Technical Proposal for Feasibility Assessment and Recommend Practical Methods for Integrating

and Revision for Expanded Programme on Immunization (EPI) Waste Management Guideline in
Nepal

Submitted to:
Unicef Nepal Country Office ,
UN house, Pulchowk, Lalitpur, Nepal

Submitted by
Binod Kumar Aryal
Tokha – 5, Dhapasi, Kathmandu
Contact: +977-9851027269
Email: binodaryal36@Gmail.com
1. Introduction
The Expanded Programme on Immunization (EPI) in Nepal has made significant progress in vaccinating
the population, but the management of waste generated during vaccination activities remains a significant
challenge. However, the waste generated during immunization activities, such as used syringes, vaccine
vials, and other medical waste, poses a risk to public health and the environment if not managed properly.

The immunization cold chain system needs a thorough technical assessment to ensure the
provision of high-quality vaccination services. With the collaboration from government entities
and relevant partners, UNICEF facilitated the execution of the Effective Vaccine Management
(EVM) assessment in 2021. Results of EVM assessment are presented in nine categories among
which the composite score for waste management is 49/100. This sub-standard score highlights
that the waste management aspect of the EPI program is currently underperformed significantly
and necessitates immediate and substantial enhancement.

The management of waste generated by the EPI program must adhere to both local and global
standards. Currently, the government, through the Ministry of Health and Population, has a waste
management guideline for disposal of medical products. However, this document lacks explicit
guidance on disposal methods tailored to the unique needs of the EPI program.

The appointed technical consultant will undertake an assessment of the EPI waste situation and
formulate a practical guideline that should include context-appropriate disposal methods in in
line with key standards.

2. Purpose of Work
The purpose of this technical proposal is to conduct a comprehensive feasibility assessment and
recommend practical methods for integrating the management of waste generated by the Expanded
Programme on Immunization (EPI) into existing health documents in Nepal.
3. Project Objectives
The main objective of this project is to assess the feasibility of integrating EPI waste management
practices into existing health documents in Nepal. This includes identifying practical methods and
strategies to streamline waste management within the EPI program, with an emphasis on environmental
sustainability. The primary objectives of this project are as follows:

 To conduct a feasibility assessment to determine the practicality of implementing an EPI waste

management system in Nepal.
 To recommend practical methods for integrating and EPI Waste Management Guideline in Nepal.
4. Project Scope
Feasibility Assessment:

 Review of existing policies and regulations related to waste management.

 Stakeholder engagement and consultations.
 Site visits to EPI centers to understand current waste management practices.
 Data collection and analysis.
 Guidelines Development:
  Development of regulatory framework for EPI waste management.
 Identification and promotion of best practices.
 Formulation of a comprehensive waste management plan.
 Training and capacity building for healthcare workers.
 Integration with Existing Health Documents:
 Incorporation of the guidelines into existing health documents.
 Coordination with the Ministry of Health and relevant authorities for endorsement.
5. Methodology
The feasibility assessment and recommendations will follow a multi-step methodology:
5.1 Literature Review:
A comprehensive review of existing guidelines, regulations, and best practices related to biomedical
waste management and EPI waste will be conducted to understand the current state of waste management
in Nepal.
5.2 Data Collection:
Data will be collected through surveys, interviews, and site visits to health facilities and EPI centers. This
will help assess current waste management practices, challenges, and resource availability. Visits to EPI
centers will provide insights into current waste management practices. Data on waste generation,
segregation, storage, and disposal will be collected.
5.3 Data Analysis
Data collected will be analyzed to identify gaps and challenges in the current waste management system
using quantitative analysis techniques, qualitative analysis techniques and framework analysis methods.
5.4 Stakeholder Engagement:
Key stakeholders, including government agencies, healthcare providers, EPI program officials, and
environmental experts, will be engaged to gather insights and understand the regulatory framework.
6. Expected Outcomes (Deliverables):
The successful completion of this project will yield the following outcomes:
1. Feasibility Report:
A comprehensive report summarizing the findings of the feasibility assessment, including challenges and
opportunities for integrating EPI waste management into existing health documents.
2. Practical Recommendations:
A set of practical methods and recommendations for EPI waste management integration, with a focus on
regulatory, infrastructural, and training aspects. Based on the findings, a set of practical methods and
recommendations for EPI waste management integration for revision on existing guideline will be
developed.
7. Timeline:
The project is anticipated to be completed in 6 months, following the timeline detailed in the project plan.
SN Tasks/Milestone
Draft execution/implementation
plan and desk review
1
Feasibility assessment and
presentation of practical scenarios
2
Assess local capacity on medical
waste management and identifies
the gaps for future focus
3
Present scenarios and disposal
4 methods
Integration of disposal methods
along with feasible/practical
recommendations for EPI waste
management into existing
guideline
Deliverables/Outputs Timeline
Submission of implementation By 15 Dec 2023
plan in Gantt Chart and result of
desk review
Submission of brief report of By 15 Feb 2024
feasibility assessment along with
scenarios presented/available.
Gaps of local capacity on medical By end March 2024
waste management presented
Disposal methods available By 15 April 2024
Disposal methods and By 15 May 2024
recommendations for waste
management of EPI products are
available, and integrated into
existing guideline