AIDSTAROne Uganda VMMC Guidelines Final

AUGUST 2013
This publication was made possible through the support of the U.S. President’s Emergency Plan for AIDS Relief
(PEPFAR) through the U.S. Agency for International Development under contract number GHH-I-00-07-00059-00, AIDS
Support and Technical Assistance Resources (AIDSTAR-One) Project, Sector I, Task Order 1.
Uganda National Guidelines: Managing Healthcare Waste Generated from Safe Male Circumcision Procedures | i
Acronyms
ACP AIDS Control Programme
HCW health care waste
HCWM health care waste management
IP implementing partner
MoH Ministry of Health
NDA National Drug Authority
NEMA National Environmental Management Authority
PEPFAR U.S. President’s Emergency Plan for AIDS Relief
PHC primary health center
PMTCT prevention of mother-to-child transmission
POP persistent organic pollutants
SMC safe male circumcision
STI sexually transmitted infections
UAC Uganda AIDS Commission
UNBOS Uganda National Bureau of Standards
USG U.S. Government
WHO World Health Organization
ii | Uganda National Guidelines: Managing Healthcare Waste Generated from Safe Male Circumcision Procedures
Table of Contents
Acronyms ......................................................................................................................................................... ii
Preface ............................................................................................................................................................. v
1.0 BACKGROUND .......................................................................................................................................... 1
1.1 HIV Situation in Uganda ........................................................................................................................... 1
1.2 National Response to the Epidemic.......................................................................................................... 1
1.3 Male Circumcision .................................................................................................................................... 1
1.4 Supply Chain Considerations ................................................................................................................... 2
1.5 Health Care Waste Management as a Challenge to Achieving Desired Targets....................................... 3
2.0 GENERAL OVERVIEW OF HEALTH CARE WASTE MANAGEMENT ..................................................... 4
2.1 Introduction .............................................................................................................................................. 4
2.2 Risks Caused by Poor Management of Health Care Wastes .................................................................... 4
2.3 Basic Elements for Safe Management of Health Care Waste for PHC Centers ........................................ 5
2.3.1 Waste Minimization and Segregation................................................................................................. 6
2.3.2 Recommended Techniques for Treatment of Infectious Waste .......................................................... 8
2.3.3 Storage and Transportation of Waste ................................................................................................ 8
2.3.4 Final Disposal .................................................................................................................................... 9
2.4 Roles and Responsibilities of Stakeholders ............................................................................................ 10
3.0 GENERAL OVERVIEW OF HEALTH CARE WASTE MANAGEMENT ................................................... 12
3.1 Identifying SMC Waste Generation Points.............................................................................................. 12
3.2 Mapping the Flow of HCW within the Health Facility or Outreach Site .................................................... 13
3.3 Considerations for All Streams of SMC Waste ....................................................................................... 14
3.3.1 How to Select a Waste Handling Service Provider ........................................................................... 14
3.3.2 Segregating SMC Waste ................................................................................................................. 15
3.3.3 Treatment of SMC Waste Streams .................................................................................................. 17
3.3.4 Decontamination and Disposal of Used Instruments........................................................................ 18
3.3.5 Summary of Treatment and Disposal Methods for SMC Kit Components ........................................ 20
4.0 REFERENCES .......................................................................................................................................... 23
5.0 ANNEXES ................................................................................................................................................. 24
5.1 List of Health Facilities Participating in SMC Supported by IPs .............................................................. 24
5.2 Laws and Regulations - Health Care Waste Management ..................................................................... 30
5.3 Estimated Volumes of Waste ................................................................................................................. 31
5.4 Managing HCW Using a Centralized System ......................................................................................... 32
Uganda National Guidelines: Managing Healthcare Waste Generated from Safe Male Circumcision Procedures | iii
5.5 List of General Hospitals with Installed Incinerators (March 2013).......................................................... 32
5.6 Licensed Waste Handling Service Providers (March 2013) .................................................................... 33
5.7 Decontamination Process ...................................................................................................................... 35
List of Figures
Figure 1: Distribution of Health Facilities Providing SMC Services ................................................................. 2
Figure 2: Critical Steps in Health Care Waste Management ........................................................................... 6
Figure 3: Colour-Coding for Waste Segregation ............................................................................................. 6
Figure 4: Waste Segregation Chart ................................................................................................................ 7
Figure 5: Roles of Stakeholders ................................................................................................................... 10
Figure 6: SMC Health Facility Client Flow and Waste Generation ................................................................ 12
Figure 7: Flow Chart for SMC Waste Generated at an Outreach Site ........................................................... 13
Figure 8: Safe Male Circumcision Waste Segregation Chart ........................................................................ 16
Figure 9: Handling and Treatment of SMC Waste ........................................................................................ 17
Figure 10: How to Decontaminate Instruments............................................................................................. 19
Figure 11: SMC Sites and HCWM Availability .............................................................................................. 22
List of Tables
Table 1: Elements for Safe Management of HCW for Primary Health Care Centers....................................... 5
Table 2: Recommended Techniques for Treatment of Infectious Waste......................................................... 8
Table 3: Waste Treatment and Disposal Methods .......................................................................................... 9
Table 4: Male Circumcision Kit Component Disposal Methods: Health Care Facility Level........................... 20
List of Boxes
Box 1: A Minimum Package of Service for SMC ............................................................................................. 3
Box 2 : Definitions .......................................................................................................................................... 4
Box 3: Key Messages .................................................................................................................................. 11
Box 4: Criteria for Selecting a Waste Handling Service Provider .................................................................. 14
Box 5: Waste Collection Supplies for SMC procedure .................................................................................. 15
iv | Uganda National Guidelines: Managing Healthcare Waste Generated from Safe Male Circumcision Procedures
Preface
These guidelines have been put together to guide health service providers when managing waste generated from safe
male circumcision (SMC). The guidelines will go a long way in mitigating risks of exposure and subsequent transmission
of infections to health service providers, patients, and the community. In addition, the guidelines will protect the
environment against undesirable effects that can result from using less than optimal methods of waste disposal. The
document provides guidance on management of SMC waste at both static and outreach service delivery points. It
highlights that waste produced during SMC activities carries a high risk of infection if not managed properly. To avoid
serious public health consequences and substantial environmental impact, it is essential to promote use of safe and
reliable methods for handling and treating health care waste.
At a stakeholder`s meeting held 26-27 February 2013 at Central Inn Hotel Entebbe, it was noted that different USG
implementing partners who support scaling up of SMC in Uganda reported unsafe waste handling practices. The
stakeholders recommended that the Ministry of Health urgently develop guidelines to be followed when handling
increasing volumes of waste generated from SMC. We hope that these guidelines will help to fill the current information
gap on specific issues related to handling waste generated from SMC. The wider scope of health care waste management
(HCWM) in this document is reflected in the title “General Overview of Health Care Waste Management.” The Ministry of
Health however, recommends that readers interested in understanding general management of HCW read the broader
health workers’ guide, “Approaches to Health Care Waste Management,” developed by the Making Medical Injections
Safer (MMIS) project.
These guidelines have been developed in consultation with government implementers at regional and district levels,
health training institutions, USG implementing partners, and representatives from the private sector. The AIDSTAR-One
Project, which is funded by PEPFAR through USAID, provided technical guidance throughout the process.
Dr. Isaac Ezati

Ag. Director General of Health Services
Uganda National Guidelines: Managing Healthcare Waste Generated from Safe Male Circumcision Procedures | v
1.0 BACKGROUND
1.1 HIV Situation in Uganda

The population of Uganda is approximately 34 million people. The national HIV prevalence rate in the general population
was initially estimated at 21% in the 1980s but dropped significantly over a 15-year period to 6.4% [1], although recent
estimates show a slight increase to 7.3% [2]. Continuous assessment at sentinel sites shows stagnation in the prevalence
with some sites registering a rise in the number of new cases [2]. Most of the new cases reportedly are occurring among
couples in stable heterosexual relationships [2]. This changing trend in HIV prevalence calls for additional strategies as
well as objective review of existing behavioral change models.
1.2 National Response to the Epidemic

Uganda’s strategic plan for HIV/AIDS control recommends several strategies for reducing the incidence of new cases of
HIV in the population. Such strategies include: creating a high level of awareness among communities on the risk factors
for HIV transmission; the ABC approach promoting abstinence, being faithful in relationships, and condom use; prevention
of mother-to-child transmission of HIV (PMTCT); and disclosure of serostatus following successful counseling and testing.
Using these strategies, the country set a target of preventing 165,000 new infections under the U.S. President’s
Emergency Plan for AIDS Relief (PEPFAR) [3].
1.3 Male Circumcision

Male circumcision is the process of removing all or part of the foreskin of the penis. It is a common surgical procedure
worldwide that can be performed for medical, social, cultural, or religious reasons. Several sociological studies highlight
the benefits of male circumcision [4, 5]. Studies have shown that male circumcision can interrupt transmission of HIV
among men contracting the virus through heterosexual intercourse. Clinical trials done in various settings in sub-Saharan
Africa found that male circumcision groups had over 60% reduction in HIV in South Africa and over 50% reduction in
Uganda and Kenya [6-8]. Based on these studies, the World Health Organization (WHO) recommends safe male
circumcision (SMC) as an additional strategy in the fight against HIV [9].
In 2010, the Ministry of Health (MoH) in Uganda under the AIDS Control Programme adopted a national SMC policy that
recommends provision of voluntary circumcision services for all men. The programme targeted to reach 4.2 million men
by extending SMC services to 1 million men annually from 2012-15. According to the Uganda AIDS Commission’s (UAC)
annual performance review of the national HIV and AIDS strategic plan (2011-12), 380,000 men were circumcised by
March 2012. According to the national SMC National Coordinator, the U.S. Government (USG) has provided funds and
commodities to circumcise 750,000 men through PEPFAR.
In 2012, PEPFAR supported a total of 263 facilities providing SMC services in Uganda. In addition, there is commitment to
reviewing the work of all implementing partners (IPs) to ensure that the services offered are of the highest medical
standards. The goal is to provide quality services at a mix of facilities, including clinics, health centers, and hospitals as
well as mobile sites. All PEPFAR partners in Uganda are accelerating their scale-up of SMC services in order to
contribute to the national target of 1 million procedures in 2013—which will help Uganda to reach its national target of 4.2
million eligible men undergoing the procedure by 2015.
The map below illustrates the distribution of health facilities providing SMC services in Uganda through IPs. Annex 1 lists
all SMC facilities by partner organization.
1 | Uganda National Guidelines: Managing Healthcare Waste Generated from Safe Male Circumcision Procedures
Figure 1: Distribution of Health Facilities Providing SMC Services
1.4 Supply Chain Considerations

To provide safe male circumcision procedures, a minimum package of services is required (WHO, 2007). Because of the
broad programme needs, supply chain issues carry significant planning implications, both in terms of matching demand
with supply and making sure that financial resources are available to ensure a full supply of required supplies and
commodities, including resources for managing resulting waste.
Box 1: A Minimum Package of Services for SMC
1. HIV testing and counseling

2. Screening and treatment for sexually transmitted
infections (STIs)
3. Condom provision and promotion
4. Counseling on risk reduction and safer sex
1.5 Health Care Waste Management as a Challenge to Achieving Desired Targets

Waste management is the collection, handling, treatment, transportation, processing, recycling or disposal, and
monitoring of waste materials [10]. The term usually relates to materials produced by human activity, and is generally
undertaken to reduce their effect on health, the environment, or aesthetics. Waste management is also carried out to
recover resources. Waste management can involve solid, liquid, gaseous, or radioactive substances, with different
methods and fields of expertise for each.
Despite the availability of many laws related to health care waste management (HCWM) in Uganda (Annex 2), unsafe
waste management practices in health facilities continue to put health workers, patients, and communities at risk for
injuries as well as potential exposure and subsequent transmission of HIV, hepatitis, and other blood-borne diseases.
Scaling up safe male circumcision to 80% of eligible males in Uganda, especially while using single use disposable kits,
will generate high quantities of hazardous waste. It is estimated that on average a single SMC procedure generates 0.5 kg
of waste [11]. With a projected target of 1 million SMC procedures in 2013 alone, it is estimated that 500 tons of
hazardous waste will be generated across Uganda. Of this, PEPFAR will generate an estimated 191 tons (Annex 3).
This additional volume of waste in settings without proper infrastructure for managing HCW will significantly add to the
burden of HCWM at individual health facilities, and also to district leaders, USG implementing partners, and to the entire
health sector.
Purpose of the manual: To provide guidance to USAID implementing partners (IPs) on how to prevent and
mitigate risks associated with unsafe management of the high quantities of waste generated from safe male
circumcision procedures.
2.0 GENERAL OVERVIEW OF HEALTH CARE WASTE MANAGEMENT
2.1 Introduction
Health care activities lead to the production of waste that may lead to adverse health effects. Most of this waste is not
more dangerous than regular household waste. However, some types of HCW represent a higher risk to health.
Box 2: Definitions
Health Care Waste This is the total waste stream from health care service delivery or research
(HCW) facilities and includes both potential risk and non-risk waste materials.
Hazardous Health This is waste with a potential to cause harm to both humans and the environment
Care Waste if exposed or improperly handled or disposed of. Approximately 20% of all HCW is
estimated to be hazardous and 1% is estimated to be sharps waste.
Non-hazardous The largest component of HCW (80%) is non-hazardous waste. However, this can
Waste cause a nuisance or create breeding sites of disease vectors like flies and rats. It
includes domestic waste, office or compound sweepings and wrappings, and
containers of medicines.
Infectious Has living organisms in it that are capable of causing disease.

Pathological These are parts of the human body that are removed because they are diseased,
usually for identifying the cause of disease.
Sharps These are objects that can penetrate skin easily and include needle/syringes.
Pharmaceuticals Related to manufacturing, dispensing, and disposing of unusable medicines and
consumables.
2.2 Risks Caused by Poor Management of Health Care Wastes

Poor management of HCW causes serious risk to personnel, HCW handlers, patients, and the community. Sources of
illness from infectious waste include injuries from used needles, reuse by other people, and diseases that may result from
contact with this dangerous waste.
Occupational Risk
During handling of waste, health care personnel and waste handlers (within and outside the health facility) can
come into contact with this waste if it has not been packaged safely. Needle stick injuries arising from improperly
stored needles and syringes may occur. At landfills or waste dumps, waste recyclers or scavengers may come in
contact with infectious waste if the waste has been disposed of without prior segregation and treatment.
Risk to the Public

The reuse of syringes by the general public represents a significant public health problem in developing countries.
Worldwide, an estimated 10-20 million infections of hepatitis B, hepatitis C, and HIV occur annually from reuse of
discarded syringes and needles without prior sterilization [12]. In Uganda, an injection safety study conducted in
2003 among 80 primary health care (PHC) facilities in ten randomly selected districts indicated a prevalence of
reuse of needles and syringes of 19% [13].
Indirect Risks via the Environment

As opposed to direct contact with HCW, waste can also contaminate the environment, water, air, or land and
therefore can indirectly impact on health.
When waste is disposed of in a pit that is not lined, the groundwater may become contaminated. The same water
may be used as a source for drinking water.
Burning plastics with organic matter leads to production of toxic gases called persistent organic pollutants (POPs),
such as dioxins. These gases are produced mainly when waste is burnt at low temperatures. Their toxic effects
have been found to cause cancer among human beings.
If waste is burned or incinerated in an incinerator without emission control, the air may become contaminated by a
large number of pollutants and cause serious illness in people who inhale this air. Alternatively, plant life that is
important to human life may be destroyed. When choosing a treatment or disposal option, environmental
friendliness is an important criterion.
Considering these health impacts, HCWM is an integral part of health care service delivery. Creating harm through
inadequate waste management reduces the benefits of health care. Health care centers must be responsible for
management of all waste they generate.
2.3 Basic Elements for Safe Management of Health Care Waste for PHC Centers
Table 1: Elements for Safe Management of HCW for PHC Centers
Comprehensive System Awareness and Training Selection of Options
 Assignment of focal person for waste  Awareness raising for all  Identification of available
management staff about risks related to waste management and
sharps and other infectious disposal resources
 Allocation of sufficient resources (financial waste
and human)  Choice of sustainable
 Training of health workers management and disposal
 Waste minimization, including purchasing regarding segregation options according to:
policies & stock management practices practices
- Affordability
 Segregation of waste at point of  Training of waste handlers - Environmental
generation: sharps, non-sharps, infectious regarding safe handling, friendliness
waste, and non-infectious waste - Efficiency
storage, and operation and
- Workers’ safety
maintenance of treatment - Social acceptability
 Implementation of safe handling, storage,
technologies
transportation, treatment, and disposal
options.  Display of written guidelines
and job aids for personnel
 Tracking of waste production and
destination
2.3.1 Waste Minimization and Segregation
Figure 2: Critical Steps in Health Care Waste Management
Recommended Colour-Coding
Sharps waste can lead to accidental needle stick injury if not properly stored in a safety box, and infectious waste can
lead to exposure to infectious fluids through abraded or intact skin. However, approximately 80% of HCW is non-infectious
(domestic) and easy to handle or recycle or dispose of in a domestic waste pit. Domestic waste or non-infectious waste
does not need special treatment, storage, or expensive methods of disposal. To prevent health risks and to increase
efficiency and cost savings, waste must be segregated at the point of generation using colour-coded bins [14].
Figure 3: Colour-Coding for Waste Segregation
Yellow sharps
Red = Highly Yellow = Infectious
container = Sharps
infectious waste waste
waste only
Black = General
Brown =
waste (wet and dry
pharmaceutical and
waste may be
chemical waste
further segregated)
Figure 4: Waste Segregation Chart
2.3.2 Recommended Techniques for Treatment of Infectious Waste
Table 2: Recommended Techniques for Treatment of Infectious Waste
Recommended treatment technique
Steam High Burning and Chemical Thermal

sterilization temperature low-temp disinfection inactivation
Type of waste incineration incineration (autoclaving)
Isolation waste Highly Highly Not Not

Recommended
recommended recommended recommended recommended
Cultures and
stocks of
Highly Highly Not Not
infectious agents Highly recommended
recommended recommended recommended recommended
and associated
biologicals
Human blood Highly Highly Not

Recommended Recommended
and products recommended recommended recommended
Pathological Highly Highly Not Not

Recommended
waste recommended recommended recommended recommended
Contaminated Highly Highly Not

Recommended Recommended
sharps recommended recommended recommended
Carcasses and Highly Highly Not Not

Not recommended
body parts recommended recommended recommended recommended
Bedding Not Highly

Recommended Recommended Not recommended
recommended recommended
Blunt surgical Not Not

Recommended Recommended Highly recommended
instruments recommended recommended
2.3.3 Storage and Transportation of Waste
An appropriate waste storage area must be available until waste can be transported for disposal (or disposed of
on-site). During storage, waste must remain segregated and in the appropriate colour-coded containers. Waste should be
disposed of as soon as possible, but when stored, it must be kept away from reach of children, animals, and the general
public. The storage area should also protect the waste from the elements, particularly rain. The storage area should be
maintained clean and free of loose waste. Special transportation vehicles must be identified; transportation companies
must be licensed to transport health care waste. Waste must be properly secured during transport to disposal sites in
order to avoid spills and waste handler injury. It is important to clean the vessel or vehicle after transporting waste.
2.3.4 Final Disposal
Table 3: Waste Treatment and Disposal Methods
Waste treatment and disposal methods Description

Autoclave Steam treatment of waste at high temperature and pressure for
sufficient amount of time for sterilization.
Autoclave with shredding or grinding A metal chamber where steam is introduced at an elevated pressure
so it reaches a saturation temperature and produces saturated
steam. Incorporated into the design of the autoclave is a grinder or
shredder, which reduces the size of the waste by shearing the
material between knives or blades. The waste is then rendered
unrecognizable.
Disinfect with bleach, autoclave for Soak stainless steel instruments in a mixture of bleach and water. If
reuse necessary, use a cleaning brush to remove organic material from the
instruments’ surface. Once instruments are disinfected, and all
organic material is removed, instruments are safe for transport to an
autoclave for sterilization and subsequent reuse.
Encapsulation Containers are filled three-quarters full with hazardous waste.
Material such as cement mortar, clay, bituminous sand, or plastic
foam is used to fill the container. When capping material is dry, the
container is buried or landfilled.
Microwave irradiation Waste is shredded, humidified, and irradiated with microwaves. Heat
destroys microorganisms.
Municipal landfill Municipal solid waste landfills (MSWLFs) are able to receive
household waste, non-hazardous waste, industrial solid waste, and
construction and demolition debris.
Open air burning Burning of waste in or next to a pit where it will be buried. May need
to add kerosene or similar fuel to maintain combustion. Not
recommended as a permanent solution, but better than burying
untreated.
Propane fueled incinerator A mobile incinerator fueled by a replaceable propane tank.
Double-chamber “pyrolitic” incineration A permanent furnace of masonry/concrete, refractory materials, and
metal. Waste thermally decomposes in the first chamber, an oxygen-
poor (pyrolitic) chamber that operates at 800-900 degrees
centigrade. The second chamber, a post combustion chamber,
burns the gases produced in the first chamber at 900-1200 degrees
centigrade.
Safe burying Burial of waste in a pit on the site. Access to the pit should be
limited. Pit lined with clay, if available.
Single chamber incinerator A permanent simple furnace of solid construction (e.g., concrete).
Waste is placed on a fixed grate. Burning is maintained by the
natural flow of air. Operating temperature reaches <300 degrees
centigrade. May need to add kerosene or similar fuel to maintain
combustion.
Source: EGSSAA. 2009. The African Bureau’s Environmental Guidelines for Small Scale Activities in Africa. (EGSSAA) Chapter 8. Washington, DC: USAID.
2.4. Roles and Responsibilities of Stakeholders
Figure 5: Roles of Stakeholders
Box 3: Key Messages
National regulations must be observed

when planning and implementing waste
treatment and disposal guidelines.
It is essential that every health facility develop

a HCWM plan and designate a focal person
and/or committee to coordinate its
management.
Infectious waste must be treated properly to

eliminate the potential hazards that this waste
poses to the health of staff, clients,
communities, and the environment.
All health care workers must receive

orientation, continuous in-service training,
and supportive supervision on health care
waste management.
All health care facilities and settings have a

responsibility to dispose of waste in a manner
that poses minimal hazard to patients,
visitors, health workers, and the community.
3.0 PLANNING FOR WASTE GENERATED FROM SMC PROCEDURES
3.1 Identifying SMC Waste Generation Points

For planning purposes, it is important that each implementing partner fully understands the range of steps that a SMC
client goes through during the safe male circumcision process. Figure 4 provides a brief summary of the steps. Since
each step generates waste, it is important to plan for the management of waste at each individual service delivery point.
It is necessary to identify the commodities and supplies required to safely contain and, where appropriate, treat the
generated waste. Such items include: waste bins, bin liners, sharps containers (safety boxes), and disinfectants. When a
facility is running multiple similar service stations, effort should be made to plan for management of waste generated at
each additional station.
Figure 6: SMC Health Facility Client Flow and Waste Generation
Key: Blue Service stations generate only ordinary waste; purple service stations generate ordinary, infectious and highly infectious
waste; orange service stations generate ordinary, infectious, highly infectious, and sharps waste.
3.2 Mapping the Flow of HCW within the Health Facility or Outreach Site Health Facility
Each SMC team should map the flow of HCW within the health facility. The flow will depend on the type of system that is
being used for handling and disposing the waste. Waste segregation requirements are identified in 3.1 above, and Figure
5 will help the planning team to identify additional requirements needed to ensure safe handling of waste as it
flows through the subsequent steps. In addition, Annex 5.4 provides an example of a waste flow system used by health
facilities in eastern Uganda—a centralized waste transportation, treatment, and disposal system.
Outreach Sites
Outreach sites are located within the community at sites such as schools and churches. These sites lack facilities for
conventional waste disposal, such as incinerators and placenta pits. Partners offering SMC procedures through outreach
must consider what provisions must be made in order to properly collect then transport the waste generated.
Figure 7: Flow Chart for SMC Waste Generated at an Outreach Site
Waste Non infectious Burn at site of

Waste segregation
generation waste (paper) outreach
Infectious &
Highly Infectious
waste
Yes Used disposable
Disposable metal instruments (metal)
instruments?
No
Infectious and highly Disinfect with sodium
infectious waste hypo chloride
Put sharps in safety box /Double

bag other waste and seal
Temporary storage
Transport to health facility

Transport to near to Yes Human No for further management
near by HC with parts
placenta pit (foreskin)
Autoclave
yes Glass, No
metal, incinerate
Dispose of Human parts in hand over to plastics
placenta pit and place the used recycling
liner in a red bag plant
3.3 Considerations for All Streams of SMC Waste
3.3.1 How to Select a Waste Handling Service Provider
Health care waste must be transported and treated by a licensed provider. The criteria in Box 3 can help in selecting a
reliable waste handling service provider.
Box 4: Criteria for Selecting a Waste Handling Service Provider
• An existing company with knowledge and skills in disposing of HCW.
• Recognition and current registration with regulatory bodies like National Environmental
Management Authority (NEMA), National Drug Authority (NDA), and Uganda National Bureau of
Standards (UNBOS).
• Good previous record in bio-safety and bio-security; the company should show good evidence
that their employees are adequately protected while at work. Protection can include: provision of
vaccinations, protective gear, health insurance, and insurance against accidents. Workers
should be well trained in HCWM.
• Previous history of safely disposing large quantities of HCW using national recommended
disposal methods.
• Previous history of safely disposing of pharmaceutical waste.
• Competence of the management team.
• A company that offers cost-effective rates.
Annex 5.6 provides a list of waste handling service providers approved by the National Environment Management
Authority (NEMA).
3.3.2 Segregating SMC Waste
To ensure both safety and cost-efficiency, it is essential to segregate SMC waste at the point of generation using
recommended colour-coded waste bins with corresponding liners.
Box 5: Waste Collection Supplies for SMC procedure
• Black waste bin with corresponding liner

• Safety box for sharps*
• Three red containers with corresponding liners:
o blunt surgical instruments
o highly infectious waste generated from used items
o the removed skin (pathological waste)
• Brown container for immediate disposal of used pharmaceuticals
*For sharps waste, the used sharp should be placed into a proper sharps container immediately after use; do not temporarily rest the used sharp on any
surface or in a kidney dish
Figures 6 and 7 summarize how SMC waste should be segregated and treated prior to disposal. Note that each category
of waste will need differing treatment and disposal methods.
Figure 8: SMC Waste Segregation Chart
SMC Waste Streams
Higly infectious
Blunt Highly infectious pathological
General Waste Sharp instruments instruments waste waste Pharmaceuticals
Paranet Gauze
Forceps
Surgical gloves
Mosquito
Packaging Gauze (12 ply)
forceps
materials
(curved)
(uncontaminated) Multi-purpose tray
Sutures
Forceps
Non- Examination
Needle and (straight) Removed
contaminated gloves Lignocaine
attached syringe foreskin
plastic containers Mosquito
Alcohol swabs
Scalpel forceps
Cans/bottles for (straight)
soft drinks and O-drape towel
water Needle holder
Surgical tape
and scissors
plaster
combo
Apron
3.3.3 Treatment of SMC Waste Streams
Figure 9: Handling and Treatment of SMC Waste
Treatment of SMC Waste Streams
Higly infectious
Sharp Blunt Highly infectious (pathological
General Waste instruments instruments waste waste) Pharmaceuticals
Does not need Seal the sharps Disinfection Double bag when Seal and store in
At static facility
special treatment box when ¾ full ¾ full a secure
dispose of tissue in
temporary
a placenta pit
Seal the bag storage area
immediately after
when ¾ full
completing daily
surgery (pour out
from bin liner).
Dispose of the
used bin liner with
infectious waste
Store in a secure Store in a secure followed by Store in a secure If at an outreach Hand over to
temporary temporary autoclaving temporary (non-static): double licensed HCW
storage area storage area storage area bag and place in a handling service
tightly closed rigid provider
red container.
Dispose of in a
placenta pit at the
nearest static
health facility
Manage as
metal scrap
3.3.4 Decontamination and Disposal of Used Instruments
Before final disposal of disposable instruments (metal scrap), decontamination is required. Regardless of what final
disposal method is chosen, this step is essential. Decontamination is achieved by presoaking and manually cleaning
disposable non-sharp metal instruments in a sodium hypochlorite solution. After decontamination, the instruments must
be thoroughly rinsed of all chemicals with potable water and dried before undergoing sterilization or transport. Figure 8
provides step by step information on the processes for mixing the sodium hypochlorite solution (disinfectant) and the
cleaning procedure. It is important to note that hypochlorite is available in various solutions. Figure 10 provides
information on how to produce a 0.5% solution for concentrations in the ranges of 3-5%, and 6-10%. For solutions outside
this range, you can use the formula provided below to make the 0.5% solution for use during disinfection of equipment.
Formula for dilution of JIK (hypochlorite solution)
• Check the container for information on the concentration of the hypochlorite you have as provided by the
manufacturer. Let us assume that this concentration is A%.
Concentration availed by the manufacturer (A %) - 1 = parts of water needed for dilution
Desired solution (0.5%)
If A = 6% then 6% = 6/100 = 0.06; 0.5% = 0.5 /100 = 0.005.
(A %) -1 = 0.06 - 1 = 12-1 = 11 parts of water.
(0.5%) 0.005
This means that for every one cup of JIK with a concentration 6%, 11 cups of water are required to achieve the correct
(0.5%) solution for use during disinfection. Please note that the number of cups of water needed will change depending on
the hypochlorite concentration provided by the manufacturer.
Once the disposable metal instruments have been decontaminated, they can then be autoclaved to render them non-
hazardous. Once autoclaved, the instruments can be transported in a vehicle that also carries usable products, provided
the instruments are safely containerized and labeled correctly for identification purposes. They should be handled,
packed, and stacked with care such that they cannot topple or break during transit, with all packaging and containers
remaining wholly intact en route to their destination. For instruments that are disinfected but not autoclaved, a licensed
company must be contracted to transport, autoclave, and then properly dispose of the instruments.
Internationally recognized methods of disposal for disposable non-sharp metal instruments include smelting (recycling)
and encapsulation. Smelting (recycling) is the process of turning used materials (waste) into new products; the metal is
melted down for reuse. Encapsulation involves immobilizing the metal instruments in a solid block within a plastic or steel
drum. The drums are filled to 75% capacity with non-sharp metal instruments, and the remaining space is filled by pouring
in a medium such as cement, plastic foam, or bituminous sand.
Figure 10: How to Decontaminate Instruments (See enlarged images in Annex 5.6)
Source: Supply Chain Management System (SCMS)
3.3.5 Summary of Treatment and Disposal Methods for SMC Kit Components
Table 4: Male Circumcision Kit Component Disposal Methods: Health Care Facility Level
Compo- Disinfect Autoclave Auto- Micro- Encap- Safe High Single Open
nent with with clave– wave sulation bury- temperature cham- air
o
bleach, shredding– munici- irradia- ing (850 C ) ber– burn-
auto- Municipal pal tion– incineration bury ing–
clave Landfill landfill municipal –bury ashes ashes bury
landfill or municipal or ashes
landfill munici-
pal
landfill
Plastic Most Most X X X Least
contain- preferred preferred pre-
er tray ferred
O-drape Most Most X X X Least
preferred preferred pre-
ferred
Surgical Most Most X X X Least
crepe preferred preferred pre-
paper ferred
paper preferred preferred preferr
tape ed
Plastic Most Most X X X Least
apron preferred preferred pre-
ferred
Alcohol Most Most X X X Least
swab preferred preferred pre-
ferred
Gauze Most Most X X X Least
swab preferred preferred pre-
ferred
Paraffin Most Most X X X Least
gauze preferred preferred pre-
ferred
gloves preferred preferred pre-
ferred
Exam- Most Most X X X Least
ination preferred preferred pre-
gloves ferred
Syringe Most X X X
with preferred
needle
Injection Most X X X
needle preferred
Suture Most X X X
with preferred
needle
Scalpel Most X
with preferred
handle
Compo- Disinfect Autoclave Auto- Micro- Encap- Safe High Single Open
nent with with clave– wave sulation bury- temperature cham- air
o
bleach, shredding– munici- irradia- ing (850 C ) ber– burn-
auto- Municipal pal tion– incineration bury ing–
clave Landfill landfill municipal –bury ashes ashes bury
landfill or municipal or ashes
landfill munici-
pal
landfill
Needle Most X X X
holder preferred
Suture Most X X X
scissors preferred
Circum- Most X X X
cision preferred
forceps,
haemo-
static
Mosqui- Most X X X
to preferred
clamp,
straight
Mosqui- Most X X X
to preferred
clamp,
curved
Plastic Most X X X X X
forceps preferred
Tissue Most X X X
waste preferred
Note: After successful autoclaving, reusable stainless steel instruments can be centrally collected and reallocated to hospitals and health care facilities
in need of this instrumentation.
Single use instruments should be handed to licensed vendors dealing in steel re-processing.
Key: [X] Can be used as alternative option
Figure 11: SMC Sites and HCWM Availability
4.0 REFERENCES
1. Ministry of Health (MOH) [Uganda] and ORC Macro, Uganda HIV/AIDS Sero-behavioural Survey 2004-2005,
2006: Calverton, Maryland, USA: Ministry of Health and ORC Macro.
2. Uganda Bureau of Statistics (UBOS) and ICF International Inc, Uganda Demographic and Health Survey 2011,
2012, UBOS and Calverton, Maryland: ICF International Inc.; Kampala, Uganda.
3. Office of the United States Global AIDS Coordinator and PEPFAR, U.S. President’s Emergency Plan for AIDS
Relief Five-Year Strategy, 2004. Washington, DC: PEPFAR.
4. Weiss, HA, Quigley, MA, and Hayes, RJ, Male circumcision and risk of HIV infection in sub-Saharan Africa: a
systematic review and meta-analysis. AIDS, 2000. 14(15): p. 2361-70.
5. Siegfried, N, et al. HIV and male circumcision—a systematic review with assessment of the quality of studies.
Lancet Infectious Diseases, 2005. 5: p. 165-173.
6. Auvert, B, et al. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk:
the ANRS 1265 trial. PLoS Medicine 2(11): e298. 2005. 2(11): p. e298.
7. Wawer, MJ, et al. Circumcision in HIV-infected men and its effect on HIV transmission to female partners in
Rakai, Uganda: a randomised controlled trial. The Lancet, 2009. 374(9685):p. 229-237.
8. Bailey, RC, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomized controlled
trial. The Lancet, 2007. 369: p. 643-56.
9. WHO/UNAIDS, WHO/UNAIDS Technical Consultation on Male Circumcision and HIV Prevention: Research
Implications for Policy and Programming, Montreux, 6-8 March 2007. New data on male circumcision and HIV
prevention: policy and programme implications. Accessed on 03/29/2013:
http://www.who.int/hiv/pub/meetingreports/mc_montreux_march07/en/, 2007.
10. Waste management, “What is Waste Management?” accessed on 03-30-2013, www.docstoc.com/docs/6460637/

what_is_waste_management.html, 2009.
11. SCMS, Recommendation Options for the Disposal of Decontaminated Surgical Instruments, 2012.
12. Hutin, Yvan JF, Hauri, AM , and Armstrong, GL. Use of injections in healthcare settings worldwide, 2000:
literature review and regional estimates. British Medical Journal, 2003; 327(7423): p.1075.
13. MoH [Uganda], A study on improvement of health care waste management in Uganda, 2003, Infrastructure
Department, Kampala, Uganda.
14. MoH [Uganda], Approaches to Health Care Waste Management: Health Workers Guide, 2009, Making Medical
Injections Safer (MMIS) Project: Kampala, Uganda.
5.0 ANNEXES
Annex 5.1 List of Health Facilities Participating in SMC Supported by USG IPs
o.
S/N NAME OF FACILITY LEVEL OF FACILITY LOCATION OF THE FACILITY
SPEAR
UGANDA POLICE FORCE (UPF)
1. Kibuli Police Training School HCIII Kampala
2. Naguru Police Kampala HCIII Kampala
3. Kabalye Police Training HCIII Masindi
4. Masaka Police HCIII Masaka
5. Mbale Police Clinic Mbale
6. Gulu Police Clinic Gulu
7. Arua Police Clinic Arua
UGANDA PRISONS SERVICES (UPS)
1. Muchsion Bay Hospital Kampala
2. Masaka Prison HCIII Masaka
3. Mbarara Prison HCIII Mbarara
4. Gulu Prison HCIII Gulu
5. Mbale Prison HCIII Mbale
6. Masindi Prison HCIII Masidi
7. Fortportal (Katojo) Prison Kabarole
8. Arua Prison Arua
9. Jinja Prison Jinja
STAR-EC
1. Bugiri Hospital Bugiri
2. Kamuli Hospital Kamuli
3. Iganga Hospital Iganga
4. Kigandalo HC IV
5. Kityerera HC IV
6. Kiyunga HC IV
7. Nsinze HCIV
8. Bugono HC IV
9. Busesa HC IV
10. Bujinja HC IV
11. Namwendwa HCIV
12. Nankandulo HCIV
13. Kidera HCIV
14. Nankoma HCIV
15. Mayuge HCIII Mayuge
16. Namugalwe HCIII
17. Bulesa HCIII
18. Mway HCIII
o.
19. Bumanya HCIV
STAR-E
1. Budaka HCIV Budaka
2. Kaderuna HCIII Budaka
3. Bududa Hospital Hospital Bududa
4. Bukwa HCIV Bukwa
5. Bukwa Hospital Hospital Bukwa
6. Bulumbi HCIII Busia
7. Dabani Hospital Hospital Busia
8. Busia HCIV Busia
9. Lumino Busia
10. Masafu Hospital Hospital Busia
11. Busolwe Hospital Hospital Butaleja
12. Nabigande HCIII Butaleja
13. Kapchorwa Hospital Hospital Kapchorwa
14. Kibuku HCIV Kibuku
15. Kapchorwa HCIV Kween
16. Bujambo HCIV Mbale
17. Busiu HCIV Mbale
18. Butebo HCIV Pallissa
19. Pallisa Hospital Hospital Pallissa
20. Budadiri Sironko
21. Buwasa HCIV Sironko
22. Muyembe HCIV Bulambuli
HIPS
1. Scoul Buikwe
2. Mabonge Buikwe
3. Nile Breweries Clinic Buikwe
4. Bulisa HCIV Bulisa
5. McHood Russels Clinic Bushenyi
6. Kyehoro- HC III Hoima
7. Kakira Sugar Hospital Jinja
8. Busirasgama (Rwenzori C) Kabarole
9. Mpanga Tea Kabarole
10. SIMLS Medical Center Kampala
11. Kitintale Medical Center Kampala
12. Old KAMPALA Hospital Kampala
13. Kyadondo Medical Center Kampala
14. Philomena Health Center Kampala
15. St Joseph's Clinic Wandegeya Kampala
16. Safe Guard Nursing Home Kampala
17. Uganda Baati Clinic Kampala
18. Mirembe Medical Care HC Kampala
o.
19. Community Health Plan Kampala
20. Hima Cement Kampala
21. KCCL Kasese
22. St Ambrose Kibale
23. EMESCO Kibale
24. New Format Clinc-l Kiboga
25. Kiruhura Engain Community Kiruhura
26. Family Health Resource Center Kiruhura
27. Nyero Health Center Kumi
28. Malata Tea Kyenjojo
29. Kigumba Rwenzori Tea Kyenjojo
30. Mwenge HCIII Kyenjojo
31. Ayira Nirango Home Lira
32. Lambu HCIII Masaka
33. Kinyara Sugar Works masindi
34. Double care Mpigi
35. People’s Medical Centre Mubende
36. Luwero Industries Ltd Nakasongola
37. Kyolera Community-Based Health Rakai
38. Executive Medical Centre Wakiso
39. St. Marys Medical Centre Wakiso
40. Wagagai Clinic Wakiso
41. Kireka SDA Wakiso
42. Boots Medical Wakiso
43. Uganda Clays Clinic Wakiso
UEC
1. Aber Hospital
2. Kalongo Hospital
3. Kamwokya Christian Caring
4. C it
Kasanga Primary Health Care
5. Nkozi Hospital
6. Nsambya home care
7. Nyenga Hospital
8. St Daniel Comboni Kyamuhunga
9. St Joseph Kitgum
10. St Mary's Lacor
11. Villa Maria Hospital
12. Virika Hospital
UPMB
1. Amai Hospital
2. Azur HCIV Hoima
3. Bushenyi Medical Centre Bushenyi
4. Family Hope Centre - Kampala Kampala
o.
5. International Hospital - Kampala Kampala
6. Kabarole Hospital Kabarole
7. Kabwhowe Clinical
8. R h t (KCRC)
Ruharo Hospital
BAYLOR
EASTERN REGION
1. Amuria HCIV Amuria
2. Bukedea HCIV Bukedea
3. Kaberamaido HCIV Kaberamaido
4. Katakwi HCIV Katakwi
5. Atutur Hospital Kumi
6. Mukongoro HIII Kumi
7. Nyero HCIII Kumi
8. Ngora hospital Ngora
9. Serere HCIV Serere
10. Princes Diana HCIV Soroti
WEST NILE REGION
11. Omugo HCIV Arua
12. Oli HCIV Arua
13. Adumi HCIV Arua
14. Rhino Camp HCIV Arua
15. Koboko HCIV Koboko
16. Pakwach HCIV Nebbbi
17. Adjumani hospital Adjumani
18. Yumbe Hospital Yumbe
19. Maracha Hospital Maracha
20. Obongi HCIV Moyo
21. Midingo HCIV HCIV Moyo
22. Paidha HCIV Zombo
AIC
1 Kabale Region Centre Kabale
2 Mbarara Region Centre Mbarara
3 Kampala Region Centre Kampala
4 Jinja Region Centre Jinja
5 Mbale Region Centre Mbale
6 Soroti Region Centre Soroti
7 Lira Region Centre Lira
8 Arua Region Centre Arua
AMREF
1 Apac Hospital (Nu-Hites) Hospital Apac
2 Apwori (Nu-Hites) HCIII
3 Bukasa HCIII
4 Bukuya HC Bukuya
o.
5 Bulondo HCIII
6 Buwambo HCIV
7 Bwendero HCIII
8 Bweyogerere HCIII Bweyogere
9 Chawente (Nu-Hites) HCIII
10 Entebbe Hospital Hospital Entebbe
11 Kajjansi HCIII Kajjansi
12 Kalagala HCIV
13 Kalangala HCIV
14 Kasaala HCIII
15 Kasambya HCIII
16 Kasangati HCIV
17 Kassanda HCIII Kassanda
18 Kiganda HCIV Kiganda
19 Kigungu HCIII
20 Kinyogoga HCIII
21 Kiwoko Hospital Hospital
22 Kiyuni HCII
23 Kiziba HCIII
24 Kyabbagu HCIII
25 Kyantungo HCIII
26 Lulamba HCIII
27 Luwero HCIV Luwero
28 Mazinga HCIII
29 Mildmay Uganda
30 Mityana Hospital Hospital
31 Mubende Hospital Hospital
32 Mwera HCIV
33 Nabiswera HCIII
34 Nabweru HCIII
35 Nakaseke Hospital Hospital
36 Nakasongola HCIV Nakasongola
37 Nakasongola Military Hospital Hospital Nakasongola
38 Naluvule
39 Namayumba HCIV Namayumba
40 Nambieso (Nu-Hites) HCIII
41 Ndejje HCIV Ndejje
42 Ngoma HCIV
43 Nyimbwa HCIV
44 Semuto HCIV
45 Teboke (Nu-Hites) HCIII
46 Wakiso HCIV Wakiso
47 Zirobwe HCIII
o.
STAR-SW
1 Bushenyi HCIII Bushenyi
2 Kyabujimbi HCIV Bushenyi
3 Kitgata Hospital Sheema
4 Kabwohe HCIV Sheema
5 Kisoro Hospital Kisoro
6 Mutorere Hospital Kisoro
7 Rubuguli Kisoro
8 Nsiika HCIV Buhweju
9 Rugazi HCIV Rubirizi
10 Kebisoni HCIV Rukungiri
11 Bugangari HCIV Rukungiri
12 Nyakibale Rukungiri
13 Rukungiri HCIV Rukungiri
14 Rwashamaire HCIV Ntugamo
15 Rubaare HCIV Ntungamo
16 Kitwe HCIV Ntungamo
17 Itojo Hospital Ntungamo
18 Mparo HCIV Kabale
19 Rubaya HCIV Kabale
20 Hamura HCIV Kabale
21 Kamwezi HCIV Kabale
22 Rugarama HCIV Kabale
23 Muko HCIV Kabale
24 Maziba HCIV Kabale
25 Kamukira HCIV Kabale
26 Mitooma HCIV Mitooma
27 Rushere Hospital Hospital Kiruhura
28 Kazo HCIV Kiruhura
29 Isongoro HCIV Ibanda
30 Ruhoko HCIV Ibanda
31 Ibanda Hospital Ibanda
32 Kambuga Hospital Kanungu
33 Kihihi HCIV Kanungu
34 Bwindi Hospital Kanungu
35 Kabuyanda HCIV Isingiro
36 Rwekobo HCIV Isingiro
37 Ruhiira HCIII Isingiro
38 Nshungyezi HCIII Isingiro
39 Nakivale HCIV Isingiro
40 Rubondo HCII Isingiro
41 Nyamuyanja HCIV Isingiro
Summary of SMC Facilities (March 2013)
No Project No. Health Facilities

1 SPEAR Project 16
2 STAR-EC 19
3 STAR-E 22
4 HIPS Project 43
5 UCE 12
6 UPMB 8
7 BAYLOR 22
8 AIC 8
9 AMREF 47
10 STAR-SW 41
Total 238
As submitted by USAID and CDC implementing partners – March 2013
Annex 5.2 Laws and Regulations - Health Care Waste Management

 The Uganda Constitution (1995) under Article 17, “it is the duty of every citizen of Uganda to create and protect a
clean environment,” Article 50 (2) stipulates controls as to what should be done in case of rule violations.
 The National Environment Act (1995) makes NEMA responsible for protection of the environment.
 The Water Act of 1995 – stipulates rights in water, planning for water use, control on use of Water Resources and
Water Works. It prohibits pollution of water sources.
 The Land Act of 1998 protects land resources and stipulates regulations against misuse.
 The Public Health Act 2000 prohibits the existence of a nuisance on any premises and stipulates the penalties to
defaulters.
 The Local Government Act and the Urban Authorities Acts 1997:
- Gives the mandate of operation of local health units under the mandate of local government or urban
authorities
- Authorizes the local authorities to remove all waste from towns and municipal councils.
 Basel Convention 1992 (UN) signed by 100 nations – polluter pays principle. Controls trans-boundary movement
of hazardous waste. Calls for environmentally sound disposal methods.
 Stockholm Convention (2001) - global treaty to protect human health and environment from persistent organic
pollutants (POPs), specifically dioxins and furans. Commits all parties to reduce release of dioxins with goal of
continued minimization and where feasible, ultimate elimination.
Annex 5.3 Estimated Volumes of Waste
The table shows the estimated volumes of waste that will be generated by SMC IPs supported by PEPFAR in the year
2013.
Total number Number of Number of Number of Estimated volume

projected SMC procedures procedures disposable kits (kg) of waste that
procedures in (Static health (Outreach that will be used will be generated
FY 2012/2013 facilities) settings) in the district
STAR-E 90,000 90,000 -- 90,000 45,000

STAR SW 100,420 80,336 20,084 90,378 50,210
NU-HITES 100,000 45,000 55,000 80,000 50,000
Uganda HIV/AIDS
21,011 3,200 17,811 22,000 10,506
in military project
HIPS 22,640 5,720 16,920 18,150 11,320
SPEAR 48,596 8,565 40,031 36,626 24,298
382,667 232,821 239,846 337,154 191,334

TOTAL
Note: It is estimated that each SMC procedure generates 0.5 kg of waste.
Annex 5.4 Managing HCW Using a Centralized System
This is a sample flow chart of managing HCW using a privately contracted centralized transportation, treatment and
disposal service.
Waste Double Loading on

segregation bagging Weighing trucks
and Transporting
and
containment recording
Treating
waste,
Invoicing Data Disposal including Off loading
compilation disinfecting
waste bins
Procurement
of waste
handling Distributing waste
Receiving materials / handling
payment Fueling of materials to the
vehicles health facilities
Annex 5.5 List of General Hospitals with Installed Incinerators (March 2013)
Hospitals with Recently Installed Incinerators
REGIONAL GENERAL
REGION HOSPITAL STATUS HOSPITALS STATUS
LOT 1 Mubende Installed Kigadi Installed

Mityana Installed
Kawolo Installed
Kayunga Installed
Fort Portal Installed Bundibugyo Installed
LOT 2 Masaka Installed Kalisizo Installed

Lyantonde Installed
Gombe Installed
LOT 3 Hoima Being Installed Masindi Installed
Kilyandongo Being Installed
Nakaseke Installed
LOT 4 Lira Being Installed Kitgum Being Installed

Anaka Being Installed
LOT 5 Mbarara March 2013 Itojo March 2013

Kabale March 2013 Kambuga March 2013
Kitagata March 2013
LOT 6 Moroto April 2013 Abim April 2013

Soroti April 2013 Kapchorwa April 2013
Mbale April 2013 Pallissa May -2013
Iganga May -2013
Tororo May -2013
LOT 7 Arua June 2013 Nebbi June 2013

Yumbe June 2013
Moyo June 2013
With permission from the MoH Infrastructure Department.
Annex 5.6 Licensed Waste Handling Service Providers (March 2013)
NO. LICENSEE ADDRESS/CONTACT TYPE OF WASTE HANDLED

INFORMATION LICENSE
TRANSPORTATION OF DOMESTIC / MUNICIPAL SOLID WASTE
1 T&D Cleaning Ltd Plot 16, Entebbe Kitoro Transportation Domestic waste
Road P.O. Box 10146
Tel: 414669860
Mob: 0712 839237
2 Green Hope Uganda P.O Box 9244 Kampala Transportation Domestic waste
Ltd Mobile:0772 486398
0712 776622
3 Kibanyi and Sons Plot14 Kanjokya Street Transportation Domestic waste
Company Ltd P.O Box 7668 Kampala
Tel: 0702 366790
0775 424855
4 JuaKaali Nakivubo Plot 54/56 William Street Transportation Domestic waste
Shauriyako P.O. Box 30554 Kampala
Association Tel: 0753895745
0782206802
5 Kikuubo Business P.O Box 511 Kampala Transportation Domestic Waste
Community Ltd Tel: 0772 503765
6 Pilling Environment P.O Box 35641 Kampala Transportation Domestic waste
Ltd Tel: 0782319778
0789 696781
INFORMATION LICENSE
7 Globe Clean Plot 318, Old Kira Rd, Transportation Domestic Waste
services Kamwokya-Kampala
8 Koyinawo Trading P.O. Box 1341 Mbarara Transportation Domestic Waste

Company Ltd Tel: 0752 422860
9 Eco Projects Ltd Plot133,Portbell Rd, Luzira Transportation Domestic waste
P.O Box 4994 Kampala
Tel: 0772332108
10 Bin-It Services Plot89,Kirard,Kamwokya Transportation Domestic waste
TRANSPORTATION OF INDUSTRIAL/HAZARDOUS
11 Array Services Ltd P.O Box 16125 Kampala Transportation Hazardous waste
Tel: 0312517749,
0701840969
12 Specialised P. O Box 11022 Kampala Transportation Used oils
Technical Tel: 0414510360
Services Ltd
13 Scrap Center (U) Mussajjallubwa Road, Off Transportation Scrap materials
Ltd Rubaga Road. 0772436856
14 Epsilon (U) Ltd Plot 1413, Mbogo Road Transportation Hazardous wastes
P.O. Box 12647 Kampala
0414 252 076
15 Green Label P.O Box 40303 Kampala. Transportation Hazardous waste
Services Ltd Tel: 0414532235
16 BioWaste Plot 64, Kisanjufu, Transportation Hazardous Waste
Management (U) Ltd Kyampisi, Mukono district.
Tel: 0772482448
17 Maziba Holdings Ltd P.O.Box 5565, Kampala Transportation Scrap materials
Contact person: Samuel
Seguya, Tel: 0772588058
18 Eco Projects Ltd Plot 133, Portbellrd, Luzira Transportation Hazardous Waste
Tel: 0772332108
STORAGE OF HAZARDOUS WASTE
19 CNOOC Ug Ltd P.O. Box 3673 Kampala Storage Hazardous waste
20 Episilon (U) Ltd Plot 1413, Mbogo Road Storage Hazardous waste
P.O. Box 12647 Kampala
0414 252 076
21 Hariss International Plot 83, Bombo Rd, Storage Hazardous waste
Ltd Kawempe P.O. Box 24972
Kampala
OWN/OPERATE A WASTE TREATMENT /DISPOSAL FACILITY
22 Quality Chemical P.O. Box 32871 Kampala Own/Operate a Industrial effluent
Industries Ltd Tel:0776997647 Waste treatment
facility
(incinerator)
23 NLS Waste Services Plot 17 Martyrs Way Ntinda Own/Operate a Medical waste
Ministers’ Village waste treatment
Tel: 0772 400995 plant
24 Bio Waste Plot 64, Kisanjufu, Own/Operate a Medical waste
INFORMATION LICENSE
Kyampisi, Mukono district. waste treatment
Tel: 0772482448 plant
25 Mukono Municipality P. O. Box 201 Mukono Katikolo Village, Compost/municipal waste
Council Mukono disposal plant
26 Jinja Municipal P. O. Box 720 Jinja Masese Compost/municipal

OTHER SERVICE PROVIDERS
27 Steel Rolling Mills Plot M-78 Tororo Road Own/operate a Steel and Metal
Ltd P.O.Box2243 Jinja Metal scrap manufacturers
Tel. 0434-120937 recycling plant (metal scrap)
0434-120978
srm@alarm-group
28 Bajo Glass Seeta off Bukerere Road Own/Operate a Glass recycling
Tel 0774 794 611 Glass recycling
plant
Source: Adapted with permission from NEMA
Annex 5.7 Decontamination Process

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AUGUST 2013

ACP AIDS Control Programme

HCW health care waste

HCWM health care waste management

MoH Ministry of Health

NDA National Drug Authority

NEMA National Environmental Management Authority

PEPFAR U.S. President’s Emergency Plan for AIDS Relief

PHC primary health center

PMTCT prevention of mother-to-child transmission

POP persistent organic pollutants

SMC safe male circumcision

STI sexually transmitted infections

UAC Uganda AIDS Commission

UNBOS Uganda National Bureau of Standards

USG U.S. Government

WHO World Health Organization

Dr. Isaac Ezati

1.1 HIV Situation in Uganda

1.2 National Response to the Epidemic

1.3 Male Circumcision

1.4 Supply Chain Considerations

1. HIV testing and counseling

1.5 Health Care Waste Management as a Challenge to Achieving Desired Targets

Infectious Has living organisms in it that are capable of causing disease.

2.2 Risks Caused by Poor Management of Health Care Wastes

Risk to the Public

Indirect Risks via the Environment

Comprehensive System Awareness and Training Selection of Options

Figure 2: Critical Steps in Health Care Waste Management

Figure 3: Colour-Coding for Waste Segregation

Table 2: Recommended Techniques for Treatment of Infectious Waste

Recommended treatment technique

Steam High Burning and Chemical Thermal

Isolation waste Highly Highly Not Not

Human blood Highly Highly Not

Pathological Highly Highly Not Not

Contaminated Highly Highly Not

Carcasses and Highly Highly Not Not

Bedding Not Highly

Blunt surgical Not Not

2.3.3 Storage and Transportation of Waste

Table 3: Waste Treatment and Disposal Methods

Waste treatment and disposal methods Description

Figure 5: Roles of Stakeholders

National regulations must be observed

It is essential that every health facility develop

Infectious waste must be treated properly to

All health care workers must receive

All health care facilities and settings have a

3.1 Identifying SMC Waste Generation Points

Figure 6: SMC Health Facility Client Flow and Waste Generation

Figure 7: Flow Chart for SMC Waste Generated at an Outreach Site

Waste Non infectious Burn at site of

Put sharps in safety box /Double

Transport to health facility

3.3.1 How to Select a Waste Handling Service Provider

Box 4: Criteria for Selecting a Waste Handling Service Provider

• An existing company with knowledge and skills in disposing of HCW.