ENVIRONMENTAL

PROGRAMS OF
NEPAL IN
RELATION WITH
HEALTH
Prepared by:
Arjun Poudel
Muskan Pudasainee
Sagar Parajuli
Sita Aryal
07/04/2022 1
 • List of Environmental Problems and
Outline Programs against them.
• Link in Relation with Health

07/04/2022 2
Air Pollution

07/04/2022 3
 Both short-term and long-term
consequences mainly on Young children,
elderly and vulnerable group
Air
Pollution in Effect not only on health but also on,
ecosystem, agriculture, forestry,
Relation biodiversity, cleaning and laundry,
buildings and monuments, visibility

with Public reduction, traffic accidents, tourism etc.

Health Diseases like ischemic heart disease,

stroke, chronic obstructive pulmonary
disease (COPD), lung cancer, and acute
lower respiratory infections in children.
07/04/2022 4
 Major Programs
• Ambient Air Quality Monitoring (With Stations) - http://pollution.gov.com.np/
• Ban on Refuse Burning
• Vehicle Retirement program - Ban on old vehicles and 2-stroke engine vehicles, Ban
on import of three-wheelers
• Pollution Control Devices program – Control of vehicular exhaust emission
• Clean Fuel and Clean Vehicles program – Promotion of gas, electric, and hybrid
vehicles
• Ensure compliance of prescribed emission standards in brick klins
• Introduce standard on coal with high calorific value lowest feasible sulfur content and
low ash content
• No new registration of brick kiln industries inside the Kathmandu Valley
• 07/04/2022
Enforce the ban on the open burning of the hospital wastes 5
 Water
Sanitation
and
Hygiene
(WASH)

07/04/2022 6
Water
Nepal - Abundant water resources. Occupies
<0.04% of the world’s total land area, it possesses
2.7% of the available freshwater on earth (
Sanitation ADBI, 2019).

and Diarrhea is the leading cause of illness and death-

Globally 88% of diarrheal deaths are due to a lack
Hygiene in of access to sanitation facilities together with
inadequate availability of water for hygiene and

relation unsafe drinking water

with Public 80% of all diseases may be attributed to water and

sanitation related causes and account for around

Health
10,500 child deaths each year from diarrhea
diseases such as dysentery, jaundice, typhoid and
cholera (UNICEF 2011)
07/04/2022 7
 Major Programs

• Ward WASH CC/M WASH CC etc.

in different Levels
• WASH in Health Institutions
• WASH in School (Free Pads, Toilet
with Incinerators etc.)
• Toilet Construction
• National Water Supply and
Sanitation Program
• Melamchi Drinking Water Project
• Bagmati River Basin
Improvement Project (BRBIP)
07/04/2022 8
 Solid Waste Management Programs &
Practices in Nepal
07/04/2022 9
 Status Quo- 170 grams/capita/day Household waste
generation rate, Household with monthly expenditure

Water
more than NRs 40,000 generating double waste than
household with NRs 5000- SWM Baseline Survey 2012
Solid Waste
Management Sanitation
Household waste contributes 50-75% of Municipal Waste

and
and It’s impact
Household Waste comprise 66% organic waste, 12%
plastic and 9% paper and paper products

on Public Hygiene in
Municipal waste- 56% Organic waste, 16% plastics, 16%
paper and paper products

Health relation
Environmental Risk- Air, water and soil pollution,

with Public
Biodiversity, Eco-system
Public Health Risks- Health Problems & Disease
Major on Urban Poor (World Bank Study), Exaggerating

07/04/2022
Health
social and economic inequalities
10
 Major Programs
• Solid Waste Management Act 2011
• Municipal Waste Management Practices-
Collection, Segregation at source, transport and
final disposal area- landfill site (Local Self
governance Act 1999)
• Application to resource recovery methods to • Commercial Initiatives- A load of rubbish,
some level- recycling and composting Rupees from rubbish, Khaalisisi, Doko,
Nepwaste, Clean valley company
• Public Awareness and Community Mobilization
• Blue Waste to Private Limited- Providing
• Special waste management-HCWM waste management services
Initiatives • Nepal Pollution Control and Environment
• SWM Strategy by Kathmandu Metropolitan Management Center (NEPCEMAC)
City in 1998
07/04/2022 11
 Best Practices at National Level
Strengthening Local Capacities in Integrated Solid Waste Management in small and medium municipalities of
Nepal”
Bhaktapur- Community Development Section, Bhaktapur composting facility & income generation (1984), City
inspector and 1 waste Inspector to each ward, Local group contractors (local employment), Street sweeping and
waste collection definite schedules (6AM, 12PM, 4PM) and tourist areas (One more time- 6 PM), Promoting HH
composting by selling subsidized compost bin
Other best practices at Bharatpur, Hetauda, Biratnagar (supposed to start first PPP Model), Kritipur

Public Private Partnership for Urban Environment (PPPUE), UNDP Nepal- National PPP Coordination
Committee established, PPP unit at local chambers
Suiro Program at Bharatpur- Exemplary Practice reducing generation of plastic waste, Plastic
Recycling & Women engagement (GESI)
Suiro Abhiyan at Hetauda
Urban Environment Management for Household Composting- Compost Trading
Women Environment Preservation Committee (WEPCO) for Urban Environments Protection- School
eco-clubs, environment training programs on composting and vermicomposting, campaigns, Green
Circle Initatives
07/04/2022 12
 Best Practices & Innovations at Global Level

Deposit- Refund Scheme for cans and drinking bottles in UK and EU

Kamilkastu in Japan, self-claimed zero waste region by 2020:

Categorization and segregation of waste into 34 categorizes by
residents and taken to recycling center (80% waste recycled)

Waste to Energy (WTE), Sweden 99% waste recycled

Eco-friendly robotic machine-USA, Biodegradable Leaf Plates-

Germany, Smart bins- Australia, Waste Bank-Indonesia,
Collaboration with informal sectors

07/04/2022 13
 Recommendations
 Promoting 4R’S (Reduce, Reuse, Recycle and Refuse)
at household and institutional level
 Social Behavior Change Communication Strategies-
NIC ASIA Ad
 Landfill site development and operation guideline
 Reward for private initiatives turning “Trash
into Cash”
 Cost recovery approach & Incentives for staff-
performance based, benefit sharing
 Public-private partnership & strengthening local
bodies, Multi-stakeholder engagement
 Tax waiver and subsides
 Integrated Solid Waste Management
 E-waste management
07/04/2022 14
 Health Care Waste

07/04/2022 15
 Status Quo- Among total Health Care Waste generated, only
Health Care 15 % are Hazardous while 85% Non-Hazardous (WHO)

Waste Water
WHO Classification of HCW- 8
UNEP/SBC/WHO 2004 Classification

Management Sanitation
and
Public Health Concern- Injuries, Toxic Exposure to

in relation
pharmaceutical and cytotoxic wastes, Chemical burns,
Thermal burns and Radiation burns, Niddle Sick Injury (NIS),

Hygiene in
Respiratory, gastroenteric, ocular, genital & skin infections,

with Public
anthrax, meningitis, Hep. A,B & C

Health relation
Environmental Risk- Emission of Dioxins, Furans and
Particulate Matter on open burning and incineration

with Public
PTMI – 70 Picograms per kilogram of body weight, Annual
Release of Dioxin and Furan is 335.97 gTEQ and among 12
gTEQ is by medical waste- National Implementation Plan for

07/04/2022
Health
Stockholm Convention on POPs, 2007 Nepal
16
 Programs & Policies-National Act, Rules & Regulations
Solid Waste Management Policy 1996- Provision for establishment separate unit at
municipality level concerning sanitation

Solid Waste Management Act 2001- Provided legal basis and regulations for HCWM,
Medical Waste defined as “Hazardous Waste produced and discharged from hospitals,
clinics, pharmacies, dispensaries, blood banks, pathology laboratories, veterinary
institutions and health research centers”
Section 4 of Sub-section 1,2, and 3 focused on provisions for management of HCWM-
by local body, institution generating waste, in coordination with local body, Section 43
of sub-section 1 and 2 of the act on Management of Medical Waste focused on granting
license to the institution with appropriate HCWM plan beforehand

Related- Town Development Act 1989, Local self-Governance Act 1989: Fine system for
haphazard dumping of wastes, Environment Protection Act and Rules 1997, Industrial
Enterprises Act 1992, Labor Act 1992; Use of PPE & Regular Health Checkup

07/04/2022 17
 Programs & Policies-National Act, Rules & Regulations
Policies & Programs
Health Care Waste Management Guideline- MoHP Nepal 2014

Environment Health & Health Care Waste Management Section under Management
Division of Department of Health Services

Signatory of Basel Convention 1989 (Concept of Environmentally Sound Management

& inter-related life cycle approach), The Stockholm Convention on Persistent organic
Pollutants 2001- Eliminate and reduce release of POPs

Tort Policies & principles- Duty of care principle, Polluter’s pay principle, Precautionary
Principle, Proximity Principles

07/04/2022 18
 Major Programs
• HCWM at institutional level
• HCWMC chaired Chief/Director of
HCFs, Department Heads, Matron,
Waste Management Officer,
Representative from Support Staff,
Smaller HCWMC (Chief, Technical &
Support staff)
• Need to make HCWM Plan
• Ban of purchase and use of mercury
containing items at HCFs
• BAT & BEP Practice
• Zero waste concept implemented by
Civil and Bir Hospital
07/04/2022 19
 Major Programs
o Achieve the sound management of
chemicals throughout their life-cycle
so that, by 2020, chemicals are used
and produced in ways that lead to the
minimization of significant adverse
effects on human health and the
environment
o Incineration of Hospital Wastes
Program - Enforce the ban on the
open burning of the hospital wastes in
the complexes
o HCWM Practice by different
Municipalities
o National
07/04/2022
Workshop on HCWM 20
Health Care Waste Management Initiatives
• 6 S system (Sort, Straighten, Shine, Systemize, Sustain and Safety”, Formation of
HCWM Committee and Plan, Zero Waste Program, Communication and Training
(Christmas Decoration from recycled items), Monthly Meeting, Waste
Management & Infection Week, monitoring and incident reporting, Potential
Waste Stream, purchasing policies and waste minimization, Ban Styrofoam, Re-
use and Recycle- Philippines
• National- Municipality Medical Waste Management System-Heatauda, Pokhara,
Nepalgunj
• Health Care Foundation Nepal working with different hospitals for HCWM
• Promoting Green Recovery project UNDP- Rapti, Narayani & Koshi Hospital

07/04/2022 21
 Climate Change

07/04/2022 22
 Long-term shifts in temperatures and weather

Climate Water
patterns. These shifts may be natural, such as
through variations in the solar cycle.

Change in Sanitation
Public Health Concern- prolonged droughts and flash

relation with andfloods, respiratory diseases like ARI, bronchitis and

asthma, Water borne diseases diarrhea, dysentery,

Public Health Hygiene in

typhoid, giardiasis, amoebiasis, gastritis, jaundice,
and infectious hepatitis, Malnutrition, Food
insecurity
relation
Environmental Risk- More frequent and intense
drought, storms, heat waves, rising sea levels,
with Public
melting glaciers and warming oceans can directly
harm animals, destroy the places they live, and

07/04/2022
Health
wreak havoc on people’s livelihoods and
communities.
23
 Major Programs
• Nepal Climate Change
Support Programme
(NCCSP) implemented local
adaptation plans (known as
LAPAs) to address the most
urgent and immediate needs
in 100 villages covering 14
districts from 2013 to 2017.
• Tree Plantation Program
• Capacity Strengthening of
Least Developed Countries
for Adaptation to Climate
Change (CLACC)
• Carbon Mitigation Projects
07/04/2022 24
Other Environmental Issues and Programs

Tobacco product control and Replacement of Mercury

regulation act implementation Thermometer by Digital
program system (Based on Minamata
convention)
07/04/2022 25
 • Save Soil Initiative by Sadhguru
• #UnmaskMyCity- UMC Campaign, Global
Climate & Health Alliance
• Increasing focus on Children’s Environmental
National & Health- Launch of CEHI
• Healthy China Initiative (2019-30)- 15 special
International campaigns by Council of China; Healthy
Environment Promotion Campaign

Campaigns & • BreatheLife Campaign by WHO, UNEP, CCAC

• Waste Segregation Practice at Household Level
Initiatives (Effective from Shrawan 01. 2079, KMC)
• Major Organizations working on Nepal:
ICIMOD, Water Aid, UNICEF, ENPHO, UNEP,
USAID, UNDP, GIZ, UKAID, China Aid and
many more
07/04/2022 26
 • Possible Alternatives- Efficient mass transit,
Promoting Cycling, Soot free vehicles, setting
emission standards and regulations
• Waste Management- Landfil gas recovery,
Waste water treatment, Management Practices
Alternatives at household level, 4 R’S
• Household air & Pollution- Low emission
Environment- stoves & fuels, Improved lighting, Passive
building design principles
Friendly options • Energy Supply- Diesel replacement,
Renewable power supply
• Industry- Improved brick kilns, Coke oven,
Fugitive emission control

07/04/2022 27
 Recommendations
 Strict laws to ban the high smoke emitting vehicles
Promote Electric Vehicles
Conduct a Feasibility Study to provide one house one tap rural and urban areas.
Provision of proper monitoring to ensure ODF Status.
Provision of Central Treatment Facility (3 Modalities) based on Public-private
partnership for waste disposal and treatment
 Training on HCWM to Hospital Administrators, HSPs and Support Staffs
 Monitoring of HCWM Practices at Hospital Level & Reward for best practice

07/04/2022 28
References
• Kathmandu to mitigate air pollution with UHI: First in Asia (who.int)
• Health Care Waste Management Guideline 2071
• World Health Organization Factsheet
• BreatheLife2030.org
• Solid Waste Management in Nepal; Current Status & Policy Recommendations
• Waste Management Baseline Survey 2020 Nepal
• Solid Waste Management in Nepal- ENPHO, WaterAid
• Best Practices on SWM of Nepalese Cities, EuropeAid, November 2008
• Best Health Care Waste Management Practices- Examples from Four Phillippines Hospital
• Public Private Partnership for Urban Environment, UNDP Nepal
• https://noharm-asia.org/articles/news/asia/nepal-transforming-healthcare-waste-management-nepal
• https://journals.sagepub.com/doi/full/10.1177/0734242X211013910
• https://www.undp.org/nepal/blog/need-healthcare-waste-management-system
• Projects | Nepal Climate Change & Development Portal (climatenepal.org.np)
07/04/2022 29
 Thank You

07/04/2022 30