospitals in-house medical waste management.

Strength: Main stakeholder in medical waste management sector Available fund for co-financing activities Strong institutional backup for implementing the project Have strong policy support for the project

Weakness: Project formulation process might be a little lengthy.

Possible Outcome from the partnership: Though DGHS is responsible for nation wide in-house waste management, so, partnership with DGHS would produce a great outcome on national in-house waste management activities. Urban Public and Environmental Heath Sector Development Project (an ADB funded project by Local Government Division): Local Government Division is the key stakeholder and authority of urban medical waste disposal. So, a partnership with UPEHSDP would improve the national capacity on final disposal options in Bangladesh.

Strength: One of the main stakeholders in medical waste management sector Responsible for secondary collection and final disposal options Available fund for co-financing activities

Strong institutional backup for implementing the project Have strong policy support for the project

Weakness: Haven’t find any

PRISM Bangladesh: PRISM Bangladesh is in a category of Waste Operator.

Strength: Long experience in medical waste management and operation Have skilled man power Strong institutional backup Most renown organization in this particular subject Strong co-financing opportunity is there.

Weakness: Centralized tendency Progress rate is slow (in context of covering no. of healthcare establishments and

replicating the model in other areas). Monitoring and supervision system is weak

SAPNO: SAPNO is in a category of Waste Operator.

Strength: Good relationship with local authorities (i.e. City Corporations, Paurashava) Good intension and keen to work Local organization Have already done the background work, now they can start working

Weakness: Co-financing process would be difficult New in the subject Lack of skill manpower Monitoring and supervision system is weak

Innovation: Innovation is in a category of Waste Operator.

Strength: Good relationship with local authorities (i.e. City Corporations, Paurashava) Good intension and keen to work Local organization Have already done the background work, now they can start working

Weakness: Co-financing process would be difficult

New in the subject Lack of skill manpower

ICDDR, B and FHI: Both the organization is in Research Organization category.

Strength: Have a clear objective and vision Have sufficient funding for co-financing Have skill manpower Have already done the background work, now they can start working

Weakness: The will only work in their own premises They are not an operator They will cover few healthcare establishments.