83% hospitals lack waste treatment facility: TIB Study

Eighty-three percent of hospitals in the country that produces the second highest amount of medical wastes in Southeast Asia lack effluent treatment plants (ETP) – a compulsory facility by rules, finds a survey of the Transparency International Bangladesh.

Among the rest, 16% have kept their plants inoperative, which means that only 1% of the country's hospitals effectively manage medical wastes with ETP.

"Medical waste management is crucial for our environment and public health, yet the country has failed to frame an institutional structure for that," TIB Executive Director Iftekharuzzaman said at the survey revealing programme on Tuesday on a virtual platform.

"Our laws and rules related to waste management have so many loopholes. There is also a lack of collaboration among different agencies concerned," he added.

TIB Researchers Newazul Moula, Shahidul Islam and Sazzadul Karim conducted the survey, titled "Governance Challenges in Medical Waste Management and Way Out", on 231 hospitals and local government agencies, and 93 medical waste workers across the country between June 2021 and November 2022.

The survey also found that 80% of city corporations and municipalities have no separate facility for medical waste management resulting in a mix-up of medical waste and general waste, and an increased risk for infectious diseases. Even the majority of agencies having medical waste plants do not use those.

Transparency International Bangladesh also found frequent reuse of medical waste, which increases the risk of AIDS and other disease spread.

"Instead of dumping, dishonest hospital staffers and waste management contractors sell used syringes, knives, scissors, bottles, canals, blades, saline bags and other wastes to unscrupulous syndicates that recirculate it and earn money," it said.

The TIB study also found huge irregularities in recruiting waste workers in different hospitals and agencies with up to Tk2 lakh being transacted as bribes. Yet, waste workers get salaries on an irregular basis. Irregularities are also common appointing waste management contractors, which prompt them to be corrupted.

It identified the lack of specific colour containers and storage rooms for waste storage, lack of technical capacity, shortage of skilled manpower, deficiency in the budget, and lack of supervision as challenges of medical waste management.

"No effective steps have been taken to comply with the Medical Waste (Management and Processing) Rules even 14 years after framing it. Hence, there is a dearth of transparency, accountability, and coordination among the institutions related to waste management. Even, the contractors are operating without licences," the report reads.

"The failures of the in-house and out-house management of medical waste are due to the lack of infrastructure, budget, modern technology, skilled human resources, and awareness of environmental protection."

"After all, medical waste management is not given adequate importance," it added.

The civil society organisation fighting against corruption puts 11 recommendations to improve the medical waste management system in the country, including the formation of separate authorities for monitoring agencies working with medical waste.

Other key suggestions are following international standards and making time-befitting rules, increasing budgetary allocation, deploying modern technologies and skilled workers, ensuring health insurance for waste workers and stopping the reuse of medical waste.