A Case Study on Geographic Distribution of Healthcare Entities & Effect of Improper Management of Healthcare Waste in Rajshahi City Corporation. N. E. Jannath, A. A. Masum, M. O. Polak & M. R. N. AlamDepartment of Civil EngineeringRajshahi University of Engineering & Technology (RUET)

1. A Case Study on Geographic Distribution of Healthcare Entities
& Effect of Improper Management of Healthcare Waste in
Rajshahi City Corporation
N. E. Jannath, A. A. Masum, M. O. Polak & M. R. N. Alam
Department of Civil Engineering
Rajshahi University of Engineering & Technology (RUET)
Department of Civil Engineering, RUET ICPACE 2017

2. Department of Civil Engineering, RUET ICPACE 2017
Abbreviations
• HCE - Healthcare Entity
• HCW - Healthcare Waste
• RCC - Rajshahi City Corporation
• GPS - Global Positioning System
• RMCH - Rajshahi Medical College Hospital
• IBMCH - Islami Bank Medical College Hospital

3. Department of Civil Engineering, RUET ICPACE 2017
Overview
• Introduction.
• Objectives.
• Study Area.
• Methodology.
• Mapping
• Geographical Accessibility & health.
• Geographic Distribution
• HCW Management
• Effect of Improper HCW Management
• Conclusion
• Recommendation

4. Department of Civil Engineering, RUET ICPACE 2017
Introduction
Healthcare is a multitude of services rendered to individuals,
families and communities.
The spatial analysis is the geographic approach to understand
inequalities in distribution of healthcare centers.
However, healthcare activities also generate waste. Improperly
managed waste possess a risk to human health and the
environment.
Planning and implementing a comprehensive program for
waste collection, transport, disposal and recycle can eliminate
these problems.

5. Department of Civil Engineering, RUET ICPACE 2017
Objectives
To study geographical distribution and ease of access to the
health services.
To analyze the situation of three major health care centers
(RMCH, IBMCH and City Diagnostic Centre) through
assessment of current waste management practices.
To identify the potential impacts on both human health and the
natural environment due to improper disposal and management
of health care wastes.

6. Department of Civil Engineering, RUET ICPACE 2017
Study Area
• Rajshahi City Corporation
lies between 24⁰21′ and
24⁰26′ north latitudes and
between 88⁰28′ and 88⁰37′
east longitudes.
• The city is bounded on the
east, north and west by
‘Paba’ and that on the south
by the ‘Padma river’ and the
shape of the city is like an
invert T with an area of
about 47.78 sq. km. Figure 1: Map of Rajshahi city corporation

7. Department of Civil Engineering, RUET ICPACE 2017
Flow Chart of Methodology
Literature Reviews and
existing data compilation
Data collection
Primary data
collection
Secondary data
collection
Practical field observation
Field based data collection
Data analysis
Collected data was analyzed through MS Excel
Mapping was done by GPS visualizer
Identify the potential impacts due to improper
disposal
Published and unpublished source
Internet

8. Department of Civil Engineering, RUET ICPACE 2017
Mapping
First we compiled all of our collected GPS location points of HCEs
and HCW discharging or dumping points into MS Excel Sheet.
Then we put them into GPS visualize web utility
(www.gpsvisualizer.com) and put desired instructions.
Finally, we got Google Maps prepared by GPS visualizer according to
our requirement for presenting research findings information through
maps

9. Department of Civil Engineering, RUET ICPACE 2017
Figure.2: Geographical Distribution of HCEs in RCCFigure.3: Geographical Distribution of HCW Dumping Points

10. Department of Civil Engineering, RUET ICPACE 2017
Geographic Accessibility & Health
• Governments try to improve the geographical coverage of a service because
they believe all sections of the population will benefit from the service if
people are closer to it.
• In this paper, current coverage is evaluated. It is not enough to argue that
utilization rates will increase if either more clinics are built or their quality
improved.
• By evaluating the potential to improve geographical coverage using the
same quantity of resources deployed in different locations, we believe it is
possible to realize substantially increased health services utilization in RCC.

11. Department of Civil Engineering, RUET ICPACE 2017
Total Number of HCEs and HCW generation
Type of
Healthcare
Entities
Total No. of
HCEs
Waste Generation
Rate (kg/day)
Hospital 19 180.26
Clinic 16 93.75
Maternity 4 62.5
Eye clinic 6 88.33
Dental Clinic 12 8.33
Diagnostic Centre 27 63.7
Physiotherapy 5 5
Pathology Centre 6 87.5
Medical Centre 2 3
Homeo Centre 17 1.17
Pharmacy 103 0.8
Fig. 3. Graphical Representation of Waste Generation Rate (kg/day)

12. Department of Civil Engineering, RUET ICPACE 2017
Average Composition of HCW in RCC
58%23%
10%
9%
General Waste
Non-Bio degradable waste
Infectious Hazardous Waste
Sharp Waste

13. Department of Civil Engineering, RUET ICPACE 2017
Collection System of HCW
INFECTIOUS
WASTE
SHARP
WASTE
HAZARDOUS
WASTE
NON-
INFECTIOUS

14. Department of Civil Engineering, RUET ICPACE 2017
Flow Diagram of HCW management in RCC
Healthcare Waste
Solid Waste
HCWs Bin
RCC
RMCH Incinerator
Incinerator Ash
RCC Burial Place
Liquid Waste
HCWs Bin
Sewerage Line

15. Department of Civil Engineering, RUET ICPACE 2017
Recent HCW Management Practice Of RCC
Figure 4: Incinerator in RMCH PremisesFigure 6: RMCH Dumping BinFigure 7: HCW Stored inside IBMCHFigure 5: Burning in Incinerator in RMCH Premises

16. Department of Civil Engineering, RUET ICPACE 2017
Improper Management of Healthcare Wastes
• Health Effect
• Effect on Aquatic Life
• Effect on Climate Change
• Effect on Receiving Stream

17. Department of Civil Engineering, RUET ICPACE 2017
Health effect
Laboratory safety and hygienic disposal are common practices in developed countries, but
unfortunately it is not being practiced in ours. HCW is a great public health threat to Rajshahi City
dwellers.
Diseases shown in following table are spreading day by day due to improper management of
healthcare wastes in RCC. Effect on Climate Change.
Type of Infection Infective Agent Transmission Agent
Gastrointestinal infections Enterobacteria (Salmonella, Vibrio cholerae, Shigella, etc.) Faeces, vomit
Respiratory infections
Mycobacterium tuberculosis, Streptococcus pneumoniae, SARS virus
(Severe Acute Respiratory Syndrome), measles virus
Inhaled secretions, saliva
Eye infections & Eye
secretions
Herpes virus Eye secretions
Skin infections Streptococcus Pus
Meningitis Neisseria meningitidis Cerebro-spinal fluid
AIDS Human Immunodeficiency Virus (HIV)
Blood, sexual secretions, other body
fluids
Haemorrhagic fever Lassa, Ebola, Marburg, and Junin viruses Blood and secretions
Viral hepatitis A Hepatitis A virus Faeces
Viral hepatitis B and C Hepatitis B and C viruses Blood and other biological fluids

18. Department of Civil Engineering, RUET ICPACE 2017
Effect On Surrounding
• The liquid HCW leached, which may pollute soil and ground water
Figure 8: Waste Disposed on Land Surface (a) IBMCH (b) Nawdapara bhagar
(a) (b)

19. Department of Civil Engineering, RUET ICPACE 2017
Effect on Receiving Stream
At Rajshahi, HCW is one of the
major pollutant that causes water
pollution.
HCWs ultimately discharged
into the river Padma, thus
polluting the river water.
Figure 9: HCW Disposed Nearby Sewerage Line in Bypass

20. Department of Civil Engineering, RUET ICPACE 2017
Effect on Aquatic Life
• When a HCW storage bin or disposal site is
located near pond or river, the wastes get
mixed with the water body through the
flow of rain water.
• Many micro-organisms are produced in the
disposal of HCW, which are harmful to
human as well as the aquatic life.
Figure 10: HCW Dumping Near Pond in Nawdapara

21. Department of Civil Engineering, RUET ICPACE 2017
Conclusions
From the study it is observed that the prime HCEs cluster in Rajshahi
city is Laxmipur area. This zone covers approximately two third of the
city’s HCEs and they account about 75% of HCW per day. The next
HCEs density zone are station road and Shaheb bazar road.
The major three HCEs do not segregate hazardous waste from non-
hazardous waste but only separate wet infectious waste.
Recent HCW management practice is not environment friendly. It has
a adverse effect on health, aquatic life, receiving stream, surrounding
and climate.

22. Department of Civil Engineering, RUET ICPACE 2017
Recommendation
HCEs in RCC City Corporation should be equally distributed.
To avoid the risk of Health effect from the wastes, it needs to
formulate proper policy regarding this issue.
To reduce environmental pollution, healthcare wastes are needed to be
segregated.
Ensure availability of waste collection van at RCC & supplying of bin
through a central system.
Ensure final collection, treatment and disposal facilities by RCC
authority to protect the environment, public health and aquatic life
from HCWs adverse effect.