Bio-medical waste management: situational analysis & predictors of performances in 25 districts across 20 Indian States

BACKGROUND & OBJECTIVES: A legislative framework for bio-medical waste management (BMWM) was established in the country more than a decade ago. Though some studies have identified gaps at local levels, no systematic effort was done to collect data from different parts of the country. The objective of this nationwide study was to document existing resources, infrastructure and practices related to BMWM across the study districts. METHODS: The study was conducted in 25 districts spread over 20 States of India including urban and rural areas. Primary (n=388), secondary (n=25) and tertiary care (n=24) health facilities from public (n=238) and private (n=199) sector were assessed and scored for the state of BMWM through 9 items representing system capacity, availability of resources and processes in place. Health facilities were assigned into one of the three categories (Red, Yellow and Green) based on the cumulative median scores. RESULTS: Around 82 per cent of primary, 60 per cent of secondary and 54 per cent of tertiary care health facilities were in the ‘RED’ category. Multivariate analysis indicated that charts at the point of waste generation, availability of designated person, appropriate containers and bags, availability of functional needle destroyers, availability of personal protective gears, segregation of waste at point of generation and log book maintenance were independently (OR-between 1.2-1.55; P <0.03 or less) associated with better BMWM system in the health facilities. This was true for both rural-urban and public or private health facilities. INTERPRETATION & CONCLUSIONS: The study highlighted the urgent need for greater commitments at policy and programme levels for capacity building, and resource investments in BMWM.