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vate/public sector partnerships should be promoted pels etc., all assumed to be infectious), non-sharp in-
(UMP/SDC Collaborative Working Group, 1996). Pri- fectious wastes, pharmaceutical and chemical residues
vate sector involvement however does not in itself and other hazardous wastes. Although most hospitals
guarantee higher efficiency. Certain preconditions require separation of their waste and the burning of
must be fulfilled so that an efficient private sector their pathogenic waste, most of the their incinerators
service can develop (Schübeler et al., 1996). are usually out of order and these wastes often enter
the municipal waste stream. This poses serious health
• An environment of competition and competitive
risks to the public, especially children, to scavengers,
bidding is necessary to ensure that private firms
collection crews and to workers at the landfill.
must perform efficiently to make a profit and to
maintain their position on the market. Private mo-
nopoly with no opposing competitive forces will not
6ROXWLRQV
achieve optimum efficiency.
The key to adequate medical waste management is
• When deciding for the option of private sector par-
the handling. It needs discipline and care from a num-
ticipation it is necessary to assess, if enterprises
ber of people, starting with the nurse or doctor, con-
with an adequate technical and organizational ca-
tinuing with the porter or laborer who provides the bags
pacity exist, to fulfill the goals specified.
and carries away the waste and ending with the person
• The public authorities need to determine clear responsible that the waste is disposed of in the correct
specifications on the outputs to be delivered. With way. Training and motivation on all these levels is very
private sector involvement government institutions important but till now is still given little care (Pescod &
shift from service provision to regulation. They Saw, 1998). Legislation or guidelines exist in many
therefore need to establish a legal and regulatory places however are seldom implemented or enforced.
framework (by-laws, and regulations) and appro- Another issue is the storage of hospital waste. For
priate systems of performance control and moni- each of the categories of hospital wastes mentioned
toring to ensure appropriate service. above, appropriate containers must be available. Dif-
ferent colored bags for different waste types and
The experience of the past years has shown that in-
puncture safe containers for sharps are recommended.
formal or formal Micro and Small Enterprises can not
The different waste in different bags or containers can
only play an important role in improving service deliv-
then be handled, treated and disposed in an appropri-
ery particularly to low-income urban areas, they also
ate way according to their content. Treating infectious
generate employment and facilitate upgrading the
waste by incineration can be very effective if the incin-
status, earnings and working conditions of waste pick-
erators operate properly (Ogawa, 1993). Often how-
ers and recyclers (UMP/SDC Collaborative Pro-
ever combustion temperatures are too low and there
gramme, 1996).
are problems of odor and smoke. Other treatment op-
tions like chemical disinfection give a false sense of
0DQDJHPHQW RI QRQLQGXVWULDO security, as they are not always reliable (WHO, 1995).
KD]DUGRXVZDVWH
)LQDOGLVSRVDORIVROLGZDVWH
7KHFKDOOHQJH
Pathogenic waste, generated by hospitals and clinics 7KHFKDOOHQJH
can be regarded the most important waste product
Most of the municipal solid waste (MSW) in developing
from the category of non-industrial hazardous waste.
countries is dumped on land in a more or less uncon-
Approximately 85 percent of the total waste generated
trolled manner. Such inadequate waste disposal cre-
by hospitals and clinics can be classified as regular
ates serious environmental problems that may impair
domestic wastes, whereas 10 percent can be regarded
health of humans and animals and cause economic
as infectious and 5 percent as non-infectious but haz-
and other welfare losses.
ardous wastes (Coad, 1994). Therefore it is essential
that the generated waste be separated, as the non- The environmental degradation caused by inadequate
infectious and non-hazardous waste can be managed disposal of waste can be expressed by the contamina-
like ordinary domestic waste. Hazardous and infectious tion of surface and ground water through leachate, soil
waste should be collected in different categories ac- contamination through direct waste contact or
cording to the way they should be processed at later leachate, air pollution by burning of wastes, and the
steps. This classification can be sharps (needles, scal-
5
SANDEC/EAWAG
spreading of diseases by different vectors like birds, Other reasons for inadequate disposal are the mostly
insects and rodents. inappropriate guidelines for siting, design and opera-
tion of new landfills as well as missing recommenda-
Due to urban growth, in the past few decades uncon-
tions for possible upgrading options of existing open
trolled dumping sites have often been encircled by set-
dumps. Many of the municipal officials think that un-
tlements and housing estates and today are often cen-
controlled waste disposal is the best that is possible.
trally located. Such uncontrolled dumps with missing
Often the only guidelines for landfills available are
site management directly endanger the health of the
those from high-income countries. These are based on
people living near to, or on the site. It is however naïve
technological standards and practices suited to the
to think that the other citizens will not be affected as
conditions and regulations of high-income countries
the chemical and biological contaminants from inade-
and do not take into account for the different technical,
quate disposal will inevitably find their way to them.
economical, social and institutional aspects of devel-
The public may be affected by the contamination of
oping countries.
their drinking water, by soil contamination passed on to
the aquatic and terrestrial food chain and through the
spreading of diseases by different vectors. People liv-
6ROXWLRQV
ing near or on the site are often subject to direct
transfer of contamination from hand to mouth and One of the key issues when tackling the problems of
through inhalation of dangerous volatile compounds inadequate waste disposal is, trying to solve the defi-
and aerosols. There is also a direct physical danger cient financial situation of municipalities in respect to
involved, deriving from possible waste landslides, col- SWM. An important factor is trying to determine the
lapsing landfills, explosions, fires and waste related actual costs of SWM and especially the costs of waste
transport accidents. disposal. Many cities do not know the total costs of
their solid waste collection and disposal services, and
Financial and institutional constraints are the main rea-
therefore can not set cost recovery targets. As many
sons for inadequate disposal of waste especially were
local governments tend to focus only on covering labor
local governments are weak or underfinanced and
costs and purchase of consumables, equipment is of-
rapid population growth continues. Financing of safe
ten old and badly worn and facilities for safe disposal
disposal of solid waste poses a difficult problem as
do not exist (Cointreau-Levine, 1997). Finance for
most people are willing to pay for the removal of the
SWM needs to cover for planning, capital, operating
refuse from their immediate environment but then “out
and monitoring costs and needs to account for safe
of sight – out of mind” are generally not concerned with
disposal of wastes. Estimated capital and recurrent
its ultimate disposal.
landfill costs are shown in table 2. They vary depend-
The present disposal situation is expected to deterio- ing on landfill size and engineered environmental pro-
rate even more in the near future because till now the tection measures (e.g. liner, drainage, leachate treat-
relative central location of the dumping sites, i.e. close ment) between 5.6 and 11.3 US$ per ton of capacity
to the collection area, and the often missing manage- over landfill life (10 years).
ment efforts, has enabled governments to dispose of
the municipal solid waste at little cost. This will change total capital and recurrent cost US$
soon as with rapid urbanization, settlements and
per ton of capacity over landfill life
housing estates now increasingly encircle the existing
(10years)
dumps and the environmental degradation associated
with these dumps directly affect the population. Waste large landfill medium small
disposal sites are therefore also subject to growing landfill landfill
1000 t/day
opposition and it is becoming increasingly difficult to 500 t/day 250 t/day
find new sites which find public approval and which are
landfill without 5.6 6.5 11.3
located at a reasonable distance from the collection engineered liner or
area. Siting landfills at greater distances to the central leachate system
collection areas implies higher transfer costs as well as
landfill with off-site 7.0 8.0 9.6
additional investments in the infrastructure of roads
clay liner and
hence intensifying the financial problems of the re- leachate system,
sponsible authorities. In addition to all this, an increase excluding
in service coverage will even aggravate the disposal geomembrane
problem if the amount of waste cannot be reduced by
Tab. 2: Estimated landfill costs for different landfill sizes
waste recovery.
(Cointreau-Levine, 1997).
6
SANDEC/EAWAG
For a city of 1 million the cost for the development of a in Malaysia (Ogawa, 1998). The "Guidance for Land-
modern sanitary landfill is estimated to be between 3- filling Waste in Economically Developing Countries"
10 million US$ depending on length of access roads (Savage et al., 1998) covers all aspects of landfills like
and engineered measures of environmental protection siting, design and operation and also describes meas-
(Cointreau-Levine, 1997). ures for remediation, corrective action and resource
recovery. Finally a new guide for decision-makers
(Rushbrook & Pugh, 1998) allows the waste managers
8SJUDGLQJH[LVWLQJVLWHV of low and middle-income countries to identify the main
As mentioned above, the estimate capital and recur- issues and problems of inadequate disposal and de-
cide on the key decisions to be taken. It recommends a
rent costs for the development of a modern sanitary
minimum standard to be achieved and also expresses
landfill for a city of 1 million are between 3-10 million
US$. Taking these costs into account, an important desirable improvements to these minimum standards.
More information is however needed on viable tech-
issue is trying to prolong the life of an existing dump
nologies adapted to the economic and technical as-
while upgrading it, so as to minimize environmental
pollution and health risks to the public. Upgrading does pects of the situation in order to achieve these stan-
dards.
not mean converting a dump to a sanitary landfill in
one step. It must be regarded as a step to step proc- A possible measure to upgrade open dumps and
ess depending on the financial situation of the authori- poorly designed or improperly operated landfills is the
ties. The process of upgrading is not necessarily diffi- reuse of decomposed waste (landfill mining). This
cult or expensive. Even simply using the available fi- practice can be observed in Deonar, the waste dis-
nances, staff and/or equipment in a different way may posal site of Mumbai, India (Coad, 1997) where labor-
already achieve improvements. ers extract decomposed materials manually from a part
of the site. The waste is dried, screened and the fine
As an example of step to step improvement, the gov-
ernment of Malaysia formulated an action plan in 1988 material bagged and sold. Landfill mining has potential
not only as a method of resource recovery but also
on the improvement of their disposal sites. When they
allows upgrading the excavated area to a better stan-
considered the limited financial and technical know-
how that was available, the strategy adopted was to dard for then reusing it as disposal space. Recovered
fine soil material may be suitable as cover material and
convert open dumping to sanitary landfills in stages
coarse inert materials might be used as for the mainte-
(Huri bin Zulkifli, 1993). The improvement target levels
were given as follows: Target 1: controlled tipping, nance of access roads. In our view the potentials of
landfill mining should be further pursued.
Target 2: landfill with embankments and daily cover,
Target 3: landfill with leachate recirculation and, Target Last but not least a continiuos technical training of per-
4: landfill with leachate treatment. sonnel is needed to ensure a satisfactory operation of
a upgraded or new landfill disposal site.
The key to upgrading a waste disposal site is, first of
all to acknowledge the deficient present landfill opera-
tional and/or design methods and then start looking for
6LWLQJDQGGHVLJQLQJQHZODQGILOOV
ways to improve them. In this, it is important that the
authorities be assisted either with site specific con- Upgrading dumps may longer their life span, however,
sulting or by guidelines and manuals on the technical due to the rapidly growing cities, the municipalities will
possibilities available for improvement. Literature is inevitably have to plan for new landfill sites. Of main
very sparse especially when it comes to taking into importance when opting for a new landfill site is deter-
account for the different technical, economical, social mining the ideal site location. A poorly chosen site may
and institutional aspects of developing countries. require high costs of waste transport (e.g. the site is far
Oeltzschner & Mutz (1994) concentrate mostly on the from the collection area) or site construction. Finding a
issues of siting new landfills however also attempts to site where no additional lining is necessary can save
close the existing gap by providing some good infor- up to 30% of the total capital and recurrent costs
mation on low-cost gas collection systems. Matsufuji (Cointreau-Levine, 1997). To identify an appropriate
(1990) provided technical guidelines for landfill design site a systematic process of selection needs to be fol-
and operation for the improvement strategy of the gov- lowed, whereby the selection criteria need to be priori-
ernment of Malaysia as mentioned above. Part two of tized according to local climatic, political and cultural
the guide covers detailed technical aspects such as circumstances (Rushbrook & Pugh, 1998). The goal of
the construction of embankments, drainage systems a careful site design is to minimize environmental im-
and liners for the engineer, but also covers operational pacts and operational problems. A good control of
procedures for the manager. This guide is widely used
7
SANDEC/EAWAG
water, traffic, soil and waste movement is an essential • Develop landfill guidelines to suggest appro-
prerequisite for a well designed landfill. priate low-cost solutions for upgrading, de-
signing and operating a landfill
•
&RQFOXVLRQVDQG5HFRPPHQGD Pay attention to siting of new landfills using a
WLRQV systematic and transparent process.
• Develop sustainable markets for products re-
covered or produced from Municipal Solid
The five major problems identified by Schertenleib & Waste so to encourage small-scale organic
Meyer (1992) in SWM in developing countries (inade- waste recycling and the existing informal recy-
quate coverage of the population to be served, opera- cling system
tional inefficiencies of municipal SW services and
management, limited utilization of the formal and in-
formal private sector in recycling activities, problems 5HIHUHQFHV
concerning the management of (non-industrial) haz-
ardous waste and specific problems related to final
disposal of solid waste) still exist to a large extent and
Coad A. ed. (1997) /HVVRQVIURP,QGLDLQ6ROLG:DVWH
need increased attention. 0DQDJHPHQW., The Water, Engineering and Develop-
The main lessons learned from research over the last ment Centre (WEDC), Leicestershire, UK.
few years can be summarized as follows:
Coad A. ed. (1994) 0DQDJLQJ 0HGLFDO :DVWHV LQ 'H
1. In order to be able to improve and properly man- YHORSLQJ&RXQWULHV. Report of a Consultation on Medi-
age the solid waste services, it is important that cal Wastes Management in Developing Countries
the municipalities know the actual costs of the dif- WHO Geneva, World Health Organiza-
ferent components of the SWM system including tion.WHO/PEP/RUD/94.1
waste disposal. Knowing the complete costs of
Cointreau-Levine S. (1995) Private Sector Participation
SWM services enables the authorities to make de-
in Municipal Solid Waste Services in Developing
cisions, identify opportunities and plan for the fu- Countries; Volume 1: The Formal Sector. 8UEDQ 0DQ
ture ("What is measured can be managed"). The
DJHPHQW 3URJUDPPH 'LVFXVVLRQ 3DSHU 1R,
current situation is still far from satisfactory.
UNDP/UNCHS/World Bank.
2. To increase coverage and efficiency of solid waste Cointreau-Levine S. (1997) Project Preparation: Solid
services, community-based and private sector in-
Waste Management, Section IV. In 8UEDQ:DVWH0DQ
volvement can be a solution. However there are
DJHPHQW *XLGHOLQHV 7RROV DQG 3UDFWLFHV LQ 6XE6D
certain preconditions for a successful operation of KDUDQ $IULFD . (ed. Obeng L. & Cointreau-Levine, S.)
such models which must be taken into considera-
Infrastructure Family, Africa Region, The World Bank.
tion.
Huri bin Zulkifli Z. (1993) Improvement of Disposal
3. Final waste disposal has till now received little in- Sites in Malaysia. 5HJLRQDO 'HYHORSPHQW 'LDORJXH ,
terest by municipalities as well as the public (out of
Vol.14 (No.3), p. 168, United Nations Centre for Re-
sight-out of mind) and uncontrolled dumping is still
gional Development, Nagoya, Japan.
the most common way of waste disposal in cities
of the developing world. However contamination of World Resources Institute (1998) :RUOG 5HVRXUFHV
water resources and air pollution of such disposal . Oxford University Press.
sites and increased health risks of people living Matsufuji Y. (1990) 7HFKQLFDO *XLGHOLQH RQ 6DQLWDU\
nearby are of growing concern. A few important /DQGILOO 'HVLJQ DQG 2SHUDWLRQ '5$)7. Technical
goals should be targeted in future to improve the Section, Local Government Division, Ministry of Hous-
current waste disposal activities: ing and Local Government.
• Stop uncontrolled waste dumping by consid- Oeltzschner H., Mutz, D. (1994) *XLGHOLQHVIRU DQ $S
ering upgrading of existing dumpsites as a first SURSULDWH 0DQDJHPHQW RI 'RPHVWLF 6DQLWDU\ /DQGILOOV.
step Deutsche Gesellschaft für Technische Zusammenar-
• Develop appropriate landfill standards to allow beit (GTZ).
for a step-to-step approach towards long term Ogawa H. (1993) Improving the Management of Hos-
standards pital Wastes. 5HJLRQDO'HYHORSPHQW'LDORJXH , Vol.14
(No.3), p.108.
8
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Ogawa H. (1998) Technical guideline on sanitary land- Need for Future Research. ,5&:' 1HZV 1R
fill used in Malaysia 3HUVRQDOFRPPXQLFDWLRQ SANDEC/EAWAG Duebendorf, Switzerland
Pescod M. B., Saw, C. B. (1998) Hospital Waste Man- Schübeler P. Wehrle K., Christen J. (1996) &RQFHSXWDO
agement in Four Cities. 8:(3 :RUNLQJ 'RFXPHQW . )UDPHZRUN IRU 0XQLFSDO 6ROLG :DVWH 0DQDJHPHQW LQ
Gouda, the Netherlands. /RZ,QFRPH&RXQWULHV. SKAT.
Pfammatter R. and Schertenleib, R. (1996) 1RQ*RY UMP/SDC Collaborative Programme (1996) Promotion
HUQPHQWDO5HIXVH&ROOHFWLRQLQ/RZLQFRPH8UEDQ$U of Public/Private Partnerships in Municipal Solid Waste
HDV. SANDEC Report No.1/96, SANDEC/EAWAG Management in Low-income Countries. Workshop Re-
Duebendorf, Switzerland port, UMP/SDC Collborative Programme on Municpal
Solid Waste Mangement in Low-Income Countries.
Rushbrook P., Pugh, M. (1998) 'HFLVLRQ0DNHUV
V
*XLGHWR6RLOG:DVWH/DQGILOOV. The World Bank. WHO (1995) +DQGERRN RQ 0HGLFDO :DVWH 0DQDJH
PHQW DRAFT
World Bank. (1998) World Bank classification of
economies KWWSZZZZRUOGEDQNRUJ World Resources Institute (1998) :RUOG 5HVRXUFHV
ZGLZGLFODVVKWP . Oxford University Press.
Savage G. M., Diaz, L. F., Golueke, C. G., Martone, C. Matsufuji Y. (1990) 7HFKQLFDO *XLGHOLQH RQ 6DQLWDU\
(1998) Guidance for Landfilling Waste in Economically /DQGILOO 'HVLJQ DQG 2SHUDWLRQ '5$)7. Technical
Developing Countries. (3$5. U.S. Envi- Section, Local Government Division, Ministry of Hous-
ronmental Protection Agency. ing and Local Government.
Schertenleib R., Meyer, W. (1992) Municipal Solid
Waste Management in DC’s: Problems and Issues;