Healthcare waste management in developing countries
Practical Action
Further considerations
Other experiences
Different opinions have been reported about the use of ‘De Montfort’ incinerators. Whereas the
incinerator has been enthusiastically adopted and used in many developing countries, there is a
body of opinion, which believes that emissions from the chimney can do such damage that other
means of disposal must be used. Some national authorities take an intermediate position
insisting on either using a very tall chimney to disperse the gases (e.g. India), or that the
incinerator conforms to a standard such as the Best Practical Environmental Option, developed
in South Africa (Picken, 2004).
Some comments about the implementation of De Montfort incinerators in low and middle
income countries are briefly summarized below. (Batterman, 2004)
Kenya: Some 44 De Montfort type incinerators were constructed in 2002, of which 55%
were in intermittent or regular use at the time of the study. Tests and interviews were
conducted at 14 sites (Adama, 2003). Only 1 of 14 sites had an operator with ‘near to
adequate’ skills, fewer than 40% of health facility managers demonstrated any level of
commitment, many technical defects were observed in the equipment, and most
incinerators were operated improperly (Taylor, 2003).
Tanzania: A total of 13 ‘De Montfort’ incinerators were constructed in 2001 and 2003,
and all were in use. Of these, less than 40% had trained operators, 70% had low smoke
disturbance and 60% had safe ash disposal (Adama, 2003).
Burkina Faso: Where utilized, equipment was poorly operated and under-utilized, i.e.,
the expected number of syringes incinerated fell short by about two-thirds (Adama,
2003).
India: Eight 1 to 2 year-old ‘De Montfort’ incinerators at hospitals in India were surveyed
by HCWH (2002). This survey indicated visible smoke from the stack; smoke emission
from the chamber door and air inlets; commingling of sharps and non-infectious waste,
despite some source segregation; large quantities of unburned materials (sometimes
plastics, syringes, glass, paper and gauze) in the ash; deficient ash disposal practices;
siting in all cases near populated areas (e.g., playground, orphanage, hospital staff
quarters, a primary school, town center) and a lack of operator training. A comment
coming from another hospital in India is provided here below.
Comments from India
"We have built 9 medical waste incinerators at our hospitals in India of the design
developed by Prof. J. D. Picken of the De Montfort University. These incinerators cost us
about US$1,000 each to build. This is about 1/10th the cost of commercial
incinerators available, all of which use large amounts of external fuel or electricity. The
design and building technique need to be followed precisely for success, and we have
found it important to train one person to oversee the building of all of the incinerators.
When operated correctly they are very effective in reducing medical waste to clean fine
ash while putting out very little visible smoke. They only need renewable fuel (wood,
coconut husks, heavy garden waste, paper and other dry household waste, etc.) to start
and, once up to operating temperature, the medical waste itself becomes the fuel to
drive the incineration process. It is actually amazing to see. Careful adherence to the
design and careful operation are keys to making this simple, yet effective, incinerator
work very well."
T. A. M, July 2002
Source: Picken, 2011
Emissions and their monitoring
Referring to environmental effects, incinerators can produce toxic emissions such as carbon
monoxide (CO), dioxins (polychlorinated dibenzo-para-dioxins or PCDDs), and furans
(polychlorinated dibenzofurans or PCDFs).
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