Regulations and Regulatory bodies

The Central Pollution Control Board (CPCB), which functions under the directives of the Ministry of Environment, Forest, and Climate Change (MoEFC) governs the biomedical waste management activities in India. CPCB receives biannual reports from State Pollution Control Boards, and responsibility at the district level is, in turn, shouldered by a committee under the chairpersonship of the District Collector or District Magistrate (Datta et al., 2018). Biomedical waste management is done as per the Biomedical waste management act 2016, which details the categorization of waste, the segregation, treatment, and disposal of trash. All the health facilities that are involved in the diagnosis, treatment, immunization or research of humans or animals come under the purview of the Act, though we increasingly concentrate on hospitals. Therein exists one of the significant limitations and, thereby, the challenge: Data on the biomedical waste generated from households, Government hospitals/Institutions, standalone clinics/ nursing homes and research facilities may not be wholly accounted for, and for all we know, it could be substantial.

Biomedical waste management and its impact on the Environment

Even general waste has an impact on the environment. Biomedical waste causes more concerns because of its potentially infectious, cytotoxic, and radioactive nature. There exist multitudes of less obvious ways in which Biomedical waste management leaves its mark on the environment, like the effect of incineration on the air quality, the methane emissions from landfills, and the energy costs of transportation of biomedical wastes.

The ‘Blue Book’, the WHO handbook on safe management of biomedical waste, was drafted in 2004 and revised in 2014. At the World Health Organization meeting held in Geneva in 2007, the fundamental principles for ensuring safe and sustainable biomedical waste management were developed. Scientifically acceptable handling, processing and disposal of healthcare waste are pivotal in attaining and retaining important Sustainable Development Goals like SDG3 – Good Health &Well-being ( Ensure healthy lives and promote well-being for all, SDG8 – Decent Work & Economic Growth (Provide inclusive & sustainable economic growth, employment and decent work for all) and SDG12 – Responsible consumption and production (Ensure sustainable consumption and production patterns) (Bagwan, 2023).

COVID-19 and its Impact

The delicate equilibrium that did exist was shaken massively by the COVID-19 pandemic and the ensuing increase in biomedical waste. The number, type and quantity of biomedical waste generated per bed or healthcare provider increased greatly during the COVID pandemic. The waste generated in 2019 (pre-COVID) was 619 Tonnes per day (TPD), and the data in 2020 shows an increase to 774 TPD. By mid-2020, separate tracking and measurement of COVID BMW was initiated, and the data was eye-opening. In April 2021, the COVID BMW was 139 TPD; by May, it had reached 203 TPD (showing an alarming 46% increase in a month). (https://cpcb.nic.in/)

Sustainability and Biomedical waste

Wholistic implementation of the triple bottom principle connects sustainability and biomedical waste management: Environment (planet), social (people) and Economic (Governance / Profits).

Sustainability practices in the reduction of environmental impact include but are not limited to (i) appropriate use of biomedical material before the generation of waste, (ii) segregation, storage, handling, and disposal of BMW, and (iii) exploration of technology to enable safe reuse of unavoidable waste.

The social issues would predominantly include aspects of the employees or contracted manpower engaged in managing biomedical waste and their associated social problems. Mainly (i) child labour, (ii) forced labour, (iii) discrimination based on caste or creed or region, (iv) the need for adequate safety precautions and training regarding the same, (v) vaccination and health support for those involved in various stages of BMW management, and (vi) social dialogue implmentation including grievances reporting.

The governance or economic factors includes (i) compliance with regulations, (ii) ethical practices and (iii) data privacy and information security related to patient/ samples.

Challenges and the way forward

We tend to quantify the waste generated as the total weight caused, which might give us a skewed perception. A state/area/hospital identified as generating high TPD maybe having more healthcare facilities or tending to a more significant number of patients. The waste generated per bed would give us a better idea.

Innovative and long-lasting solutions, like using Bio-converters for the biological disposal of biomedical waste and promoting biodegradable plastics to manufacture disposable biomedical devices, are cost-effective (Datta et al., 2018). Another innovative way forward would be Bar code-based tracking at the Weighing facility (at the waste generator) and Bluetooth-enabled systems for better monitoring which already exists in a few HCE. The stakeholders at either end of Biomedical waste management should be involved, aware and educated, as we can’t afford errors at the point of segregation and disposal. Any mistakes at either of these ends can have huge repercussions on public health (Kumar et al., 2019).

Conclusion

The challenges in the path to achieving 100% compliance with the regulatory act, safe management of biomedical waste, and the SDGs associated with it would include:

• Obtaining accurate and timely data from all probable sources of biomedical waste generation
• Inadequate stakeholder engagement and education
• Mixing of biomedical waste with domestic waste
• Insufficient capacities to handle the generated biomedical waste.

And the way forward would essentially include the following:

• Stakeholder engagement
• Provision of education for all involved personnel
• Education of the public
• Better and streamlined data capturing, with probable GPS or Geographical Information System (Bagwan, 2023)
• Innovative solutions which are environment friendly
• A functional ‘Polluter pays principle’ or “Environment Compensation”.
• Integrating Registration of Health department to PCB authorisation.
• An empowered system with Adequate manpower for monitoring waste generation & treatment
• Correlation of Social indicators and monitoring them
• Defining and monitoring the governance indicators, including ethical parameters, infosec and data privacy.

References

• Mishra, P. K., & Dey, K. (2018). Governance of agricultural value chains: Coordination, control and safeguarding. Journal of Rural Studies, 64, 135-147
• Datta, P., Mohi, G. K., & Chander, J. (2018). Children Flounce Cold Shoulder Gingham Dress with Belt. Journal of Laboratory Physicians, 10(1), 6.
• Kumar, V., & Kumar, P. (2019). Pesticides in agriculture and environment: Impacts on human health. Contaminants in agriculture and environment: health risks and remediation, 1, 76-95.