NATIONAL WORKSHOP
Integrated Healthcare Waste Management (IHCWM) and Water Sanitation & Hygiene (WASH) in Healthcare Facilities
एकीकत सवासथयजनय फोहोरमलवा वयसवापन तवा सवासथय ससवामवा खवानपवानी, सरसफवाई तवा सचछतवा समबननधि रवाषटरिय कवाययशवालवा गोषी
December 10 to 12, 2019 (मससर २४ दनख २६ गत, २०७६)Hyatt Regency, Kathmandu, Nepal हयवात रजननस, कवाठमवानवा
Together for a healthy Nepal
No time to waste !
“सस नपवालकवा लवासग सग सग”
Background
The World Health Organization’s Water, Sanitation and Hygiene (WASH) in Health Care Facilities Global Baseline Report 2019 found that only 5% of healthcare facilities in Nepal properly segregate healthcare waste. Healthcare waste is made up of general healthcare waste and hazardous or ‘risk’ healthcare waste, which includes laboratory, chemical and pharmaceutical waste, sharps (e.g. needles), bio-hazardous waste (e.g. samples of potentially infected lab cultures, body parts) and a growing amount of e-waste. An assessment conducted in Bidur Municipality by GIZ’s Support to the Health Sector Programme (S2HSP) found that 38% of the 52.13 kg of waste generated in healthcare facilities every day was risk waste. According to WHO guidelines, the proportion of risk waste should be between 10 and 25%.
If such waste is not properly managed it can have negative environmental impacts, with implications for the integrity of ecosystems, natural resources and ultimately human health. The risk of injury and infection is not only a threat to waste handlers, but also to patients, medical staff, housekeeping staff and, indirectly, to the general public through air pollution, chemical hazards, and contamination of the food chain and natural environment.
Objectives of this workshop
The workshop will help to assess gaps in the area of healthcare waste management and WASH in healthcare facilities in Nepal. It will bring together Nepali and international actors to raise awareness of the current issues in healthcare waste management and WASH in the country and provide a forum for an exchange of knowledge and experience.
Outputs
1. Exchange of knowledge, tools, technology and practices of sustainable healthcare waste management and WASH in healthcare facilities at subnational level.
2. Advocacy for global and national actions to improve healthcare waste management and WASH in healthcare facilities and support in decision making and resource allocation.
3. A common understanding of the urgent need for joint efforts at all levels (national and subnational government, private and public sector etc.) to address the unsafe management of hazardous waste and poor WASH practices in healthcare facilities.
4. National and international networking, alliance building, peer learning, and inter- and intra-sectoral cooperation for learning and innovation.
5. A roadmap towards Integrated Health Care Waste Management (IHCWM) in Nepal.
6. Commitment of stakeholders to endorse an IHCWM model and resolutions on actions to implement the model.
AGENDA - DAY 1TUESDAY, DECEMBER 10, 201901:00-02:15 pm Registration with high tea
02:15-02:25 pm Welcome Mr. Bhogendra Raj Dotel, Director, Management Division, Department of Health Services (DoHS)
02:25-02:45 pm Workshop inauguration Welcome proceeding
National anthem
E-inauguration
02:45-03:30 pm Short film about healthcare waste in Nepal
Opening remarks Key initiatives to address environmental health issues in Nepal, focusing on IHCWM and WASH in healthcare facilities
Mr. Chudamani Bhandari, Chief of Environmental Health and Healthcare Waste Management Section, Management Division, DoHS
03:30-03:50 pm Keynote addressHealthcare waste management: Why it needs urgent attention and sustainable interventions at all levels
Ms. Ruth Stringer, International Science & Policy Coordinator, Health Care Without Harm
03:50-04:30 pm Experience sharing Perspectives from field-level practitioners
VideoFacts and figures on IHCWM and WASH in Nepal
Ms. Maya Tamang Informal Waste Worker, Samyukta Safai Jagaran (SASAJA)Mr. Chet Narayan Kafle, Senior Auxiliary Health Worker, In-charge of Jamuni Health Post, Bardia Ms. Radhika Ghimire, Healthcare Waste Management Coordinator, Kathmandu Model Hospital
04:30-05:15 pm Remarks Special GuestsRepresentatives from Government of Nepal
05:15-06:00 pm Marketplace introduction and visit Ms. Basundhara Sharma / Mr. Raj Kumar Rai
06:00-08:00 pm Dinner
AGENDA - DAY 2WEDNESDAY, DECEMBER 11, 201908:00-09:00 am Registration and Breakfast
09:00-09:15 am Summary of key messages from Day 1 Ms. Basundhara Sharma / Mr. Raj Kumar Rai
Plenary Session: Overview of Healthcare Waste Management and WASH in Healthcare Facilities in NepalChair: Dr. Roshan Pokharel, Director General, Department of Health Services
09:15-10:15 am Policy and strategy for environmental health promotion in Nepal
Dr. Dipendra Raman Singh, Chief, Quality Assurance and Regulation Division, MoHP
National guidelines and strategy on IHCWM and standards for WASH in healthcare facilities
Mr. Chudamani Bhandari, Chief, Environmental Health and Healthcare Waste Management Section, Management Division, DoHS
Legal framework on HCWM: Compliance monitoring practice in Nepal
Mr. Indu Bikram Joshi, Deputy Director General, Department of Environment
10:15-10:30 am Question and answer session Ms. Basundhara Sharma / Mr. Raj Kumar Rai
10:30-11:00 am Coffee break
Plenary Session: Waste Management and WASH in Healthcare Facilities: Practices from the RegionChair: Dr. Vasudev Upadhaya, Director General, Department of Ayurveda and Alternative Medicine
11:00 am-12:00 pm Healthcare waste management and WASH in healthcare facilities: Situation analysis and key interventions for improvement
Dr. Sudan Raj Panthi, National Professional Officer, World Health Organization (WHO), Nepal
Emerging trends and practices related to the regulatory framework for HCWM in SAARC nations
Prof. Dr. Ashok Agrawal, President, Indian Society of Hospital Waste Management, India
Emerging waste management practices: Experiences from waste incineration to zero waste cities in Asian countries
Mr. Froilan Grate, Executive Director, Global Alliance for Incineration Alternatives, Philippines
User-friendly tool for WASH in healthcare facilities
Dr. Lim Khankryka, Quality Assurance Officer, Hospital Services Department, Ministry of Health, Cambodia
12:00-12:30 pm Question and answer session Ms. Basundhara Sharma / Mr. Raj Kumar Rai
12:30-01:30 pm Lunch
Continued on next page
DAY 2 (CONTINUED) WEDNESDAY, DECEMBER 11, 2019Parallel Session 1: Healthcare Waste Management
01:30-03:00 pm Parallel Session 1A: Governance and Leadership in Waste Management
Legal framework, leadership and business plan for integrated HCWM in Nepal
Implementing Biomedical Waste Rules 2016: The experience of a government tertiary care hospital in New Delhi, India
Question and answer session
Facilitator: Mr. Tirtha Kumar SinhaChair: Mr. Bhogendra Raj Dotel, Director, Management Division, DoHS Co-Chair: Dr. Paul Rueckert, Chief Technical Advisor, GIZ - S2HSP
Dr. Dhundi Raj Pathak, Geotechnical & Geo-environmental Engineer, GIZ-S2HSP
Prof. Dr. K. T. Bhowmik, Directorate General, Ministry of Health & Family Welfare, India
Parallel Sessions 1B:Experiences on HCWM from Nepal and other Asian Countries
Implementation of safe healthcare waste management at the T.U. Teaching Hospital, Nepal
Learning exchange on healthcare waste management: The experience of Taiwan
Question and answer session
Facilitator: Mr. Pravin Tiwari / Mr. Tejendra ThapaChair: Dr. Tara Nath Pokharel, Director, Curative Service Division, DoHS Co-Chair: Dr. Kedar Ceintury, Director, Bir Hospital
Prof. Dr. Prem Khadga, Executive Director, T.U. Teaching Hospital
Dr. Ming Nan Lin, Vice Superintendent, Dalin Buddhist Tzu Chi Hospital, Taiwan
Parallel Sessions 1C: Technologies in Waste Management
Use of non-burning technologies in HCWM, and injection safety practices among hospital staff and waste workers
Waste Reduction, Refuse, Reuse and Recycling (4R) practices in healthcare waste: The circular economy, monitoring and tracking, and digitising HCWM information systems
Question and answer session
Facilitator: Dr. Sudan Raj PanthiChair: Dr. Rajendra Koju, Dean, Dhulikhel Hospital Co-Chair: Representative, Ministry of Social Development
Mr. Mahesh Nakarmi, Director, HECAF
Dr. Sumitra Amatya, Chairperson, Lead Nepal andMs. Ruth Stringer, International Science & Policy Coordinator, Health Care Without Harm
DAY 2 (CONTINUED) WEDNESDAY, DECEMBER 11, 2019Parallel Session 1D: Types of Waste and Methods of Disposal
Disposal of chemical and pharma waste, histopathological waste and cytotoxic waste
Liquid waste management in healthcare facilities
Management of e-waste: The health consequences of electronic waste dismantling amongst informal sector workers in Manila
Question and answer session
Facilitator: Ms. Asmita Thapa Chair: Dr. Runa Jha, Director, National Public Health Laboratory, DoHS Co-Chair: Mr. Vijay Singh, Assistant Country Director, UNDP
Mr. Anders Bolmstedt, Board Chairman, Health Care Without Harm, Sweden
Mr. Krishna Ram Yandyo, Director, Eco Concern
Dr. Guillaume Fauvel, General Coordinator, Médecins du Monde France
03:00-03:45 pm Live drama show, followed by coffee break
Parallel Session on WASH in Healthcare Facilities
3:45 - 5:15 pm Parallel Session 2A: Strategy and Governance
Water and Sanitation in Health Facility Improvement Tool (WASH FIT)
Monitoring and assessment of WASH in healthcare facilities
Governance modalities and oversight strategies for strengthening WASH and waste management practices in rural health facilities of Nepal
Question and answer session
Facilitator: Ms. Upama AdhikariChair: Mr. Ramakanta Duwadi, Joint Secretary, Ministry of Water Supply Sanitation (MoWS) Co-Chair: Dr. Md Khursid Alam Hyder, Public Health Administrator, WHO Nepal
Ms. Shrijana Shrestha, Senior Public Health Administrator, Health Office
Dr. Arundati Muralidharan, Manager Policy (WASH in Health & Nutrition, and Schools), WaterAid India
Mr. Ambar Kumar Sharma, Senior Auxiliary Health Worker, Tribeni Health Post, Tribeni Rural Municipality, Salyan
Continued on next page
DAY 2 (CONTINUED) WEDNESDAY, DECEMBER 11, 2019Parallel Session 2B: Menstrual Hygiene Management
Best practices on disposal of menstrual waste
Menstrual hygiene management: Case study and best practice in global context
Question and answer session
Facilitator: Ms. Pragya Shrestha / Ms. Sami PandeChair: Dr. Bhim Singh Tinkari, Director, Family Welfare Division, DoHS Co-Chair: Ms. Tripit Rai, Country Director, WaterAid NepalMr. Vivek Singh Thakuri, Executive Director, Mitra Samaj
Ms. Thérèse Mahon, WASH in Education & MHM Specialist,WaterAid UK and Mr. Jan-Christoph Schlenk, Advisor Sustainable Sanitation Programme, GIZ
Session 2C: Learning, Reflection and Adaptation from Piloted Districts
Gender friendly and inclusive approaches on WASH in healthcare facilities
Behavior change and communication for improved WASH practices in rural health facilities of Nepal
Question and answer session
Facilitator: Ms. Siddhi ShresthaChair: Mr. Mohammad Daud, Director, National Health Training Center, DoHS Co-Chair: Dr. Bandana Pradhan, Professor for Public Health and Environment, Tribhuvan UniversityMr. Chet Narayan Kafle, Senior Auxiliary Health Worker, In-charge of Jamuni Health Post, Bardia
Mr. Rajeev Banjara, Monitoring, Evaluation and Learning Advisor, SNV Nepal
Parallel Session 2D: Climate Smart Healthcare
Global Green Hospital Movement for climate smart healthcare
Climate, disasters and health action for making smart hospitals
Climate Resilient Health System: Nepal initiation
Question and answer session
Facilitator: Ms. Charu Shree NakarmiChair: Mr. Mahendra Prasad Shrestha, Chief, Health Coordination Division, MoHP Co-Chair: Ms. Abha Shrestha Karna, Director General, Department of EnvironmentMr. Ramon Pascal, Executive Director, Health Care Without Harm Asia, Philippines
Ms. Connie Cai Ru Gan, Public Health Researcher, Griffith University Centre for Environment & Population Health, AustraliaMr. Rajaram Pote Shrestha, National Professional Officer, WHO Nepal
05:15-05:30 pm Short film on occupational health of informal waste workers, Sisdol
Médecins du Monde, France
05:30-05:45 pm Closing Ms. Basundhara Sharma / Mr. Raj Kumar Rai
AGENDA - DAY 3THURSDAY, DECEMBER 12, 201908:00 - 09.00 am Registration and Breakfast
09:00 - 9:10 am Summary of key messages from Day 2 Ms. Basundhara Sharma / Mr. Raj Kumar Rai
09:10-10:30 am Panel Discussion: Policy Framework for HCWM and WASH in Healthcare Facilities
Moderator: Dr. Sushil Baral, Managing Director, Herd International
Dr. Dipendra Raman Singh, Chief Policy Planning and Monitoring Division, MoHP
Mr. Indu Bikram Joshi, Deputy Director General, Ministry of Forest and Environment (MoFE)
Mr. Rishi Aacharya, Joint Secretary, Ministry of Federal Affairs and General Administration (MoFAGA)
Mr. Ramakanta Duwadi, Joint Secretary, MoWS
10:30-10:45 am Coffee break
10:45-11.15 am Debriefing of parallel session outputs and key lessons learned
Mr. Chudamani Bhandari, Chief, Environmental Health and Healthcare Waste Management Section, Management Division, DoHS
11:15-12:45 pm Panel Discussion: Implementation of HCWM and WASH in Healthcare Facilities
Moderator: Dr. Sushil Baral, Managing Director, Herd International
Representative, Sudhurpaschim Province, Ministry of Social Development, MoSD
Dr. Kedar Ceintury, Bir Hospital
Dr. Bharat Pradahn, Model Hospital
Ms. Uma Thapa Magar, Deputy Mayor, Nepalgunj Sub-metropolitan city
Dr. Sumitra Gautam, Bhaktapur Hospital
12:45-01:45 pm Lunch
Continued on next page
DAY 3 (CONTINUED) THURSDAY, DECEMBER 12, 2019Plenary Session: Research and Development in Environmental Health
Chair: Dr. Pan Bahadur Chhetri, Director General, Department of Drug Administration
01:45-02:45 pm Presence of antibiotics in waste water of hospitals in Kathmandu Valley
WASH intervention and diarrheal diseases: Case studies on disposal of sanitary waste in Nepal
Question and answer session
Mr. Shrawan Kumar Mishra, Joint-Chief Medical Technologist, National Public Health Laboratory
Dr. Meghnath Dhimal, Chief Research Officer, Nepal Health Research Council
Plenary Session: National Experiences on the Design and Implementation IHCWM
02:45-03:15 pm Integrated HCWM at local level: Experience of Nilkantha Municipality
Experiences from the design of integrated waste management Birendranagar Municipality
Mr. Deepak Koirala, Technical Advisor, Nilkantha Municipality
Mr. Hari KC, Engineer, Birendranagar Municipality, Surkhet
03:15-03:45 pm Coffee break
03:45-4:00 pm Presentation of resolutions Mr. Chudamani Bhandari, Chief, Environmental Health and Healthcare Waste Management Section, Manage-ment Division, DoHS
4:00-05:00 pm Closing ceremony
05:00-05:15 pm Group photo
रट १ (सनधिवारवा – एरपोटय - हवायवात)रट १ (सनधिवारवा – एरपोटय - हवायवात) समय समय (ददन १)(ददन १)
समय समय (ददन २ र ३) (ददन २ र ३)
सनधिवारवा बस षटबसौनी (षटरिपरशवर तफय )
११:०० ०७:१५
रतनपवाकय ११:०५ ०७:२०
मवाईसतघरबस षटबसौनी (बवानशवर तफय )
११:१५ ०७:३०
नय बवानशवर बस षटबसौनी (नय एभरसट होटल ननजक)
११:२० ०७:३५
सतनकन बस षटबसौनी ११:३० ०७:४५
सीनवामगल बस षटबसौनी ११:४० ०७:५५
रिीभ न अनतरवानसरिय एयरपोटय बस षटबसौनी
११:४५ ०८:००
जय बगशवरी मननदर बस षटबसौनी १२:०० ०८:१५
चवादहल (बौदध तफय ) १२:१० ०८:२५
हवायवात ररजसी १२:२५ ०८:३५
रट २ (सनधिवारवा-लवानजमपवाट-हयवात)रट २ (सनधिवारवा-लवानजमपवाट-हयवात) समय समय (ददन १)(ददन १)
समय समय (ददन २ र ३)(ददन २ र ३)
सनधिवारवा बस षटबसौनी (षटरिपरशवर तफय )
११:१५ ०७:१५
लवानजमपवाट बस षटबसौनी ११:३० ०७:३०
दटसचङ असपवातल बस षटबसौनी ११:४५ ०७:४५
नवारवायण गोपवाल चोक बस (भवाटभटनी सपर षटबसौनी,
महवारवाजगज)
११:५० ०७:५०
धिमबवारवाही बस षटबसौनी १२:०० ०८:००
सकधिवारवा बस षटबसौनी १२:०५ ०८:०५
चवादहल (बौदध तफय ) १२:१५ ०८:१५
हवायवात षटबसौनी १२:३० ०८:३०
रट ३ चवाहवाषटबल रट ३ चवाहवाषटबल दनख हवायवातदनख हवायवात
समय (१ ददन)समय (१ ददन) समय (२ र ३ ददन)समय (२ र ३ ददन)
चवादहल १२:०५ १२:४० ७:४० ८:१५
हवायवात ररजसी १२:२० १२:५५ ७:५५ ८:३०चवादहल बवाट हवायवात Regency ओहोरदोहोरको लवागी छटट सनरनतर सवा ददन बस उपलबधि गरवाईएको छ ।हरक ददनको कवाययकरम समवापन पशयवात सोदह रटमवा बसहर फदकय न वयसवा गररएको छ ।
बस सवाको लवागी प जवानकवारी आशयक भएमवा महश परसवाद जोशी (९८५११९२७६८) लवाई समपकय गनयहोलवा ।
A 1
B
AC
G
D
E
F
2
3
45
6
7
8
9
Shuttle bus service
हवायवात ररजसी हवायवात ररजसी
चवादहलचवादहल
चवादहलचवादहल
जय बगशवरी मननदर जय बगशवरी मननदर
रिीभ न अनतरवानसरिय एयरपोटय रिीभ न अनतरवानसरिय एयरपोटय
सीनवामगल सीनवामगल
सतनकन सतनकन नय बवानशवर नय बवानशवर
मवाईसतघरमवाईसतघर
रतनपवाकय रतनपवाकय
लवानजमपवाट लवानजमपवाट
दटसचङ असपवातल दटसचङ असपवातल
नवारवायण गोपवाल चोक नवारवायण गोपवाल चोक
धिमबवारवाही धिमबवारवाही
सकधिवारवा सकधिवारवा
सनधिवारवा सनधिवारवा
1
2
3
4
5
6
7
8
9
A
B
C
D
E
F
G
वातवारणीय सवासथययः पथीमवा कलकवायन उतपवादनमवा सवासथय करिल ४% असर पवारको छ भन हवाल नपवालमवा नसनन वातवारणीय सवासथययः पथीमवा कलकवायन उतपवादनमवा सवासथय करिल ४% असर पवारको छ भन हवाल नपवालमवा नसनन रोगबवाट हन मतयदर ६७% रहको छ । नसनन रोगमवा वातवारणको परतयक असर रहको छ । रोगबवाट हन मतयदर ६७% रहको छ । नसनन रोगमवा वातवारणको परतयक असर रहको छ । (Step survey 2019, Nepal)तसय,
सस नजनको लवासग सस वातवारणमवा हवामी सब सहभवागी बनौ ।
कन पसन फोहोर नजलवाउ जलवाय पररतयनलवाई नययनीकरण गरौ ।
सरनकत भषटषयको लवासग सवासथयजनय फोहरको उसचत वयसवापन गरौ ।
सवासथय जनय फोहर बयसवापनयः षटशवमवा असपतवाल तवा सवासथय ससवाहरबवाट षटबरवामीलवाई हन सकरमणको कवारणल सवासथय जनय फोहर बयसवापनयः षटशवमवा असपतवाल तवा सवासथय ससवाहरबवाट षटबरवामीलवाई हन सकरमणको कवारणल नजवात सशशको मतयदर वाषटयक करीब ४३०,००० रहको छ। नजवात सशशको मतयदर वाषटयक करीब ४३०,००० रहको छ। (WHO 2016)
सवासथयजनय हवासनकवारक फोहरको मवापदण अनरप बयसवापन गरौ, मवान सवासथय र वातवारणमवा पनन नकवारवातमक असरलवाइ नययनीकरण गरौ ।
सवासथयजनय फोहरको उसचत परषटसधिदवारवा सनमयलीकरण तवा वयसवापन गरौ, घवाउ चोटपटक, HIV, Hepatitis जसतवा सकरवामक तवा ददघयकवासलन रोग लवागनबवाट बचौ ।
सवासथय ससवाल जोनखम यकत र जोनखम रदहत फोहोरमलवाको शोतम बसगयकरण (Segregation) अनीवायय रपमवा गरौ ।
मवापदण अनसवार सवासथयजनय फोहरको नबवाली (Non-Burning) परषटसधिदधवारवा सनमयलीकरण गरी बयसवापन गरौ ।
सवासथय ससवामवा खवानपवानी सरसफवाई र सचछतवाको लवागीसवासथय ससवामवा खवानपवानी सरसफवाई र सचछतवाको लवागी
सवासथय ससवामवा खवानपवानी सरसफवाई र सचछवाको ससनसचतवा र गणसतररयतवा कवायम गरौ । सवासथय ससवाहरबवाट हन सकरमण घटवाउ ।
असपतवालमवा मवापदण अनसवारको पवानी, सबको सदह तररकवाको हवात धिन बवानी ।
-वातवारणीय सवासथय तवा सवासथय ससवाजनय फोहरमलवा बयसवापन शवाखवा, बयसवापन महवाशवाखवा, टक
“जहवा सवासथय तयहवा सरसफवाई, जहवा सरसफवाई तयहवा सवासथय ।”
Together for a healthy Nepal
No time to waste !
मयल सदशहर ( Key Messages )( Key Messages )
फोहरको पनयःपरयोग र पनर चदकरय वयसवापन, शोत आजयनको कलपीक मवाधयम ।
एदककत रपमवा बयसवापन गनय सवायजसनक सननज सवाझदवारी मोलमवा सघ, परदश वा सवासनय सतरमवा फोहोरमलवाको ददगो बयसवापन गरौ ।
“सस नपवालकवा लवासग सग सग”