1. Background
FHI 360 is a global organization that mobilizes research, resources, and relationships so
people everywhere have access to the opportunities they need to lead full and healthy lives.
With collaborations in over 60 countries, we work directly with local leaders to advance
social and economic equity, improve health and well-being, respond to humanitarian crises,
and strengthen community resilience. We share data-driven insights and scalable tools that
expand access and equity so communities can effectively address complex challenges,
respond to shocks, and achieve thriving futures.
FHI 360 has been working in Nepal since 1993 in the areas of HIV/AIDS, family
planning/reproductive health, nutrition, antimicrobial resistance, environment, COVID-19
response, procurement and supply chain management, capacity building, civil society and
media strengthening, and governance reform. FHI 360’s work is grounded in evidence and
aligns with and provides support to the Government of Nepal’s development priorities and
plans.
Meeting Targets and Maintaining Epidemic Control (EpiC) Nepal supported by the United
States Agency for International Development (USAID) and The US President’s Emergency
Plan for AIDS Relief (PEPFAR) and implemented under the global EpiC Project in
collaboration with National Center for AIDS and STD Control (NCASC) and National Public
Health Laboratory (NPHL), provides continuum of HIV prevention, care and treatment
(CoPCT) services among female sex workers (FSWs), clients of FSWs, men who have sex with
men (MSM), male sex workers (MSW), transgender people, other high risk individuals who
do not identify themselves as key populations (KPs) and people living with HIV (PLHIV) in 37
project’s districts of Nepal.
EpiC Nepal, through USAID’s support, is supporting the Ministry of Health and Population
(MoHP), Government of Nepal (GoN) to optimize COVID-19 testing, treatment, case
management and prevention, and to mitigate COVID-19 transmission, morbidity, and
mortality, as well as to strengthen the resilience of Nepal’s health system to prevent, detect
and respond to the current and future pandemics. EpiC Nepal provides support for COVID-
19 testing including COVID-19 genome sequencing; oxygen ecosystem; COVID-19 case
management; logistics supply chain management; capacity building on essential critical
care; COVID-19 vaccine storage, delivery, deployment, and administration; and technical
assistance for capacity building on USAID-donated ventilators.
The delivery of health services generates considerable amount of wastes. Besides, general
waste, it also generates substantial amount of hazardous waste which includes laboratory,
pharmaceutical waste, sharps such as needles, and biohazard waste such as sample of
potentially infected lab cultures, body parts and additional amount of e-waste. Poor
management of such hazardous waste can be easily exposed to health care workers, waste
handlers, patients, communities and can have negative impacts on environment too. Hence,
it is essential that all health care wastes are segregated at point of source, appropriately
handled, properly treated and safely disposed. For safety of people and clean environment,
public health service act 2075, National Health Policy 2076 and Public Health Regulation 2077
have ensured safely management of all kinds of waste generated during health services.
Based on those documents, Government of Nepal (GoN) has introduced the “National
health care waste management standards and operating procedure- 2020”, which covers
all the aspects of health care waste management (HCWM) such as development of HCWM
implementation plans, management and oversight and the technical aspects related to
waste management in the health care facilities.
In 2076, GoN prepared documents outlining the minimum services standards for the
different level of health care facilities, specifically primary hospitals with general services,
primary hospital with specialized services, secondary hospital, tertiary hospital and health
post. These standards cover a range of issues for the health care facilities, “hospital waste
management” including a scoring system for the segregation, collection and
transportation, treatment and disposal of waste for the different levels of health care
facilities. A waste management plan requires a partnership with a hospital which has its
own waste management capacity. A comprehensive plan to implement HCWM system at
facility level is essential for safe, sustainable and efficient waste management in health care
facilities (HCFs) while steps related to implementation of HCWM system are listed below:
1. Health care waste management committee formation
2. Waste assessment
3. Planning
4. Treatment center designing and construction
5. Transportation route planning
6. Testing of the treatment technology
7. Capacity building and sensitization
8. Initiation of the system
9. Supportive supervision and continuous monitoring
While developing the waste management plan, the first step is diagnostic assessment of the
waste generated within the facility. The assessment begins by establishment of a baseline
of how much and what kind of waste is being generated by each department or ward. This
involves gathering data regarding the waste streams, processes and operations, types of
practices, information on input materials, economic information and data collected for few
days provides the waste flow in the HCF. Assessing the waste over the period of seven
continuous days provides a clearer picture of waste generation, as the waste generation
pattern differs from day to day. Through this data, the HCF can establish the flow of waste
and generation rates from every unit and department of the HCF. Waste composition data
can be used to analyze segregation practices. Data from the waste generation survey
should form the basis for the HCWM information system and the development of an HCWM
plan as well as a strategic plan at the local, provincial, and federal level.
Hence, an experienced organization working in the relevant field is required to conduct the
Diagnostic assessment of HCF to trace the activities emphasizing the implementation of
waste management procedures.
2. Detailed Scope of Work
The assignment’s main objective is to conduct a diagnostic assessment of 12 HCFs in
Lumbini Province. The identified HCFs are listed as follows:
1. Arghakhanchi Hospital
2. Bhim Hospital
3. Gulmi District Hospital
4. Kapilvastu Hospital
5. Lamahi PHC, Basic Hospital
6. Parasi District Hospital
7. Pipra Hospital
8. Pyuthan District Hospital
9. Rampur Hospital
10. Rolpa Hospital
11. Rukum East Hospital
12. Sushil Koirala Prakhar Cancer Hospital
The overall objectives of the assignment are as follows:
1. Carry out waste audit or diagnostic assessment (1 day for pre-testing + 7 days for the
assessment) at HCFs and analyze the patterns of waste generation for HCWM system.
2. Detailed waste characterization study based on existing Standard Operating Procedure
(SOP).
3. Identify necessary logistic items/supplies with specifications and cost estimation for
developing sustainable HCWM system.
In order to achieve the objectives, the following activities, but not limited to, will be carried
out:
1. Conduct consultation meetings and/or workshop with relevant stakeholders of the
Provincial Health Directorate, Ministry of Social Development, and local level
government to develop integrated waste management approach and other supporting
documents such as approaches, municipal policy for waste management, business
models, etc. for implementation of integrated solid waste management.
2. Review different acts and regulations of HCWM.
3. Carry out the hospital level assessment, including meetings and discussions with various
stakeholders for HCWM related issues/problems and possible solution.
4. Identify existing status, practices of waste management through primary data collection
for healthcare waste.
5. Incorporate feedback and comment and finalize the report disposal as per recyclability.
6. Prepare the presentation for communication to local level decision-makers.
7. Report after completion of an assignment.
