How Bio-medical Waste Management Initiatives Started in India
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Global History
During 1987–88, an environmental crisis known as the “syringe tide” struck Connecticut, New Jersey, and New York, causing extensive medical waste and raw garbage, including hypodermic syringes, to wash up on the Jersey Shore, New York City, and Long Island beaches. This led to beach closures along the Atlantic coast, exacerbating concerns amid the HIV/AIDS epidemic of the 1980s.
Responding to these events, participants of the New Jersey Harbor Estuary Program (HEP) enacted the Short-term Floatables Action Plan in 1989. This successful plan aimed to reduce debris wash-ups by intercepting debris slicks within the Harbor. Its key components include regular environmental patrols to spot debris slicks, cleanup efforts led by the United States Army Corps of Engineers (USACE) targeting potential slick occurrences, additional cleanup actions when new slicks are identified, and a coordinated communication network overseen by the United States Environmental Protection Agency to manage reporting and cleanup operations among program participants.
World Health Organization (WHO) assembly in June 2007, essential principles were established for effective and sustainable healthcare waste management. The inaugural edition of the WHO guidebook, known as “The Blue Book,” was released in 1999, with a subsequent 2014 edition incorporating newer methodologies for safe biomedical waste (BMW) disposal, updated pollution control measures, and detection methods.
Three international treaties—the Basel Convention on Hazardous Waste, the Stockholm Convention on Persistent Organic Pollutants (POPs), and the Minamata Convention on Mercury—significantly influence waste management policies due to their relevance in environmental protection and sustainable development. The Basel Convention, encompassing 170 member countries, focuses on safeguarding human health and the environment from hazardous waste, particularly clinical waste generated in healthcare facilities. The Stockholm Convention targets Persistent Organic Pollutants (POPs) such as dioxins and furans, produced by medical waste incineration and threaten living organisms. It guides Best Environmental Practices (BEP), including source reduction, segregation, and resource recovery. The Minamata Convention, established in 2014, addresses the adverse impact of mercury on human health and the environment. This treaty involves phasing out mercury-containing medical items like thermometers and blood pressure devices from healthcare services.
A 2012 WHO survey evaluated the healthcare waste management status in 24 West Pacific countries, highlighting satisfactory performance in management, training, and policy aspects except for Micronesia, Nauru, and Kiribati. While Japan and the Republic of Korea implement Best Available Technologies (BAT) for BMW logistics and treatment, many countries face financial constraints hindering effective healthcare waste management. In Canada, variations in medical waste management practices exist among provinces, lacking uniform regulations. Hospitals in Canada are transitioning from on-site incineration to centralized provincial facilities for BMW sterilization, showcasing evolving waste management strategies.
Introduction
Biomedical Waste (BMW) management in India has transitioned from an overlooked issue to a domain of structured and sustainable practices, largely driven by judicial activism and evolving legal frameworks. Initially the Environmental Protection Act, 1986, and Hazardous Wastes (Management and Handling) Rules, 1989 did not cover Bio Medical Waste. The focus on bio medical waste disposal came from the judiciary, particularly through the landmark judgment of Dr. B.L. Wadhera Vs Union of India.
The Wake-Up Call: Dr. B.L. Wadhera Vs Union of India
In 1995, the case brought the neglected issue of BMW to light, emphasizing the government oversight in not categorizing it as hazardous waste. The Supreme Court directives for incinerator installation and improved waste management practices in Delhi served as a wake- up call. The court emphasised upon the responsibility to dispose of the waste upon the producers ( hospitals) and ruled that all hospitals >50beds must install incinerators. This legal judgement not only exposed the regulatory gaps but also set in motion the formulation of the Biomedical Waste (Management and Handling) Rules in 1998, marking the beginning of a specialized focus on BMW.
The Criticism and the Shift
The Supreme Court directives, while well-intentioned, were met with criticism due to the environmental and health concerns associated with incineration.
Court Case and Judgement
The pushback from environmentalists and health experts like Mr. Ravi Agarwal ( Director Toxic Links) and Dr Vijay Agarwal ( The then Chairman Nursing Home Forum of Delhi Medical Association) led to a judicial reassessment. This criticism was instrumental in shifting the focus from merely disposing of waste by incineration to considering the environmental and health implications of disposal methods, leading to more sustainable approaches in BMW management. Widespread incineration was linked to production of Dioxins and Furans which are known carcinogens.
The Emergence of Centralized Waste Management Facilities
The revised judicial stance encouraged the development of Centralized Waste Management Facilities, a concept that revolutionized BMW disposal. These facilities offered a more eco- friendly, efficient, and controlled approach, marking a significant departure from the earlier, more haphazard practices. The model, initiated in the National Capital Region, became a blueprint for nationwide BMW management strategies.
Implementations and Amendments
The implementation of the Biomedical Waste (Management and Handling) Rules represented a paradigm shift. Subsequent amendments in 2000 and 2016 further refined these rules, ensuring they remained relevant with the advancing technologies and more effective management strategies. These changes illustrate the dynamic nature of legal frameworks adapting to new challenges and innovations in waste management.
Role of CPCB and SPCBs
The Central Pollution Control Board and State Pollution Control Boards emerged as vigilant overseers of BMW management. Their role expanded from mere regulatory bodies to active enforcers of compliance, with a significant focus on regular inspections, authorizations, and penalizing non-compliance. Their evolving function reflects the growing seriousness and sophistication in BMW regulation.
Future Aspects
The future of BMW management in India is geared towards increasing the awareness and capacity of healthcare providers. Educational programs, technological advancements, and collaborative efforts between various stakeholders are becoming increasingly significant. These initiatives are crucial for embedding sustainable waste management practices within the healthcare sector’s ethos.
Conclusion
The evolution of BMW management in India from judicial intervention to sustainable practices is a testament to the power of legal impetus and collective effort. The journey from ignorance to awareness and then to action highlights a significant shift in understanding and addressing the complexities of BMW. It reflects a broader commitment to public health, environmental protection, and the sustainable development goals.
The proactive role of the judiciary, coupled with the responsive legislative amendments and the increasing involvement of environmental and health activists, has been instrumental in shaping a more responsible approach to BMW management in India.
