Partial Update 2015
Last Full Update: Prior to 2003
PDF (632 KB)
Small-scale healthcare activities, such as rural health posts, immunization posts, reproductive health posts, mobile and emergency healthcare programs, and urban clinics and small hospitals, provide important and often critical healthcare services to individuals and communities that would otherwise have little or no acess to such services. The medical and health services they provide improve family planning, nurture child and adult health, prevent disease, cure debilitating illnesses, and alleviate the suffering of the dying.
Currently, little or no management of healthcare wastes occurs in small-scale facilities in developing countries. Training and infrastructure are minimal. Common practice in urban areas is to dispose of healthcare waste along with the general solid waste or, in peri-urban and rural areas, to bury waste, without treatment. . In some cities small hospitals may incinerate waste in dedicated on-site incinerators, but often fail to operate them properly. Unwanted pharmaceuticals and chemicals may be dumped into the local sanitation outlet, be it a sewage system, septic tank or latrine.
More information about waste management (including waste management of asbestos or lead) for hospitals under construction or rehabilitation can be found in the Construction Sector Environmental Guideline. The importance of potable water and sanitation projects to improve public health is discussed in the Water and Sanitation Sector Environmental Guideline.
- Medical Waste: Storage, Transport and Disposal. U.S. Environmental Protection Agency Guidelines. Re-issued September 2003. http://www.epa.sa.gov.au/xstd_files/Waste/Guideline/guide_medical.pdf
This guideline defines medical waste and provides an overview of environmental protection legislation (Schedule 1, Part B of the Environmental Protection Act 1993). It also discusses requirements for storing, collecting, and transporting medical waste.
- The Basel Convention on the Control of Transboundary Movements of Hazardous Wastes and Their Disposal: Protocol on Liability and Compensation for Damage Resulting from Transboundary Movements of Hazardous Wastes and their Disposal. 1992. http://www.basel.int/Portals/4/Basel%20Convention/docs/text/BaselConventionText-e.pdf
The goal of this international environmental agreement is to “protect human health and the environment against the adverse effects of hazardous wastes.” As of March 2013, 180 countries have ratified the agreement. Annex 1: Categories of Wastes to Be Controlled includes medical and pharmaceutical wastes.
- Safe management of wastes from health-care activities, edited by A. Prüss, E. Giroult and P. Rushbrook. Geneva, WHO, 1999, 228 pages. Available at: http://whqlibdoc.who.int/publications/9241545259.pdf. English (French and Spanish in preparation). Can be ordered from WHO, MDI, CH-1211 Geneva 27 (e-mail: firstname.lastname@example.org). Price: SwF 72, SwF 50.40 for developing countries.
This comprehensive handbook recommends safe, efficient and sustainable methods for the handling, treatment and disposal of wastes from healthcare activities. It addresses a variety of technical options, as well as organizational and policy issues essential in managing healthcare wastes. The handbook is targeted at public health professionals, regulators, and hospital managers and administrators.
- Teacher’s Guide – Management of wastes from health-care activities, A. Prüss & W.K. Townend, World Health Organization, Geneva, 1998, 227 pages. Available at: http://www.who.int/injection_safety/toolbox/docs/en/Teachersguide.pdf.. English (French and Spanish in preparation). Can be ordered from WHO, MDI, CH-1211 Geneva 27 (e-mail: email@example.com) Price: SwF 35.-, SwF 24.50 for developing countries.
The Teacher’s Guide accompanies the WHO handbook on management of wastes from healthcare activities described above. It provides teaching materials (ready-to-copy texts for overhead transparencies, lecture notes, handouts, exercises and course evaluation forms) and recommendations for a three-day training course. It is designed mainly for managers of healthcare establishments, public health professionals and policy-makers.
- Guidelines for safe disposal of unwanted pharmaceuticals in and after emergencies. World Health Organization, Geneva, 1999, 31 pages. Available at: http://whqlibdoc.who.int/hq/1999/WHO_EDM_PAR_99.2.pdf. Can be ordered from WHO, MDI,
CH-1211 Geneva 27 (e-mail: firstname.lastname@example.org). Price: CHF 8.-, CHF 5.60 for developing countries.
Practical guidance on the disposal of drugs in difficult situations in or after emergencies, in relation to armed conflicts, natural disasters or others. In such situations, large quantities of unwanted drugs may accumulate due to difficulties, mismanagement of stocks and inappropriate donations. The guidance provided consists of relatively simple and low-cost measures and is addressed to local authorities, healthcare personnel or other professionals confronted with these kinds of problems.
- Management of Solid Health-Care Waste at Primary Health-Care Centres: A Decision-Making Guide. World Health Organization, Geneva, 2005, 57 pages. ISBN 92 4 159274 5. Available at: http://www.who.int/water_sanitation_health/medicalwaste/decisionmguide_rev_oct06.pdf
Decision tree-based guidance for selecting the most appropriate for option safely managing solid waste generated at Primary Health-Care centres (PHCs) in developing countries. The approach takes into consideration the most relevant local conditions, the safety of workers and of the general public as well as of environmental criteria.
- Findings on an Assessment of Small-scale Incinerators for Health-care Waste. S. Batterman. WHO, Geneva, 2004, 77 pages. Available at: http://whqlibdoc.who.int/hq/2004/a85187.pdf.
This report provides an analysis of low cost small-scale incinerators used to dispose of health-care waste in developing countries. The report includes a situation analysis, a “best practices” guide, a screening level health risk assessment for ingestion and inhalation exposure to dioxin-like compounds, and other information related to the operation and evaluation of the incineration option for health-care waste.
- Resources for low-cost pyrolitic (double-chamber) incinerators. A number of moderate to low-cost incinerator designs are available. Of these, DeMontfort incinerators are probably the most widely deployed and evaluated. Developed specifically as a technically effective, appropriate-technology, low cost option in the developing country context, they have been used and tested widely by a number of organizations including WHO, UNICEF and UNDP. They are preheated by burning paper, coconut husks or other biofuel, bringing temperature in the combustion chamber up to ~600C prior to the introduction of infectious waste. Except for very wet loads, they do not require additional fuel (e.g. kerosene or diesel) to maintain combustion.
- Managing Health Care Waste Disposal: Guidelines on How to Construct, Use, and Maintain a Waste Disposal Unit. WHO Africa /IT Power India, 2005, 93 pages. Available at http://www.path.org/publications/files/TS_waste_disposal_guide.pdf. Provides specifications, including construction diagrams, installation, operation and maintenance instructions for a Waste Disposal Unit based on the “De Montfort” Mark 8 pyrolitic incinerator.
- "De Montfort" medical waste incinerators website. Provide siting, technical specifications, and operations and m aintenace guidance for the “De Montfort” series of low-cost pyrolitic incinerators. (Estimated materials costs $250–$1000). www.mw-incinerator.info/en/101_welcome.html.
- Findings on an Assessment of Small-scale Incinerators for Health-care Waste. S. Batterman. WHO, Geneva, 2004 (see above).
This document provides photo-illustrations of numerous operating and maintenance shortfalls with DeMontfort incinerators leading to poor performance. Annex B contains information on other small-scale incinerator makes. http://www.who.int/immunization_safety/publications/waste_management/en/assessment_SSIs.pdf.
- Vital to Health? Briefing Document for Senior Decision-Makers, 1998. World Health Organization/US Agency for International Development (USAID). Contact: WHO Headquarters, attention Mario Conde, CH 1211, Geneva 27, Switzerland. Tel 41-22-791-4374 or US Agency for International Development, Children’s Vaccine Programme, Office of Health and Nutrition, 3.07-037 Ronald Reagan Building, Washington DC 20523. Tel 1-202-712-4808, Fax 1-202-216-3702.
This document provides information on unsafe injections. It illustrates misuse of medical sharps, and circumstances that lead to misuse. The document provides detailed information about safety standards for disinfecting sharps and their disposal. It also addresses the choice of different kinds of injection equipment and the issue of waste management.
- Healthcare Waste Management Guidance Note. Johannessen, Lars M. et al., Waste Management HNP Anchor Team. The World Bank, 2000, 68 pages. Available at: http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Resources/281627-1095698140167/Johannssen-HealthCare-whole.pdf.
A working document that attempts to synthesize currently available knowledge and information in healthcare waste management. It is meant to complement WHO’s guidelines and provide particular information necessary for World Bank projects. Gives attention to management and policy issues and technical background on particular issues in greater detail than the WHO guidelines.
- Managing medical wastes in developing countries: report of a Consultation on Medical Wastes Management in Developing Countries, Geneva, September 1992. World Health Organization, Geneva, 1994. Available at: http://whqlibdoc.who.int/hq/1994/WHO_PEP_RUD_94.1.pdf. WHO/PEP/RUD/94.1. Unpublished document
This report is concerned with waste management practices in hospitals and other facilities which are associated with health care. It promotes procedures and facilities to reduce the risk of disease transmission and the occurrence of accidents associated with such wastes. The main focus is on countries in tropical areas and those which are seriously constrained by the lack of financial resources and trained manpower.
- Safe Management of Healthcare Waste at Health Posts and other Small-Scale Facilities (Draft). 2000. USAID AFR/SD and REDSO/ESA.
A quick but thorough introduction to healthcare waste hazards and practices to minimize those hazards. Designed to be used in conjunction with. Safe management of wastes from health-care activities, Prüss et al., 1999, World Health Organization. Emphasizes an incremental approach to healthcare waste management at small-scale facilities. Designed to address the practices most predominant in Africa.
- Healthcare or Health Risks? Risks from Healthcare Waste to the Poor, Jenny Appleton and Mansoor Ali, WELL, Loughborough University 2000
Study considers relative risk of various potential adverse environmental impacts of healthcare waste and considers these in relation to people most likely to be exposed to risk focusing particularly on the poor. The report provides examples of good practice and suggests an overall strategy for healthcare waste management that stresses an incremental approach with attention to areas of highest risk. http://www.lboro.ac.uk/well/resources/well-studies
Climate Change Resources
Note: USAID's Global Climate Change (GCC) Office can provide support on the climate change aspects of this Guideline. To contact the GCC office, please email: email@example.com
- USAID. 2007. Adapting to Climate Variability and Change: A Guidance Manual for Development Planning. http://pdf.usaid.gov/pdf_docs/PNADJ990.pdf
- USAID. 2009. Adapting to Coastal Climate Change: A Guidebook for Development Planners. http://pdf.usaid.gov/pdf_docs/PNADO614.pdf
The guidances provide information to assist planners and stakeholders as they cope with a changing climate throughout the project cycle.
- UNEP. Waste and Climate Change: Global Trends and Strategy Framework. 2010. http://www.unep.or.jp/ietc/Publications/spc/Waste&ClimateChange/Waste&ClimateChange.pdf
- IPCC Fourth Assessment Report: Climate Change 2007. Chapter 10: Waste Management. 2007.
- USEPA. Solid Waste Management and Greenhouse Gases. 2013. http://www.epa.gov/climatechange/waste/SWMGHGreport.html
- National Communications are submitted by countries to the UNFCCC and include information on country context, broad priority development and climate objectives, overviews of key sectors, historic climate conditions, projected changes in the climate and impacts on key sectors, potential priority adaptation measures, limitations, challenges and needs.
- The World Bank’s Climate Change Knowledge Portal is intended to provide quick and readily accessible climate and climate-related data to policy makers and development practitioners. The site also includes a mapping visualization tool (webGIS) that displays key climate variables and climate-related data. http://sdwebx.worldbank.org/climateportal/
- National climate change policies and plans. Many countries have policies and plans for addressing climate change adaptation.
DOCUMENTOS DISPONIBLES EN ESPAÑOL
- Guías sobre medio ambiente, salud y seguridad para instalaciones de atención sanitaria. Corporación Financiera Internacional. 30 Abril 2007. http://www1.ifc.org/wps/wcm/connect/65b19780488555b1b7b4f76a6515bb18/Healthcare_-_Spanish_-_Final-%2Brev%2Bcc.pdf?MOD=AJPERES&CACHEID=65b19780488555b1b7b4f76a6515bb18
- Manual de Gestión Integral de Residuos. República de Colombia Instituto Nacional de Salud. CODIGO: MNL-A05.002.0000-001 VERSIÓN 00. Gestión de Salud Ocupacional y Ambiental República de Colombia Instituto Nacional de Salud. 2010. http://www.ins.gov.co/lineas-de-accion/Red-Nacional-Laboratorios/Documentos%20de%20inters%20SRNL/PGIRH%20INS.pdf
- Gestión Integral residuos hospitalarios y similares en Colombia. http://www.slideshare.net/JoseG7/manual-residuos-hospitalarios
DOCUMENTS DISPONIBLES EN FRANÇAIS.
- Directives environnementales, sanitaires et sécuritaires pour les établissements de santé. La Société financière internationale. 30 Avril 2007. http://www1.ifc.org/wps/wcm/connect/5606648048855559b644f66a6515bb18/013_Health%2BCare%2BFacilities.pdf?MOD=AJPE
- Lignes directrices sur la gestion des déchets biomédicaux au Canada, CCME, 1992. http://www.ccme.ca/files/Resources/fr_waste/pn_1061_fr.pdf
- Manuel de gestion des déchets médicaux. Comité international de la Croix-Rouge http://www.icrc.org/fre/assets/files/publications/
- Gestion des déchets d’activité de soins. Pour réduire la charge de morbidité, la gestion des déchets d’activité de soins doit être rationnelle et recourir à d’autres techniques que l’incinération. Aide-mémoire N°281 Octobre 2011. http://www.who.int/mediacentre/factsheets/fs281/fr/index.html