State of health

   

A research commissioned by the health department found the biomedical waste management in Kashmir as primitive and highly hazardous for public health and environment. Kashmir Life reproduces excerpts of the research by Dr S Hassan Mir, Dr Syed Rumaiya Sajjad.

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Jammu and Kashmir, especially the Kashmir Region does not fulfill the basic criteria laid by the World Health Organanisation and is not ensuring a state of complete health to its people. The gap between the provision and need is needs to be seriously looked at.

Health is an important individual value which decides the collective level of living and socio- economic development of any state. Health being a social responsibility; the government, semi-government, non- government and volunteer organisations should take vital steps to implement, regulate and maintain health standards therefore, providing preventive and curative service.

The purpose of health care is to improve the health status of the population through identification of local health problems, factors pertaining to such problems, gap between need and provision, and attitudes as well as available resources to ensure better health condition for all.

The Government of India, through the five year plans has expanded infrastructure and health services through Primary Health Centres and Sub-centres. However, the efficacy is still a question because of understaffing, poor supply of medicines and equipment, and basic awareness about the concept of healthcare at all levels especially about the management of biomedical waste.

The biomedical waste (potentially hazardous wastes from hospitals and clinics which have a pathogenic, chemical, explosive, or radioactive nature) management has been identified as one of the critical factors for determining the overall status of healthcare.

The biomedical waste management and handling rules of 1998 of Government of India requires every occupier of an institution generating bio-medical waste, which includes a hospital, nursing home, clinic, dispensary, veterinary institution, animal house, pathological laboratory, blood bank by whatever name called to take all steps to ensure that such waste is handled without any adverse effect to human health and environment. Hospital waste generated from different units of hospital can cause serious health hazards like spread of HIV infection, Hepatitis B and C etc.

Biomedical Waste management (collection, transport, processing, recycling or disposal, and monitoring of waste materials from the healthcare facilities) has become a major environmental, health and aesthetic issue. The insanitary methods adopted for disposal of biomedical wastes is, therefore, a serious health concern.

The poorly maintained landfill sites are prone to groundwater contamination. Open dumping of garbage facilitates the breeding for disease vectors such as flies, mosquitoes, cockroaches, rats and other pests. Indiscriminate land-filling leads to deterioration of water quality in neighbourhood areas of landfill sites. This has adverse health impacts on people living nearby, causes bad odour, and the people living nearby live in the constant fear of explosion of methane gas that can accumulate at the landfill sites.

Landfill gas, which is 50 to 60 percent methane, contributes significantly to global warming.The present piece of micro research was intended to enhance the basic existing knowledge of biomedical waste management with the following objectives.

To assess the existing scenario of the hospital/healthcare facility waste characterisation studies and successive survey of public perception on the quality of services.

To generate new knowledge, technologies and approaches for a viable and sustainable management of hospital/healthcare facility wastes.

To generate the awareness among the concerned that its improper management poses risks to health care workers, waste handlers, patients, community in general and largely the environment.

To establish a long-term platform for further research

To evoke awareness about Personal Protective Equipment (PPE)

It was an empirical and exploratory research. This research study was carried out in the four districts (Anantnag, Pulwama, Shopian and Srinagar) of Kashmir valley. The total sample size was taken from government as well as private hospitals/ test labs/ clinics. The employees / functionaries and population were the respondents of the researchers. The sample of the study was of representative type.

The relevant information were recorded/collected about the concerned topic through a detailed questionnaire and interview method. The questions in the questionnaire were open ended and close ended type; depending upon the nature of the question and information required for the question. The research was done with due authorization from the directorate of Health.

Findings, Suggestions and Recommendations Keeping the field visits and the available statistics in view, the situation of the biomedical waste management system in Kashmir seems absolutely appalling and the compatibility between combating mechanism is almost non-functional, even after outsourcing the hospital waste to the available waste management facility in the valley, as advised by pollution control department and recommended by the health department of J&K.
 
The collection of waste by the outsourced agency as found in the study is not done according to the protocol at any of the places visited. In most of the hospitals, it is managed by the sweepers who do it according to their convenience. The waste is collected in any of the bags (irrespective of the colour coding specified by the outsourcing facility in their pamphlets).

The reason for such irresponsible attitude is lack of knowledge not only on the waste collector’s front but at almost every level of the healthcare system. The waste is kept in the backyard of the hospital until the van from the outsourced facility arrives, after which it is transferred and taken away. The waste is not collected on a daily basis from most of the hospitals/ health facilities as found from the study. But surprisingly the sources at outsourced facility claimed to collect the waste on a regular basis. Many a times it is also found that the waste keeps on lying in the hospital for more than 48 hours which is harmful for the population.

Segregation of waste:  Segregation of waste is a major problem as found in the study. Proper segregation is done neither at the source nor at the disposal site, again due to ignorance/ lack of proper training. All types of wastes were found mixed in the bags used for carriage, which is very harmful according to the WHO standards. Most of the respondents are not even aware of the concept of waste management standards.

During the research, we found different hospitals following different standards of colour coding. Though only IPHS (Indian Pubic Health Standards) or WHO standards are applicable, we wonder how these hospitals can have their own standards.

Treatment of waste: The autoclaving and incineration done at the outsourced facility for the hospital waste disposal is not adequate according to the WHO standards. Although they do treat the waste, but the proper methods are not adopted. For example the chimney is too small for 100 kg capacity of biomedical waste, which tends to emit poisonous gases in the nearby population. Likewise many factors were found which point fingers towards the malfunctioning of the outsourced facility.

Disposal of waste: There is only one dumping site in place for over two years. It is used for dumping of the ashes after treatment. The researchers really wonder how only one dumping site could cater to such a large waste for such a long time.

As per the minimum standards, the representative universe is lacking almost on all the fronts which predict serious potential threat to human lives which are availing facilities directly or indirectly.

It was found that the present practice of outsourcing the waste is not in proper practice because of lack of sense of responsibility by the concerned but unfortunately it is still in place just because the hospital registration authorities have made it mandatory for the registration process.

Therefore a serious effort in terms of a detailed research, a series of awareness campaigns at all levels, training and workshops for the mid-level managers, and finally monitoring, control after implementation of the programme is necessary to address the present crisis of hospital waste management system across the valley.

State specific IEC (Information, Education and Communication) / awareness Strategy to be developed

District level arrangements- collection, segregation, treatment and disposal.

Trainings and workshops at all levels (state, district, block and villages).

Support, control/ check and monitoring to the existing system.

There is a definite need for a future course of action (enhanced research study on hospital waste management)

A wide gap has been found as far as WHO and Indian standards are concerned therefore, to develop deeper understanding about the hospital waste management an action research is strongly recommended by the consultants.  

The gap between need and provision needs to be reduced by taking necessary steps as per set norms.

Enforcement of medical waste management regulations The provision available under NRHM (National Rural Health Mission), with its main aim to provide accessible, affordable, accountable, effective and reliable primary healthcare, especially to poor and vulnerable section of the population is a clear determinant of the importance of biomedical waste management in the annual healthcare plans of the states.

According to the NRHM  guidelines, each district of any state where NRHM has been implemented needs  to have a district action plan, a perspective 7 year plan outlining the year-wise resource and activity needs of the district, which would be the key strategy for integrated action under NRHM.

The district action plan of Pulwama district, Dec 2007 does have a clause mentioning handling of biomedical waste, which according to the findings of our research is not even known to most of the respondents of the study. And it is very unfortunate that these clauses were never worked upon further, and were never taken as a point of reference for the management of biomedical waste management by the authorities.

(The detailed in depth research with necessary suggestions and recommendations was shared with concerned authorities, Kashmir with a request for urgency at least for the awareness campaigns regarding management of biomedical waste. However the implementation is still awaited after one and a half year.)

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