Unregistered hospitals hindering waste management efforts
The absence of a system for registration and regulation of hospitals and clinics run in the private sector has hindered the city district government's efforts to properly manage hospital waste. A source in the municipal services department of the CDGK said that about nine months ago, an exercise was launched to prepare a union council-wise inventory of hospitals, clinics, health-care centres, maternity homes and pathological laboratories and approach the medical establishments concerned to observe safe medical practices, which, however, received a less than encouraging response from hospitals. The field officers could not press the hospitals for details and the exercise remained a one-sided affair which yielded a very limited list. Under the Pakistan Environmental Protection Act, 1997, hospital waste falls within the hazardous waste category, and institutions improperly handling it can be prosecuted. Hazardous waste, existing as solid waste or a combination of solid waste, because of its quantity, concentration or physical, chemical or infectious characteristics, is considered a reservoir for disease-transmitting organisms contributing to an increase in mortality or an increase in serious illnesses. It poses a potential peril to human health or the environment when improperly treated, stored, transported, or disposed. Knowing the fact that not all the small and big clinics and hospitals, both in the government and private sectors, were in a position to segregate medical waste and dispose of it properly, in the 1990s, the then municipal organisation of the city established two incinerators for safe collection and disposal of hospital waste, including hazardous waste. However, despite all efforts, till date only about 140 hospitals, health centres, laboratories and clinics are availing the government facilities against some payments, and as such it can be said that only 10-15 per cent of the waste in question is being disposed of scientifically, the source said. It was learnt that there were about 3,500 hospitals, health centres, laboratories, clinics and doctors, including qualified dentists, operating throughout the city and also generating medical waste in solid or liquid forms. The source said that since there was no proper documentation of medical establishments available with any government agency or department, the city government's municipal services department had tasked its various field workers and inspectors with collecting the relevant data. The purpose was to get the statistics and locations of hospitals and health centres and then go for counselling and coordination on medical waste disposal. However, despite all efforts the department could prepare a list of only 300-400 establishments, which could be attributed to the fact that there was no set of laws under which the hospitals and clinics could be regulated and accredited and be made to ensure, among other things, that they were environmentally and human health friendly, said a waste manager of the city government. Experts felt that it was due to the lack of a single management scenario that health-care workers, hospital administrators, sanitary workers and other health professionals were unable to understand the necessity of protecting themselves and the public from exposure to hazardous waste. Legislation ready and waiting A source privy to the public health management section of the Sindh government said that after a long exercise and consultation with all the stakeholders, including hospital managers, a draft legislation on the regulation and registration of private sector hospitals in the province was also prepared and later approved by the then chief minister in the first half of 2007 for promulgation, but it was still awaiting the consent of the governor. "Had the ordinance been promulgated, the health department, with the cooperation of the district governments, could have addressed the issue of medical waste management and streamlined the hospital waste disposal system as well,' the source noted. When contacted, Masood Alam, the City Government's EDO for Municipal Services, said his department had started an exercise to list the hospitals, but it remained half complete for a couple of reasons. "Now that the CDGK has entrusted the job of the city's solid waste management to a Chinese company, it would be the responsibility of this firm to look into the issues of all sorts of solid waste, including hospital and hazardous waste,' Mr Alam emphasised.Replying to a question, he said that his department had no real record of hospitals in the city, but it was now understood that the Chinese, who had already started visiting the union councils of the city, would also opt for listing medical establishments to manage medical waste.