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”