Value in waste

KMC’s pilot project’s success could lead to similar projects in other municipalities and involvement of the private sector on a bigger scale

Sujata Awale
Kathmandu

Solid waste management is always an uphill task for Kathmandu Metropolitan City (KMC). To manage organic waste, for the first time in Nepal, KMC with support from the European Union (EU) has successfully installed a waste-to-energy plant at the Teku transfer centre. The project has been initiated as a one-year pilot project. The system will consume three tonnes of solid organic waste daily and produce 14 kilowatts of electricity.

Besides producing electricity, the plant will also produces 300 kilograms of bio-organic fertiliser, 300 cubic metre of biogas along with 1,500 litres of treated water. Stakeholders stated that the project is a positive step to manage solid waste in a sustainable way.

Leading by example

According to the KMC, they collect 500 tonnes of waste every day and 70 per cent of that waste is organic. “With the successful installation of the project, it will surely help the metropolitan city to manage its organic waste on a daily basis,” said Gyanendra Karki, Spokesperson of the KMC. He further said, “It will cut down the expenses of the municipality on managing solid waste each year.”

Karki informed that each year KMC spends Rs 500 million in fuel, staff and other development activities at the Sisdole dumping side. He further said, “If this pilot project is successful, waste can be managed at its source by establishing this technology.” As of now, the plant will consume the organic waste of ward number 12, 15, 18 and 20.

Citing that they are waiting for the results, he said, “We will study this pilot project and plan accordingly for the future.” Being optimistic about the project, he said, “Waste that was the main source of pollution can be used for generating electricity, water, bio-gas and fertiliser which is indeed a good step in managing waste sustainably.” According to KMC, the electricity generated will be used for street lights and operation of the KMC office.

“Though we started on a small scale, this project will set an example,” said Rabin Man Shrestha, Chief of Environment Management Division at KMC and Director of the project. He further said that if the project is a success, they will use the technology broadly. “We have initiated plans to separate organic from non-organic waste, however, it will take time to bring awareness and change,” Shrestha said, adding that separating the waste is the main challenge they are facing at present.

According to him, the waste-to-energy project is a three-year project initiated in 2014 and will end in February, 2017. The KMC awarded the contract by joint venture to Raj and Riwaz, Nepalese Waste and Xeon companies to import machinery and establish a 14 kilowatt electricity plant. The equipment was imported from Pune, India. The project was 80 per cent funded by the EU and 20 per cent by the KMC. The total project cost is Rs 18.2 million.

Challenges ahead

Operating and sustaining the waste-to-energy plant is still a challenge as there is no mechanism for separating organic and non-organic waste from the source. Although the KMC has initiated the separation of waste from households by distributing green and red bins, it has not really materialised.

“Despite being a small project, waste-to-energy is one of the most feasible technologies for Nepal that produces bio-gas from organic waste and electricity from the gas,” said Environmentalist Bhusan Tuladhar. However, he said, “The main challenges that the KMC may come across is proper management, lack of technical expertise and waste homogeneity.” He further added, “There are many examples of failure for similar kinds of projects initiated by the government due to lack of technical expertise, skills and institutional obligations. Hence, the KMC should focus on developing expertise and practice on proper management.”

He stated that KMC can get organic waste sufficient for the pilot project, however, it will face challenges in case of operating bigger plants in the valley as there is no mechanism for separating waste from the source.

Tuladhar informed, “KMC collects such a big amount of waste that, if planned and segregated properly, will be sufficient to establish a bigger plant and produce electricity and gas that can be used for household or transportation.” He further said, “Organic waste and leachate is the main cause of water, air and land pollution and for many diseases. If the organic waste is used for generating electricity, the problem of managing waste will be solved significantly.”

Lesson to learn

KMC is planning to replicate the project in other municipalities if the one-year pilot project succeeds. Furthermore, the project also tries to change attitude and behaviour change among the public. The metropolis has already started an initiative ‘waste to money’ and this project will lead with example if it succeeds.

“The project not only helps in managing waste but it will also mitigate the problem of energy crisis that the country goes through every year,” said Ranjan Kumar Shrestha, Senior Programme Manager at EU. He further said, “This initiative also helps changing attitude and behaviour of public on waste and develops the habit of organic and non-organic segregation.”

Citing that the project will lead with example, Shrestha said, “Government entities as well as the private sector can adopt this technology to make money out of waste. And the government should create a conducive environment for the private sector to enter the waste management sector.” He said, “The government should attract the private sector with tax breaks and other incentives to invest in the waste sector as the government alone will not be sufficient to manage it,” adding that learning from the project should be shared.

Stating that expertise development is required for the sustainability of the project, he said, “Many times government projects fail due to the lack of ability to retain experts in the project. For sustenance, the Solid Waste Management and Technical Centre should take charge of capacity building and conducting training, coordination, rapport building and management in integrated way to create awareness.”

The waste-to-energy plant will consume three tonnes of solid organic waste daily and produce 14 kilowatts of electricity.

Besides producing electricity, the plant will also produces 300 kilograms of bio-organic fertiliser, 300 cubic metre of biogas along with 1,500 litres of treated water.



Published on The Himalayan Times, Perspectives, November 13, 2016 ིissue.
http://thehimalayantimes.com/perspectives/value-in-waste-kathmandu-metropolitan-city/

Unmanaged laboratories, unhealthy practices

Loopholes in policy encourages black marketers to play foul with public health

 

Sujata Awale
Kathmandu

A resident of Kalanki, Krishna Devi-63 (name changed) recently lost her life due to the wrong prognosis of her blood report. She was suffering from heart ailment. Doctors from Ganga Lal Hospital sent her home after two months of treatment. The doctors had strictly instructed her family members to conduct regular blood tests. Residing in Kalanki itself, her blood was regularly sent to a nearby polyclinic for diagnosis and the blood reports clearly showed that the level of sugar and haemoglobin both were normal. But suddenly her health deteriorated and she was rushed to the hospital only to find that her haemoglobin level was far too less than normal. She was shifted to the ICU but it was too late.

Likewise, Manju Dangol (name changed) a patient from Patan, diagnosed with chest infection, was asked to have culture of sputum. She did the culture from Mediquest Laboratory at Pulchowk. In the report, she was diagnosed with Pseudomonas virus, a rare virus found in human body. Her doctor asked her to get admitted in the hospital soon after studying the report as the virus was resistant to oral antibiotics. Being skeptical about the report, she then consulted with doctors from Patan Hospital, Norvic Hospital and Grande Hospital. There she was told that she had already recovered from the chest infection. The virus showed in the report was due to the negligence of the laboratory; the sputum was infected in the laboratoryitself.

These are just a few examples. Due to wrong reports provided bypathology laboratories, many people receive wrong diagnosis and medicines, leading to untimely death.

Heights of Carelessness

Unskilled manpower, use of low quality equipment and reagent and not maintaining the temperature are major reasons that lead to wrong reports. Furthermore, haphazardly opened pathology laboratory, not following minimum standards, loopholes in policy, weak monitoring and enforcement and unhealthy competition among laboratory further encourage such foul play with public health.

“Laboratory reports play a vital role in terms of determining the cause of a patient’s ailment and severity of the disease. Wrong reports can be dangerous as doctors prescribe medicines according to the report,” said Dr Anjani Kumar Jha, President of National Medical Association. He also said, “Not only does the patient suffer from substandard laboratory reports but the laboratories not following the basic standard can be dangerous for operators as well.”

Agreeing that various issues of wrong reports from laboratories have come up in recent times, Jha said, “Unskilled manpower is one of the main reasons for incorrect report.” He elaborated, “The government has not defined specifications for who should conduct which tests. In polyclinics and labs, a lab assistant who may be unqualified handles all the tests.” He further said that the government should come up with proper guidelines clearly stating the qualifications required to conduct a particular test. “In Nepal, MBBS doctors and lab assistants trained for 15 months or so work on the same tests without restriction,” he added.

Agreeing with him, Chintamani Sharma, Laboratory Chief at National Reference Laboratory (NRL) said, “Ambiance, equipment selection, quality of reagent, temperature, lighting and human resource play equally important roles in maintaining the quality of any laboratory report.”

Citing that the quality of reagent determines the quality of the tests, Sharma said, “Quality reagent is important for a reliable test. It has to be stored in between the temperature of two to eight degree Celsius constantly. But many laboratories neglect the handling of reagent and use low quality product leading to incorrect results.” Pointing that the government’s monitoring mechanism is not functional and therefore, ineffective, he said, “There should be strict quality control but the government doesn’t bother to even go and monitor the laboratories that directly affect people’s health.”

Loopholes in policy

According to National Public Health Laboratory (NPHL), there are altogether 1,500 registered laboratories across the country. However, NPHL, the authorised body to inspect quality of pathology laboratories are unaware about the number of unregistered illegal laboratories across the country.

“The chaotic situation of laboratories is the outcome of the government’s negligence,” said Kishor Kumar Khanal, Managing Director at NRL. “The government has set a minimum standard to follow but due to lack of proper monitoring the rule is violated easily and frequently,” he added. He is of the opinion that the government should conduct proper and periodic monitoring, have proper database, categorise the laboratory as per their services and should seal the laboratory if found in violation of the minimum standard.

According to him, there is no specific licensing and grading system to service providers provided by the Public Health Office. While asked about illegal laboratories, Dr Geeta Shakya, Director of NPHL, said, “NPHL is responsible to recommend and monitor the quality check of polyclinic, diagnostic centres and pathology laboratories. However, we don’t have the right to punish such illegal entities.”

To control such illegal and haphazardly opened laboratories, she said, “We need proper guidelines, policies and act to regulate laboratories.” According to her, they have already submitted the draft of Guidelines of Laboratories to the Cabinet and are waiting for its approval.

About quality control, Dr Shakya said, “Accuracy detention is crucial for quality checking and maintenance but we don’t have any guidelines. We are planning to make accuracy detention with the ownership of the Department of Industry that includes quality testing of products, equipment and laboratory.”

Stating that the situation of mushrooming illegal pathology laboratories is just an outcome of impractical policy introduced in 2073, she said, “We are not given much authority and the existing policy is entangled and cumbersome for service providers. They operate services without obliging by the rules enjoying the loopholes in the policy.”

At present, laboratories get registered at the Office of the Company Registrar or the Small and Cottage Industries Development Centre under the Ministry of Industry. The Ministry of Health and Population (MoHP) has given the responsibility of registration and renewing of pathology laboratories and medical diagnostic centres to the Regional Health Directorate based on the recommendation from NPHL and District Public Health Office (DPHO). However, no one bothers to renew their laboratory as the policy has not made it mandatory.

The MoHP formulated Minimum Laboratory Standard (MLS) to be followed in 2061. The MLS states that the minimum area for any laboratory to be set up should be 300 sq ft. There should be refrigeration facility to store reagent and other necessary medication, power back up system, allocated standard of incubator and reagent with minimum staff qualification to operate laboratories among others. However, NPHL said that 50 per cent of registered laboratories are operating below the standard and non registered laboratories are beyond the government’s eyes.

Dr Shakya said, “In our monitoring report of 2071/72 fiscal year, we found that only 50 per cent laboratories are following the basic standards while 25 per cent needs to upgrade their standard whereas remaining 25 per cent has not been following any norm.”

The government has no demarcation of certification to know the difference between registered and non-registered pathology laboratories. She said, “Until the parliament approves the proposal of Public Health Act and Guideline of Laboratories, we can’t do anything to control the situation.”

Non-operating legal provisions

Advocate Ram Chandra Simkhada said that the government is indifferent to increasing cases of sufferers from substandard reports of the laboratories. He informed that there are plenty of acts that protect the right to health. “If anyone suffers due to a wrong report from any pathology laboratory, one can file the case against the laboratory and the person performing the test as per Consumers Protection Act.”

The provisions in the Muluki Ain 2064 related to ‘cheating’ states that with or without carrying out any test, if a pathology laboratory provides wrong prognoses, both the laboratory and the person performing the tests are made to compensate for the fees paid by the service seekers and are fined up to Rs 5,000 as well as sentenced to imprisonment for five years.

The Consumers Protection Act 2054, Section 18 (D) provisions fines up to Rs 500,000 and five years of imprisonment to violating individuals and institutions that provide false services or counselling by taking fees or charges. He informed that there are plenty of acts that protect the rights of consumers for quality service such as Law Against Black Marketing and Social Act 2032, Competition Management and Market Protection Act 2063 and Consumers Protection Act 2054. If a service provider is found guilty of false services s/he can be asked to compensate to sufferers along with Rs 50,000 penalty plus five years of jail sentence and also up to Rs 500,000 penalty with lifelong imprisonment.

“Unhealthy competition, weak monitoring system, turning service business into commercial business, use of low quality material and unskilled manpower are reasons behind the increase in black marketing,” said Simkhada, who was also the immediate past secretary of Forum for Protection of Consumer Rights. According to him, the government should take sole responsibility to crack down on such malpractices. The Department of Quality Control, DPHO and NPHL should conduct regular market surveillance.

On this, Dr Senendra Raj Upreti, Secretary for MoHP, said, “We don’t have enough policies to crack down on existing illegal laboratories. We cannot restrict such illegal laboratories and diagnostic centres. We can only instruct service providers to abide by the law and MLS.” Citing that pathology laboratories and medical diagnostic centres began mushrooming after 2057, he said, “Earlier while drafting the policy, policy makers failed to take into account the growth of private sector at such a rapid pace. Now we are working on the policy level to manage this situation better.”



Published on The Himalayan Times, Perspectives, October 30, 2016

http://thehimalayantimes.com/perspectives/unmanaged-laboratories-unhealthy-practices/