TASHI DEKI | Thimphu
Bhutan’s healthcare waste management system remains at a moderate level of maturity, with the country generating about 700.15 tonnes of healthcare waste in 2022, according to the Baseline and Benchmarking Assessment for Health Care Waste Management in Bhutan, prepared in 2024.
The assessment, prepared by Karma Choden, was undertaken as part of a multi-country initiative led by the United Nations Development Programme (UNDP) in collaboration with Bhutan’s Ministry of Health and National Medical Services. It examined the country’s healthcare waste management practices, policies, regulations, training, compliance, budgeting and availability of treatment technologies.
The report found that healthcare waste generation increased from 622.05 tonnes in 2020 to 700.15 tonnes in 2022. In 2020, the Ministry of Health recorded 622.05 tonnes of waste from all 20 districts.
Of this, 46 percent was general waste and 54 percent was classified as infectious waste. By 2022, total healthcare waste had reached 700,148.864 kilograms, or about 700.15 tonnes.
The report also noted that healthcare waste generation had been particularly high during the COVID-19 pandemic. In 2021, the Bhutan State of Environment Report-2022 recorded around 690 tonnes of healthcare waste, comprising 268.21 tonnes of general waste and 421.57 tonnes of infectious waste. The assessment said the rise in infectious waste was likely associated, at least partly, with the surge in COVID-19-related waste, although the report cautioned that gaps in available data make it difficult to establish a complete picture.
In 2022, healthcare facilities recorded 362.77 tonnes of non-infectious waste and 337.37 tonnes of infectious waste. Tertiary-level facilities generated 210.75 tonnes of non-infectious waste and 193.46 tonnes of infectious waste, while secondary-level facilities generated 138.75 tonnes and 127.45 tonnes respectively. Primary healthcare facilities generated 13.26 tonnes of non-infectious waste and 16.47 tonnes of infectious waste.
The report calculated the healthcare waste generation rate at 0.33 kilograms per person in 2022, based on a total healthcare caseload of 2,109,458 people and total waste generation of 700,148.864 kilograms. It also estimated infectious or hazardous waste generation at about 0.56 kilograms per hospital bed per day, higher than the World Health Organization estimate of 0.2 kilograms for low-income countries. However, the report cautioned that waste generation rates can vary depending on facility size, number of beds, occupancy, services provided and the population served.
Thimphu accounted for the largest share of healthcare waste in 2022, producing 50.2 percent of the national total, compared with 32.4 percent in 2020. Wangdue accounted for 8.5 percent in 2022, followed by Sarpang at 7.7 percent. Chukha’s share, meanwhile, fell sharply from 38.2 percent in 2020 to 6.5 percent in 2022. The report said such large variations highlight the need for reliable, evidence-based primary data to better understand waste generation across districts.
The assessment found that Bhutan’s healthcare waste management system scored 2.539, generally reported as 2.5, on the GAVI Healthcare Waste Management Maturity Model, placing the country at Level 2. The model assesses six areas: awareness, training and supportive supervision; adherence and compliance; national policy and strategic planning; budget and planning; practical guidance; and technology and equipment availability and use.
The report identified training and awareness as one of the major weaknesses. While healthcare waste management training is conducted, the frequency of training is affected by funding constraints, and high staff turnover makes it difficult to maintain knowledge and practices among healthcare waste handlers. According to records cited in the report, 321 people were trained on healthcare waste management between March 2023 and January 2024, with training covering healthcare workers as well as support staff from hospitals, municipalities, private sectors and diagnostic facilities.
Compliance with waste segregation and other recommended practices was another concern. Although colour-coded bags and bins are supplied to healthcare facilities, the assessment found evidence of non-compliance with segregation at the point where waste is generated. It also reported instances of inadequate use of personal protective equipment and failure to use separate trolleys for different waste categories. However, the report clarified that observations of open burning and some other practices were based on a limited number of facilities visited and therefore cannot be considered conclusive for the entire country.
The report also raised concerns over the continued use of open burning and incineration. As of January 2024, Bhutan had three operational healthcare waste incinerators, although four had initially been installed during the COVID-19 pandemic. A 100-kilogram-capacity incinerator at Memeylakha in Thimphu and a 300-kilogram-capacity incinerator at Konbar in Mongar were functional. A 300-kilogram unit at Memeylakha had been non-functional since 2022 because of budget and human-resource constraints, while another 300-kilogram unit at Toribari in Phuentsholing was also non-functional.
The assessment noted that the World Health Organization discourages open burning and incineration of healthcare waste. Despite this, open burning remains prevalent in some primary healthcare centres. The report said this was partly linked to difficulties in transporting waste to designated disposal facilities. It also noted that all healthcare facilities were equipped with autoclaves, considered a Best Available Technology, although data on their functionality were not available at the time of the assessment.
The report recommended stronger monitoring by the Ministry of Health, the Department of Environment and Climate Change and district health authorities, along with standardised reporting from healthcare facilities. It called for an urgent healthcare waste management strategic plan, dedicated annual budgeting, stronger implementation of reduce, reuse and recycle practices, standardised operating procedures and better integration of healthcare waste data into the national waste inventory.
It also recommended prioritising appropriate treatment technologies at primary healthcare centres to replace environmentally harmful practices such as open burning and encouraging non-burning and low-emission alternatives. The assessment said strengthening healthcare waste management is essential not only for protecting healthcare workers and patients but also for safeguarding Bhutan’s environment. With healthcare services continuing to expand, the report warned that waste generation is likely to increase, making stronger data systems, financing
