Capacity assessment and implementation analysis of common treatment facility for the management of infectious healthcare waste in rapidly urbanising city of Nepal.

This study is one of the first systematic attempts to examine the possibility of a common treatment facility (CTF) to treat infectious healthcare waste (HCW) in Nepal. First, the survey was conducted in 14 healthcare facilities (HFs) ranging from health posts to large hospitals selected from 120 total HFs in Nepalgunj sub-metropolitan city (SMC), a rapidly urbanising city of Nepal to investigate the current practices of HCW management (HCWM) and to estimate the waste generation and characteristics in the different HFs. The result shows that the average unit waste generation rate for health posts, clinics, urban health centres, and hospitals was estimated at 1.397 kg day-1, 1.608 kg day-1, 0.178 kg day-1 and 1.818 kg bed-1 day-1, respectively. Of the total 1242 kg day-1 HCW generated in Nepalgunj SMC, 73% is infected in the current situation, but if fully sorted at source, only 32% of the waste will be infected. Based on these HCW generation data and fraction of infectious waste, including waste management practices, three different scenarios are proposed for the capacity assessment and designing implementation modality of the CTF to treat infectious waste from all HFs of Nepalgunj SMC as a case study where an integrated solid waste management facility including material recovery facility and sanitary landfill site for municipal solid waste management is already in operation. The different implementation analyses are discussed, and the best implementation arrangement has been recommended for the sustainability of the project. This approach can be replicated in other cities alone or regions with many neighbouring cities of Nepal and explores a workable solution for HCWM in the rapidly urbanising cities of developing countries to help them improve their condition.

Implementing Federalism in the Health System of Nepal: Opportunities and Challenges.

Nepal moved from unitary system with a three-level federal system of government. As federalism accelerates, the national health system can also speed up its own decentralization process, reduce disparities in access, and improve health outcomes. The turn towards federalism creates several potential opportunities for the national healthcare system. This is because decision making has been devolved to the federal, provincial and local governments, and so they can make decisions that are more representative of their localised health needs. The major challenge during the transition phase is to ensure that there are uninterrupted supplies of medical commodities and services. This requires scaling up the ability of local bodies to manage drug procurement and general logistics and adequate human resource in local healthcare centres. This article documents the efforts made so far in context of health sector federalization and synthesizes the progress and challenges to date and potential ways forward. This paper is written at a time while it is critical to review the federalism initiatives and develop way forward. As Nepal progress towards the federalized health system, we propose that the challenges inherent with the transition are critically analysed and mitigated while unfolding the potential of federal health system.