Islamic University, Bangladesh

Healthcare Waste in Bangladesh: Impact of COVID-19 and Sustainable

Management
Course Title: Practical: Research Colloquium
Course Code: GE-4107

Submitted to: Submitted by:

Md. Inzamul Haque Rafia Razzak Ria
Assistant Professor Roll: 1831032
Department of Geography and Reg No: 2236
Environment
Department of Geography and
Islamic University, Bangladesh Environment
Islamic University, Bangladesh

Submission Date: 24 September, 2023

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 Acknowledgement
Firstly I would like to pay the deepest gratitude to Allah for granting me the power, wisdom, and
passion to complete this study. I would like to express my special gratitude to my parents who
inspired me to successfully complete this study.
I gratefully acknowledge my honorable course teacher Md. Inzamul Haque, Assistant Professor of
Geography and Environment, Islamic University, Kushtia-7003, Bangladesh for her instruction
and proficient guidance to carry out this study. Without her advice and guidance, I could not have
succeeded to this stage.
Finally, I would like to express my special thanks to all the participants of all medical, community
clinic and diagonostic in this study for sharing their opinions and views with me which assisted in
my effective course completion.

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 ABSTRACT
Healthcare waste comprises the waste generated by healthcare facilities, medical laboratories and
biomedical research facilities. Improper treatment of this waste poses serious risks of disease
transmission to waste pickers, waste workers, health workers, patients, and the community in
general through exposure to infectious agents. Poor management of the waste emits harmful and
deleterious contaminants into society. COVID-19 has accelerated the generation of healthcare
(medical) waste throughout the world. In recent years, Bangladesh has experienced increasing
medical waste generation with estimated growth of 3 % per year The objectives of this study is
evaluate medical waste and its generation rate, impact of covid-19 and identify and evaluate
medical waste management system and assessment of Sustainable Management Practices. The
existing healthcare waste management in Bangladesh is far behind the sustainable waste
management concept. The estimated generation of medical waste in Bangladesh without
considering the surge due to Covid-19 and other unusual medical emergencies would be
approximately 50,000 tons (1.25 kg/bed/day) in 2025, out of which 12,435 tons were predicted to
be hazardous waste. However, our calculation estimated that a total of 82,553, 168.4, and 2300
tons of medical waste was generated only from handling of Covid patients, test kits, and
vaccination from March 2021 to May 2022. From the analysis, it has been found that several
national guidelines have been formulated during this pandemic covering important issues related
to the MWM system, which is commendable. Some of these guidelines comply with international
guidelines, but there are inconsistencies among these. Recommendations for Sustainable
Healthcare Waste Management.

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 TABLE OF CONTENT
Serial Number Contents Page Number
Acknowledgement ⅱ

Abstract ⅲ
1 Introduction 1-5
1.1Background of the 1-2
Study
1.2 Statement of the 2-3
Problem
1.3 Rationale of the 3-4
Study
1.4 Objectives 4-5
1.5 Scope and 5
Limitation
1.6 Organization of the 5
Study
2 Literature Review 5-7

2.1 Healthcare Waste in 5-6

Bangladesh
2.2 Impact of Covid-19 6
on Healthcare Waste
2.3 Sustainable 6-7
Management of
Healthcare Waste in
Bangladesh
2.4 Example of Some 7
relevant case studies
3 Methodology 7-11

3.1 General Overview 8

of Study Area
3.2 Physical 8-9
Environmental
Overviews
3.2.1 Geography and
Topology
3.2.2 Climate
3.2.3 Soil
3.3 Socio-Economic 9-10
Overview
3.3.1 Population
3.3.2 Economy

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 3.4 Materials 10
3.4.1 Source of Data
3.5 Method 10
3.6 Methodological 10-11
Framework
4 Results & Discussion 11-16

4.1 Medical waste: 11-13

Generation
4.2 Effect of Covid-19 13-14
on medical waste
generation
4.3 Medical Waste 14
Management
4.4 Life cycle 14
assessment
5 Conclusion 15
6 Reference 16-22

List of Figures
Name of the Figures Page No.
Figure 1: Study Area Map (source: 9
Wikipedia)

Figure 2: Methodological Framework 11

Figure 3: Compositional analysis of 12

medical waste from different health care
facilities (Source: PRISM, 2013):

Figure 4: Hazardous medical waste 13

generation rate (tons/year) of 6 divisions of
Bangladesh. (Source: MOHFW, 2011)

Figure 5: Monthly medical waste 14

generation in tons due to infection march
2020 to July 2022

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 CHAPTER-1
INTRODUCTION
1.1Background of the Study: Healthcare waste, associated with clinical activities during
diagnosis, treatment, and research purposes of humans and animals, contains both hazardous (15
%) and non-hazardous wastes (85 %). (European Commission, 2000; US EPA, 2016; WHO,
2014). There are no definite concrete definitions of medical waste (MW) as it varies depending on
the viewpoint and economic status of countries and regions (Windfeld and Brooks, 2015). In
different literature, MW is also referred to as hospital/health care waste (HCW), or biomedical
waste (BMW) (Minoglou et al., 2017). MW in general is classified as non-hazardous or domestic
waste and hazardous waste. Non-hazardous waste contains materials generated from
administrative, housekeeping functions, and maintenance and mainly contains packaging plastic,
food, and paper wastage (WHO, 2014). Hazardous waste is generally categorized into 7 groups
e.g., sharp waste, infectious waste, pathological waste, pharmaceutical waste, cytotoxic waste,
chemical waste, and radioactive waste (WHO, 2014; Zamparas et al., 2019). Reecent literature
pointed out the increase of the medical waste generation rate (MWGR) in developing countries
with the improvement of economic status, availability of health care, and technological
advancement (Korkut, 2018). Bangladesh, which is undergoing rapid economic growth in recent
years, has also been found to follow increasing MW generation with estimated growth of 3 % per
year (MOHFW, 2011). The outbreak of coronavirus disease 2019 (COVID-19) has arisen from the
SARS-CoV-2 virus, which causes an acute respiratory disease (Mol and Caldas, 2020; WHO,
2019; WHO, 2020b); it was first reported in Wuhan, China (Wang et al., 2020) in December 2019.
It has been acknowledged as a Public Health Emergency of International Concern (PHEIC)
(Wilder-Smith and Osman, 2020), and the virus has spread to almost all countries across the globe.
The pandemic continues to be a significant public health threat worldwide. The rapid increase in
the number of COVID-19 infected patients and the highly transmissible nature of the disease have
led to a high number of hospitalizations. Thus, the generation of healthcare solid waste has rapidly
increased. Additionally, the increase in the amount of personal protective equipment (PPE) used
during the COVID-19 pandemic, compared to normal circumstances, has further contributed
towards the increase in healthcare solid waste (Haji et al., 2020; Wei and Manyu, 2020; WHO,
2020b).

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1.2 Statement of the Problem: Healthcare waste has been a growing concern across the world
over the last few years. The outbreak of coronavirus disease 2019 continues to be a significant
public health threat worldwide. The rapid increase in the number of COVID-19 infected patients
and the highly transmissible nature of the disease have led to a high number of hospitalization.
Thus, the generation of healthcare solid waste has rapidly increased. To maintain this excess waste
great challenge for Bangladesh. . It is very crucial to properly segregate, treat and dispose of the
hazardous MW, however, WHO estimated that one out of three health care facilities (HCFs) lacks
the safe management criteria (WHO, 2004, 2022a).

Bangladesh currently has around 14,770 HCFs of which 654 public hospitals, 5055 private
hospitals, and clinics along with 9061 diagnostic centers and pathological labs. A total of 141,903
beds are available for the patient which are producing a huge amount of MW throughout the
country (Rahman et al., 2020a). On average health care waste generation rate (HCWGR) is found
to vary from 1 to 2.6 kg/bed/day throughout the country. Dhaka city is found to generate more
medical waste than the rest of the regions although there is a lack of enough extensive studies in
other divisions of the country compared to Dhaka. . Like other developing nations, Bangladesh
also suffered from huge surges of MW due to the Covid-19 situation. Which lead to an increase in
the MWG rate from an average of 1.6–1.99 kg/bed/ day to 3.4 kg/bed/day (Barua and Hossain,
2021; Rahman et al., 2020b). MWG rate varies with the infection rate and around 14,500 tons of
MW had been produced just in April 2020 (Rahman et al., 2020a).

In a study conducted by MoHFW, GoB projected the MWGR per year from 2009 to 2015 which
was further extrapolated to 2025. This covered 6 divisional levels of the country considering 1.5
% population growth, 6.5 % of availability for health services with no significant change in
demand in each year. The study found that medical waste generation will increase by
approximately 3 % in each upcoming year. Dhaka was projected to produce 1930 tons/year of
hazardous medical waste in 2025 and the lowest amount was predicted for Barishal (400 tons/year)
as Barishal has fewer HCFs than Dhaka (MOHFW, 2011).

With the rapid population and economic growth, proper medical service demand led to an increase
in MWG. Thus the concern about proper handling and disposal of MW has become a complex and
demanding challenge and this requires definite guidelines, policies, and rules to control and

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maintain environmental pollution and public health (Mbongwe et al., 2008; Minoglou et al., 2017;
Windfeld and Brooks, 2015).

1.3 Rationale of the Study: Healthcare waste comprises the waste generated by healthcare
facilities, medical laboratories and biomedical research facilities. Improper treatment of this waste
poses serious risks of disease transmission to waste pickers, waste workers, health workers,
patients, and the community in general through exposure to infectious agents. (Das et al., 2021).
Tushar et al., 2023 studied Emerging economies are struggling with proper and efficient
management of waste due to their constrained resources and weak management. In recent days,
this crisis has worsened due to the outbreak of the highly contagious COVID-19 pandemic.
Different countries have adopted the best possible management approaches based on their
capacity, resources, and commitment (Singh et al., 2020b; Zand and Heir, 2020c). Different
organizations have offered guidelines for managing healthcare waste in a way that follows safety
measurements and is sustainable (WHO, 2020a). Higher-income countries are prone to generate
more medical waste (4–8.2 kg/bed/day) than lower-income countries (1–2 kg/bed/day). But
higher-income countries also found to maintain the general guidelines and legislation imposed by
local government and international bodies which is very unlikely for the lower income countries.
(Dihan et al., 2023)

According to WHO, 2022a Asian cities, MWG increased 10 times due to Covid-19 than the
previous, producing 3.4 kg/day/bed of hazardous MW. Medical waste generation increased from
40 tons/ day to 240 tons/day in Wuhan city whereas 469 tons/day MW was reported to be
generated in China related to only Covid-19. In Malaysia, India, the Philippines, and Columbia 30
%, 17 %, 25 %, and 27 % increases in infectious waste generation in hospitals were recorded and
in Indonesia, approximately 12,740 tons of MW were generated in 60 days after the first recorded
Covid-19.

Different countries have different waste management systems, but they all have the same
fundamental steps: segregation, collection, storage, transportation, treatment, and disposal (WHO,
2014). Historically, in the US, the concern for potential health risks from medical waste was first
discussed in the 1980s, when medical wastes were shown up in the oceans and on the east coast
beaches and nature trails, which led the US government to enact the Medical Waste Tracking Act

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An international study from Singh et al, regarding 24 countries with economies in transition shows
that 18–64% of healthcare providers do not perform the appropriate health care waste disposal
techniques and do not possess a waste management system.

According to Khairunnisa et al. 2021, India does not possess or implement a proper sustainable
waste management system in its public healthcare sector. An average percentage of 10–15% of
waste is hazardous and, in some cases, such waste is disposed of in the open environment (e.g., in
the rivers); this could lead to the spread of toxic odors that could affect the public health due to the
illnesses it can cause, such us hepatitis B and C, cholera, etc. Singh et al. 2022, Performed a survey
to collect data from 78 countries, based on articles, publications, and other sources for the time
period of January 2000 until May 2020, regarding the management of medical wastes worldwide.
Their finding shows that most of the health care waste is not managed in a correct way, and there
is also an absence of proper training of the healthcare staff involved in the waste management
process and safe practice.

1.4 Objectives: The general objective of the research is to investigate estimate medical waste and
its generation rate, impact of covid-19 and identify and evaluate medical waste management
system and assessment of Sustainable Management Practices. In order to fulfill the goal, the
specific research objectives are as follows:

• Assessing the Scale and Composition of Healthcare Waste

• Impact of COVID-19 on Healthcare Waste Generation

• Assessment of Sustainable Management Practices

• Recommendations for Sustainable Healthcare Waste Management

1.5 Scope and Limitation: Scope of the study is the study focuses specifically on Bangladesh,
examining the healthcare waste management situation within the country. It encompasses various
types of healthcare waste generated in healthcare facilities, including infectious, hazardous, and
non-hazardous waste. The study includes an analysis of the impact of COVID-19 on healthcare
waste generation and management, covering the pandemic's onset and its immediate aftermath.
The study explores sustainable healthcare waste management.

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Limitation: Limited access to comprehensive and up-to-date data on healthcare waste generation
and management practices in Bangladesh may hinder the depth of the analysis. The study's
timeframe may not capture the long-term effects of COVID-19 on healthcare waste management
or sustainable practices that have evolved over an extended period.

1.6 Organization of the Study:

The first chapter: This chapter introduces the topic of the study along with reason for the study.

The second chapter: Literature Review, provides previous knowledge about the study on national
and international basis.
The third chapter: Methodology, provides information about data sources along with the method
used for the analysis of data.

The Fourth Chapter: Result and Discussion.

The Fifth Chapter: Concludes the study with providing some recommendations.

Chapter-2

Literature Review

2.1 Healthcare Waste in Bangladesh: It includes various forms of waste, both hazardous and
non-hazardous, such as sharps, human body parts, blood, chemical waste, pharmaceutical waste,
and medical devices (Rodriguez-Morales, 2013). All of this waste is produced mainly by hospitals,
primary care facilities, laboratories, mortuaries, autopsy centers, laboratories, blood banks, nursing
homes, and other medical locations (Pepin etal2014). It is generated during diagnosis, treatment,
immunization of humans or animals, research, or the production or testing of biological. If not
properly handled, it can have devastating effects on human health (Johannessen et al., 2000). Yves
Chartier et al., 2014 describes, Waste that contains chemical substances, i.e. laboratory reagents,
film developing reagents, expired/unused disinfectants, solvents, and waste containing heavy
metals (batteries, broken thermometers, blood-pressure gauges, etc.) is considered hazardous
chemical healthcare waste.

2.2 Impact of Covid-19 on Healthcare Waste: The rapid increase in the number of COVID-19
infected patients and the highly transmissible nature of the disease have led to a high number of
hospitalizations. Thus, the generation of healthcare solid waste has rapidly increased. Additionally,
5
the increase in the amount of personal protective equipment (PPE) used during the COVID-19
pandemic, compared to normal circumstances, has further contributed towards the increase in
healthcare solid waste (Haji et al., 2020; Wei and Manyu, 2020; WHO, 2020b)

2.3 Sustainable Management of Healthcare Waste in Bangladesh: Medical waste management

still lacks effectiveness, and safety issues in Bangladesh which are also found to be common in
other countries with transitional economies. Also, in developing countries, people involved in the
collection of MW are reported to lack proper knowledge, training, and awareness, as well as they
face injuries from handling sharp materials (Ali et al., 2017; Singh et al., 2022). Studies that were
conducted across the Bangladesh about MWM scenario found that most of the HCFs didn't follow
the color-coded segregation method suggested by DGHS and WHO. Open dumping and mixing
up with the waste bin for MSW are found to be common phenomena. All of the HCFs didn't have
any personal treatment facilities and they depend on a few NGOs who take care of MW i.e.,
PRISM, Swapno, Protidin, BASA, etc.

PRISM Bangladesh, an NGO that started its operation in 1989 with the help of UN organizations,
now collects MW from 1121 HCFs in Dhaka city. PRISM has only fully developed MWM
procedure, treatment facilities, and disposal system in Bangladesh. This NGO engaged in the
MWM system in 2004 in Dhaka and has currently expanded its operation to other major districts
of Bangladesh (PRISM, 2022)From the points of generation, 56 % of clinical MW are disposed of
in municipal waste, with the remaining 44 % managed by PRISM Bangladesh.

2.4 Example of Some relevant case studies: Higher-income countries are prone to generate more
medical waste (4–8.2 kg/bed/day) than lower-income countries (1–2 kg/bed/day). But higher-
income countries also found to maintain the general guidelines and legislation imposed by local
government and international bodies which is very unlikely for the lower income countries. (Dihan
et al., 2023) According to WHO, 2022a Asian cities, MWG increased 10 times due to Covid-19
than the previous, producing 3.4 kg/day/bed of hazardous MW. Medical waste generation
increased from 40 tons/ day to 240 tons/day in Wuhan city whereas 469 tons/day MW was reported
to be generated in China related to only Covid-19. In Malaysia, India, the Philippines, and
Columbia 30 %, 17 %, 25 %, and 27 % increases in infectious waste generation in hospitals were
recorded and in Indonesia, approximately 12,740 tons of MW were generated in 60 days after the
first recorded Covid-19. Identifying research gaps is an essential step in the development of a

6
comprehensive literature review. Medical waste management (MWM) has long been a hot topic
among researchers, but the recent epidemic has motivated researchers to examine many
MWMrelated issues. Recently, a number of scholars have drawn attention to the implications of
COVID19 and pertinent issues regarding the successful implementation of medical waste
management in emerging economies. The COVID-19 situation presents a unique opportunity for
research that integrates environmental sustainability, medical waste management implementation
challenges, and qualitative and quantitative methodologies. Moreover, a significant study gap is
the lack of explanation in earlier studies of the connections between the obstacles to MWM
implementation

Chapter-3

Methodology

3.1 General Overview of Study Area: Bangladesh officially the People's Republic of
Bangladesh, is a country in South Asia. It is the eighth-most-populous country in the world, with
a population of around 169 million people in an area of 148,460 square kilometer’s (57,320 sq mi).

3.2 Physical Environmental Overviews:

3.2.1 Geography and Topology: Absolute location of Bangladesh is 23.6850° N, 90.3563° E and
relative location of Bangladesh is located in the delta of the Padma (Ganges [Ganga]) and Jamuna
(Brahmaputra) rivers in the northeastern part of South Asia. It is bordered by the Indian states of
West Bengal to the west and north, Assam to the north, Meghalaya to the north and northeast, and
Tripura and Mizoram to the east. To the southeast, it shares a boundary with Myanmar (Burma).
The southern part of Bangladesh opens into the Bay of Bengal. In its southern region, Bangladesh
is fringed by the Sunder bans, a huge expanse of marshy deltaic forest. The country is divided into
three regions. Most of the country is dominated by the fertile Ganges Delta, the largest river delta
in the world. The northwest and central parts of the country are formed by the Madhupur and the
Barind plateaus. The northeast and southeast are home to evergreen hill ranges.(Rajagopal,2020)

3.2.2 Climate: Straddling the Tropic of Cancer, Bangladesh's climate is tropical, with a mild
winter from October to March and a hot, humid summer from March to June. The country has

7
never recorded an air temperature below 0 °C (32 °F), with a record low of 1.1 °C (34.0 °F) in the
northwest city of Dinajpur on 3 February 1905. A warm and humid monsoon season lasts from
June to October and supplies most of the country's rainfall.

3.2.3 Soil: The major part of Bangladesh is alluvium. It is formed by the three major rivers
Brahmaputra, Ganges and Meghna. The system drains a basin of some 1.76 million sq km. Over
millennia, the sediments carried by the huge discharges of these rivers have built a broad delta.
Thus, they formed about 80% of Bangladeshi soil. Pleistocene Terrace covers about 8% of total
soils of Bangladesh. Tertiary and Quaternary Sediments of Hills covers about 12% soils of
Bangladesh. (Planet, 2023)

Figure 6: Study Area Map (source: Wikipedia)

3.3 Socio-Economic Overview:

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3.3.1 Population: According to the 2022 Census, Bangladesh has a population of 165.1 million,
and is the eighth-most-populous country in the world, the fifth-most populous country in Asia, and
the most densely populated large country in the world, with a headline population density of 1,265
people/km2 as of 2020. (BBS, 2023)

3.3.2 Economy: Bangladesh is the second largest economy in South Asia after India. The country
has outpaced India (of which it was a part until 1947) and Pakistan (of which it was a part until
1971) in terms of per capita income. According to the World Bank, "When the newly independent
country of Bangladesh was born on December 16, 1971, it was the second poorest country in the
world—making the country's transformation over the next 50 years one of the great development
stories. Since then, poverty has been cut in half at record speed. ((Ahmed, 2022)

3.4 Materials:

3.4.1 Source of Data: Data collection is the systematic process of obtaining information in many
ways in order to gain a complete and correct understanding of this topic. For this study data was
gathered by secondary data source.

Secondary Data Sources: Government Records, Healthcare Facility Records, COVID-19 Data
Academic and Research Studies.

3.5 Methodology: Methodology explains the research methods and procedures used in the study.

The data from measuring waste generation rate in waste samples were subjected to further analysis.
The descriptive statistical analysis was performed using Microsoft Excel. These tools were used
to produce various graphs and charts visually representing the data, making it easier to understand
the results.

3.6 Methodological Framework:

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 Figure 7: Methodological Framework

Chapter-4

Results & Discussion

4.1 Medical Waste Generation: We reviewed that Bangladesh currently has around 14,770 HCFs
of which 654 public hospitals, 5055 private hospitals, and clinics along with 9061 diagnostic
centers and pathological labs. A total of 141,903 beds are available for the patient which are
producing a huge amount of MW throughout the country (Rahman et al., 2020a). On average health
care waste generation rate (HCWGR) is found to vary from 1 to 2.6 kg/bed/day throughout the
country. Dhaka city is found to generate more medical waste than the rest of the regions although
there is a lack of enough extensive studies in other divisions of the country compared to Dhaka.
An extensive study was carried out taking into consideration of whole Dhaka city and this study
estimated approximately 50 tons/day of medical waste generation of which 26 % was found to
contain hazardous content (PRISM, 2013). A study was conducted solely on private HCFs in

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Dhaka by (Rumi and Karim, 2018) and found that private hospitals generate 0.17 kg/bed/day MW.
In that study, the low patient admission to the highly specialized hospital due to cost was
represented as the main reason behind lower waste production. Seasonal variability of waste
generation is also found in the literature (Haque et al., 2021b; Rumi and Karim, 2018).

Figure 8: Compositional analysis of medical waste from different health care facilities
(Source: PRISM, 2013):
In a study conducted by MoHFW, GoB projected the MWGR per year from 2009 to 2015 which
was further extrapolated to 2025. This covered 6 divisional levels of the country considering 1.5
% population growth, 6.5 % of availability for health services with no significant change in
demand in each year. The study found that medical waste generation will increase by
approximately 3 % in each upcoming year. Dhaka was projected to produce 1930 tons/year of
hazardous medical waste in 2025 and the lowest amount was predicted for Barishal (400 tons/year)
as Barishal has fewer HCFs than Dhaka. These studies were mainly conducted in the pre-covid-19
timeline, so they are more likely to depict the general medical waste generation and characteristics
excluding the effect of major outbreaks.

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Figure 9: Hazardous medical waste generation rate (tons/year) of 6 divisions of Bangladesh.
(Source: MOHFW, 2011)
4.2 Effect of Covid-19 on medical waste generation: We know that Bangladesh experienced the
most severity of Covid infection in 2021. On July 2021, around 340,000 confirmed cases were
recorded in a single month which is the highest till the present day. The 3rd wave of Covid-19
lasted 2 months, January 22 and February-22, although the death rate was lower than the 2nd wave.
A total of 45,885 tons of MW were generated from March 2020 to July 2022 considering Covid-
19-related patients were treated on average for 7 days. The testing capacity of Bangladesh was low
in the initial days which rapidly raised and almost 1.2 million tests were done on August-21. MW
related to testing kits contributed a lower portion of the total MW generated during this period, 2–
5 tons per month in normal conditions and 10–15 tons in peak times. A total of 168.4 tons of waste
have been produced due to Covid-19 testing kits. In 2020, a survey led by ESDO (ESDO, 2020)
found that 386 tons/day of potentially hazardous and non-hazardous plastic waste was generated
of which 53 tons/day were from the single-use surgical masks that were disposed of every day.

12
Figure 10: Monthly medical waste generation in tons due to infection march 2020 to July
2022
4.3 Medical Waste Management: Medical waste management still lacks effectiveness, and safety
issues in Bangladesh which are also found to be common in other countries with transitional
economies. Also, in developing countries, people involved in the collection of MW are reported
to lack proper knowledge, training, and awareness, as well as they face injuries from handling
sharp materials (Ali et al., 2017; Singh et al., 2022).

Singh et al., 2022 Studies that were conducted across the Bangladesh about MWM scenario found
that most of the HCFs didn't follow the color-coded segregation method suggested by DGHS and
WHO. Open dumping and mixing up with the waste bin for MSW are found to be common
phenomena. All of the HCFs didn't have any personal treatment facilities and they depend on a
few NGOs who take care of MW i.e., PRISM, Swapno, Protidin, BASA, etc. Prism collects three
types of MW (infectious, plastic, and sharp), and after final management, these MW are treated
according to their type. Infectious wastes are treated through autoclaving, incineration, and burial
method, sharp waste through autoclaving and deep burial, and plastic waste through chemical
disinfection, shredding, and recycling.

13
A survey conducted in Dhaka City by PRISM in 2014 reported that on average 57 % HCFs
collected MW without any management whereas 10 % HCFs followed color-coded segregation
method and the rest of the HCFs found to follow partial segregation procedures (PRISM, 2013).
Patwary et al. (2009) found in 2009 that the 68 % of the total HCFs didn't follow any segregation
whereas only 7 % did follow proper collection procedures. This scenario is improved due to the
increasing capacity of NGOs and also due to increasing training from DGHS. During Covid-19,
huge surges of MWG both in HCFs and household activities led the existing facilities to soar. A
survey pointed out that 93 % of Covid-19 related MW were out of management. Only 35 tons/day
got properly treated among produced 248 tons/day throughout the country. Lack of implementation
of legislation, unconcerned regulatory authorities, corruption, unconsciousness of the HCFs' stuff
and cleaners, lack of proper training, absence of any CE strategies, gaps in existing rules and
legislations, and economic constraints led to the improper MWM in Bangladesh (Barua and
Hossain, 2021; Dana, 2011) In Bangladesh, the importance of providing proper protective
measures for the people who works in MWM is not given the attention it deserves. With the applied
MWM process, we must also ensure the safety of those who work in the wastewater treatment
units. Avoiding skin contact, ingestion, and inhalation of water mist, and wearing PPE are just
some of the measures that wastewater treatment plant workers should follow (Barcelo, 2020).

4.4 Life cycle assessment: Life cycle assessment (LCA) is a methodology and an analysis tool
used to examine the environmental implications of all stages of a product's life, from raw material
extraction to materials processing, manufacturing, distribution, and consumption (Ibáñez-Forés et
al., 2021; Muralikrishna and Manickam, 2017). LCA studies for achieving eco-friendly MWM
system are rare worldwide and it is still ignored in Bangladesh. Very few studies are available that
took the whole MWM system as the boundary condition. Zhao et al. (2021) conducted a
comparative LCA on two scenarios (hazardous incineration and landfilling) with 5 alternatives (0,
15, and 30 % energy recovery in incineration and 0 and 10 % efficiency in landfilling) (Zhao et
al., 2021). He found that the incineration procedure with 30 % energy recovery had the lowest
impact. Dioxin emission contributed 10 % of human toxicity whereas landfilling process with and
without energy recovery had seven times higher environmental effects than the incineration
techniques. The life cycle assessment (LCA) is also a more trustworthy method for determining
the most environmentally friendly technique for long-term MWM which can also satisfactorily
operate during emergencies like Covid-19.

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 Chapter-5

Conclusion

This study complied all the secondary information available about medical waste generation,
existing practices in the HCFs, and legislation in Bangladesh. In recent years, the issue of waste
management draws attention in terms of increasing environmental problems, concerns about
human health and ensuring both economic and environmental sustainability. The impact of waste
on the lives and habitats of living things has led all states to organize worldwide regulations and
plan waste management process. In comparison to developed and other Asian countries,
Bangladesh lacks effective administration and facilities, as well as an implementation difficulty of
existing legislation due to the lack of proper collaboration between health care organizations and
the government. Some recommendation are provided through implementing life cycle assessment
we can achieve sustainable medical waste management.

15
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2. US EPA, 1988. Medical Waste Tracking Act

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4. Korkut, E.N., 2018. Estimations and analysis of medical waste amounts in the city of
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Waste Manag. 81, 168–176.

5. Minoglou, M., Gerassimidou, S., Komilis, D., 2017. Healthcare waste generation
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