Diagnostic assessment of the health care facilities in Lumbini Province, FHI 360
Diagnostic Assessment of the Healthcare Facilities in Lumbini Province
Project Overview:
FHI 360 has been working in Nepal since 1993 in the areas of HIV/AIDS, family planning/reproductive health, nutrition, antimicrobial resistance, environment, COVID-19 response, procurement and supply chain management, capacity building, civil society and media strengthening, and governance reform. FHI 360’s work is grounded in evidence and aligns with and provides support to the Government of Nepal’s development priorities and plans in health.
It’s a challenge for a single hospital to set up healthcare waste management system as it may lacks proper implementation plans, oversights into proper logistics required, treatment technology as well as infrastructure like waste treatment center to establish a systematic HCWM.
Most of the hospitals under federal government have been established with a proper healthcare waste management system in Nepal. But provincial hospitals and local level hospitals are struggling to manage their waste on their own. The hospitals in district level are partially supplied with the treatment technology, either autoclave or microwave. There is strong need of support in terms of waste treatment center development as well as implementation of HCWM. Development of a proper HCWM implementation plan is insufficient without having substantial knowledge of the actual scenario of HCWM practices, average daily waste quantity, available resources like manpower, technology, and infrastructure. Hence this study will collect all the relevant information regarding a safe, efficient and sustainable HCWM system in 12 HCFs in Lumbini Province. The assessment begins with a baseline survey of how much and what kind of waste is being generated by each department or ward. Additionally, there is an engineering survey in terms of construction of waste treatment center, placenta, and sharp pit. And finally, a best suited HCWM implementation plan including monitoring and supervision framework will be recommended.
Location and Duration: USAID, FHI 360 extended support to the 12 provincial hospitals federal, provincial and local) of Lumbini Province. The duration of the assignment was 3 months’ time span until the end of February 2024. HCFs are listed as follows:
- Arghakhanchi Hospital
- Bhim Hospital
- Gulmi District Hospital
- Kapilvastu Hospital
- Lamahi PHC, Basic Hospital
- Parasi District Hospital
- Pipra Hospital
- Pyuthan District Hospital
- Rampur Hospital
- Rolpa Hospital
- Rukum East Hospital
- Sushil Koirala Prakhar Cancer Hospital
Technical Support and Leadership: Waste Service Pvt. Ltd., provided technical support, leveraging its expertise to drive the project towards success Tika Ram Poudel, a recognized leader in waste management, headed the project as the Team Leader.
The overall objectives of the assignment are as follows:
- Conduct consultation meetings with relevant stakeholders of the Provincial Health Directorate, local level governments, hospitals as well as local recyclable vendors to develop integrated waste management approach.
- Carry out the hospital level assessment, including 7 days long waste quantification as well as observational visits and questionnaire surveys.
- Identify existing status, practices of waste management through primary data collection for healthcare waste.
- Identify necessary logistic items/supplies with specifications and cost estimation for developing sustainable HCWM system.
As one of the consultant partners, Waste Services Pvt. Ltd. following activities were carried out during the projects:
- Consultation meetings and/or workshop with relevant stakeholders of the Provincial Health Directorate, Ministry of Social Development, and local level government to develop integrated waste management approach and other supporting documents such as approaches, municipal policy for waste management, business models, etc. for implementation of integrated solid waste management.
- Review different acts and regulations of HCWM.
- Carried out the hospital level assessment, including meetings and discussions with various stakeholders for HCWM related issues/problems and possible solution.
- Identified existing status, practices of waste management through primary data collection for healthcare waste.
- Incorporated feedback and comment and finalized the report disposal as per recyclability.
- Prepared the presentation for communication to local level decision-makers.
- Reported after completion of an assignment.
Output of the projects were:
- According to the HCWM practice observational checklist as per HCWM SOP 2020, the color code for all 12 hospitals of Lumbini Province is “white” which represents many revolutionary changes are required to achieve a safe and sound HCWM system.
- Bhim Hospital, Prithivi Chandra Hospital and Sushil Koirala Prakhar Cancer Hospital have shown tremendous concern over management of solid waste while other hospitals in Lumbini Province are really neglecting the genuine issue of waste management in their practices.
- Only Prithivi Chandra Hospital was found practicing autoclaving, while Bhim Hospital and Sushil Koirala Prakhar Cancer Hospital are initiating treating its waste as they are equipped with functional autoclaves.
- Bhim Hospital have recently constructed waste treatment center while Ropla Hospital have just lunched the construction in to tender system. Waste treatment center at Prithvi Chandra Hospital is functional but lacks waste segregation chambers, thus a minor refabrication is recommended. Other than these three hospitals, all 9 hospitals are in serious need of waste treatment center.
- All the hospitals are equipped with autoclaves but only 1 hospital ie Prithvi Chandra Hospital is practicing in a daily routine. The functionality of the autoclaves present in hospital is really doubtful as some are not installed or remain as it is for long period of time. Thus, a routine analysis from a biomedical professional is highly recommended.
- None of the hospital have dedicated staff for autoclaving of waste except Prithivi Chandra Hospital.
- The current practice of waste disposal in 9 hospital is open pit burning, while Lamahi hospital and Prithivi Chandra and Bhim Hospital send their waste to municipal landfill for final disposal.
- Sushil Koirala Prakhar Cancer Hospital outsource their waste to Nepalgunj central treatment facility despite having its own autoclave and microwave.
- In average, there are 140 color coded bins with average size of 28 ltr in each of 12 HCFs studied. Out of them, only 32 % of the bins have appropriate labelling. While more 52% of the total bins are properly cleaned and only around 32% of the total bins are properly segregated.
- Hospitals hygiene situation is satisfactory in all hospitals as they were equipped with the hygiene materials like soap or ABHR in hygiene station.
