Medical waste

The objective of this project is to ensure that medical waste in Sierra Leone is managed and disposed of in a safe, sustainable and environmentally friendly manner. This includes hospital and laboratory waste, solid and liquid medical waste, human and animal pathological waste and cultures, sharp medical waste, and any other regulated medical waste. There is no official data for medical waste generated in Sierra Leone, but according to the desk research conducted by AMB Ecosteryl consultants in 2012, it is about 2,000 tonnes per year. This untreated and contaminated medical waste is disposed of by medical facilities that generate it; about 80% of it is openly burnt in hospital backyards or disposed of at dumpsites or in water bodies. The majority of autoclaves and small scale incinerators that have been bought in the past 10 years for treating medical waste are not operating due to their high operating costs and the lack of funding for maintenance. Policies and guidelines for medical waste management do exist, but they are not enforced. Mismanaged medical waste poses a threat to public health and creates a high risk of epidemics. Premier Enviro Solutions is determined to change the situation.

Through extensive market research, Premier Enviro Solutions identified AMB Ecosteryl, a Belgian company, as the best provider of suitable equipment for processing medical waste. AMB Ecosteryl has nearly 20 years of experience in commercial treatment of medical waste without burning. They’ve designed four different patented systems that use a continuous microwave technology and produce no polluting discharge. Over 200 of their machines are currently operating in Europe, Asia, Africa, North and South America.

Premier Enviro Solutions is proposing a public–private partnership (PPP) model where all capital and operational expenditure is borne by the company. The service provided will include medical personnel training, supply of plastic bags and bins for medical waste, collection and treatment of medical waste, baling of treated medical waste and final disposal. To ensure efficient management of medical waste, medical personnel will be informed about the risks associated with handling medical waste and trained to identify medical waste and place it into the provided appropriately marked bins. Premier Enviro Solutions will collect medical waste from government and private hospitals and other generators, and safely transfer it to the company’s Clinical Waste Treatment Facility equipped with a cold room for storing the waste that cannot be treated immediately. At this facility medical waste will be shredded and treated using the microwave technology from AMB Ecosteryl to decontaminate the waste and reduce its volume by 80%. The process requires only electricity, no water is used and no emissions are produced. Treated medical waste will be baled and transported either to Kingtom dumpsite or to a facility where it will be used as refuse-derived fuel (RDF).

Premier Enviro Solutions can start providing this service within six months after the outsourcing contract with the Ministry of Health is signed. The company will provide weekly reports listing the amount of medical waste collected from each of the facilities, and monthly invoices for the total weight of medical waste treated. As this is a large investment, Premier Enviro Solutions will require a long-term contract for at least 10 years, with an option to renew for further 10 years. Additional support from the government could include assistance with fast‐tracking the environmental impact assessment (EIA) approval process, enforcing policies related to safe disposal of medical waste, a GST waiver, and tax waivers for importing the necessary equipment.

The proposed implementation schedule includes two phases. During the first phase a Clinical Waste Treatment Facility will be installed in Kingtom, where medical waste from Western Area and North West province will be treated. Government medical facilities will be the first ones to whom the collection service will be offered. Since there is no official data about the amount of medical waste generated, during this phase the capacity of the facility might be unsuitable for the total amount of medical waste generated in the area. During the second phase the capacity of the facility in Kingtom will be adjusted as required, and the service will be extended to private hospitals and clinics. Additional facilities will be installed in strategic locations in Northern, Eastern and Southern provinces of Sierra Leone, thus extending the coverage of the service to reach another 5 million people.

By managing medical waste in a safe, sustainable and environmentally friendly manner, the following outcomes will be achieved:

Reduced risk of epidemics and increased life expectancy
Reduced environmental pollution and reduced air pollution from open burning of medical waste
Ministry of Health will become a regulator for medical waste, and will be able to focus on strategy instead of on implementation
Improved likelihood of Sierra Leone getting further medical aid and grants for improving health care system in the country