TOPIC 6 WHO COSTING TOOLS for Health-Care Waste Management. WHO Costing Tools

Transcription

1 TOPIC 6 WHO COSTING TOOLS for Health-Care Waste Management Objective WHO Costing Tools To help estimate costs and annual budgets related to health-care waste management Intended Users Senior management or other trained personnel Consultants National policymakers Note disclaimer

2 Approach Calculations based on key indicative values Costing done at facility and national levels Equivalent annual cost method: Annualized cost = annualized capital costs (ACC) + annual operating costs (AOC) CC = capital cost, r = discount rate, CC () r where n = equipment lifespan WHO Costing Tools ACC = ( + r) n WHO Costing Tools Four Tools Costing Assessment Tool (CAT) Expanded Costing Assessment Tool for Low-income countries (ECAT-L) Expanded Costing Assessment Tool for Middleincome countries (ECAT-M) Expanded Costing Assessment Tool for High-income countries (ECAT-H)

3 CAT Seven sections Introduction: Provides basic information Tool A: Initial estimate of total annual cost Tool B: Costs for small HCFs Tool B: Costs for medium HCFs Tool B3: Costs for large HCFs Tool B4: Costs at national level and Summary of costs at all levels Tool C: List of items and average values HCF = health-care facility CAT Tool A Initial estimates Input Total amount of waste generated per year Total number of staff Total beds Total number of small, medium and large facilities Indicative values Cost to treat kg health-care waste, waste generation per bed per day, staff/patient ratio, average number of beds for small (4 beds), medium (40 beds) and large (400 beds) HCFs, etc. Calculates initial estimates for national costs

4 CAT Tool B Costs for a small HCF Input Numbers of bins, personal protection equipment, needle removers, treatment system, small pit Annual numbers of safety boxes, bags, fuel, healthcare waste worker, maintenance, training Indicative values Unit prices of each item above, fuel rate, wage rate, maintenance as % of capital cost Calculates annual capital and recurrent costs for a small HCF Total annual costs for all small HCFs Cost per kg of treated waste CAT Tools B and B3 Tool B: Costs for a medium HCF Add a wheeled bin, storage area, and large pit Tool B3: Costs for a large HCF Add a larger treatment system, sharps pit, long-term training, waste management officer, and cleaning products Calculates annual capital and recurrent costs for a medium or large HCF Total annual costs for all medium or large HCFs Cost per kg of treated waste

5 CAT Tools B4 and C Tool B4: Costs at national level Office/equipment, vehicle, training set, staff, transportation, meeting per diem, maintenance Calculates annual capital and recurrent costs at national level Summary of total annual capital and recurrent costs for all small, medium and large HCFs Grand total cost and cost per kg of waste Tool C Listing of unit prices of all items ECAT Expands the CAT Differentiates between low, middle and high income countries Expands the size categories of HCFs Allows several treatment options Allows centralized and/or decentralized treatment Computes potential revenues from the sale of sterilized plastic parts for re-melting

6 ECAT Size Categories Small HCFs: 0 to 4 beds Medium HCFs: 5 to 99 beds Large A HCFs: 00 to 499 beds Large B HCFs: 500 beds or higher Medium cluster: 300 to 000 kg/day Large cluster: greater than 000 kg/day ECAT Ten sections Introduction: Provides basic information Input: Input required data Assumptions: List of assumed costs & average values Small HCFs: Costs for small HCFs Medium HCFs:Costs for medium HCFs Large HCFs: Costs for large HCFs Clusters: Costs at the facility level and costs at the central facility level for the clusters National: Costs at national level Results: Tabulation of all costs Summary: Summary table and graph

7 ECAT Key indicative value Infectious waste generation rates kg / bed per day Low-Income Countries 0.6 Kg per bed per day kg/b-d Bangladesh Bangladesh Bhutan Cambodia India India India Kyrgyzstan Lao PDR Nepal Nigeria Nigeria Pakistan Pakistan Tanzania Vietnam Vietnam Middle-Income Countries.5 Kg per bed per day Brazil Brazil Brazil Botswana Bulgaria Bulgaria Columbia Columbia Cuba Guatemala Guyana Iran Jamaica Jordan Jordan Lebanon Malaysia Moldova Peru Philippines Philippines Kg per bed per day South Sri Lanka Sri Lanka Thailand Thailand Turkey France Germany Hong Kong High-Income Countries Italy Japan Japan Kuwait Netherlands Norway Portugal Saudi Arabia Spain Switzerland United Arab Emirates United Kingdom United States Infectious waste generation rates 0.5 kg/b-d

8 Key indicative value ECAT Sharps waste generation rates kg / bed per day Sharps waste generation rates 0.06 kg per bed per day W. Europe Botswana hospitals Botswana hospitals Botswana hospitals Botswana health post Botswana clinics Uganda health centers Kenya hospital Bhutan hospitals 0. kg/b-d ECAT - L Four options for low-income countries. Autoclave, sharps pit small & medium HCFs Autoclave, reusable sharps container, sharps pit large HCFs Autoclave, shredder cluster or central plant. Incinerator, ash pit small, medium & large HCFs Incinerator with pollution control that meets international standards large central plant only 3. Same as Option but with on-site needle removers at small, medium and large HCFs 4. Same as Option but with on-site needle removers at small, medium and large HCFs

9 ECAT - M Higher infectious waste generation rate Same basic four options as in ECAT L Option and 3: Added shredders to the autoclaves of large HCFs as well as central plants Option and 4: Increased the level of pollution control for incinerators of medium and large HCFs Added stack testing of incinerators used in clusters or central plants ECAT - H Higher infectious waste generation rate Includes cost of disposing hazardous chemical waste Replaces all safety boxes with plastic sharps containers Different four options:. Autoclaves for small and medium HCFs; Autoclave-shredders for large HCFs and central plants

10 ECAT - H Four options (continued). Incinerators for large HCFs and central plants; autoclaves for small and medium HCFs All incinerator designs meet international standards (e.g., temperature control of primary and secondary chambers, high residence time, controlled loading, ash sump, etc.) Pollution control meets international standards Parametric monitoring and periodic stack testing Disposal of incinerator ash in hazardous waste landfills ECAT - H Four options (continued) 3. Small to large microwave treatment systems for small, medium and large HCFs as well as for central plants 4. Advanced steam treatment systems (e.g., double-walled autoclave with internal shredding, cooling and drying) for large HCFs and central plants; regular autoclaves for small and medium HCFs

11 Questions and Comments by Audience District A B C D E F G H I J K L M N O Q R S T U P # hosp. 3 beds Sadat International, 430 Inc. ECAT-L Demonstration beds beds 5 Small Low-income country Total small HCFs = 45 Total medium HCFs = 9 - average beds = 46 Total large HCFs = 8 - average beds = 4 Total very large HCFs = 0 Number of medium clusters = Total small HCFs in cluster = 77 Total medium HCF in cluster = - total beds = 9 Total large & very large HCFs = 5 - total beds = 9

12 ECAT-L Demonstration Population: Total beds: 3900 Annual health budget: $ GDP: $ Wage HCW worker: $ 3/day Wage WMO: $4/day National staff: $430/year Electrical cost: $0.047/kWh Water/sewage cost: $.09/cubic meter ECAT-L Demonstration

13 ECAT-L Demonstration: Results with cluster Total Annual Costs ($/yr) Summary of Results Option 3 4 Description Autoclaves and sharps pits for small and medium HCFs; autoclaves, reusable sharps containers and sharps pits for large HCFs; transport vehicle(s), medium to large autoclaves and shredders for clusters Incinerators and lined ash pits for small, medium and large HCFs; transport vehicle(s), medium to large incinerators and lined ash pits for clusters; only the incinerator for large clusters meets international standards Needle removers, autoclaves and small pits for small and medium HCFs; needle removers, autoclaves, reusable sharps containers and small pits for large HCFs; transport vehicle(s), medium to large autoclaves and shredders for clusters Needle removers, incinerators and lined ash pits for small, medium and large HCFs; transport vehicle(s), medium to large incinerators and lined ash pits for clusters; only the incinerator Sadat for large International, clusters meets Inc. international Engineering standardsand Environmental Services $657,309 $85,737 $608,696 $8,558 Total A nnual C osts $900,000 $800,000 $700,000 $600,000 $500,000 $400,000 $300,000 $00,000 $00,000 $0 3 4 Options Potential revenues: $6,80 Central vs. On- Site Treatment, ECAT-M & Pollution Control Total Annual Costs $50,000 $00,000 $50,000 $00,000 $50,000 $0 Country G 3 4 Options Decentralized cluster ECAT-L Low-Income Country ECAT-M Middle-Income Country

14 ECAT Sample Results Collection & st orage Collection & storage ECAT-L: Country S Labor & t raining Treatment & disposal Treat ment & disposal Labor & training ECAT-M: Country P Transportation Facility labor and training Central plant labor and training Facility collection & storage Central/Cluster Treatment Central treatment and disposal ECAT Sample Results Total Annual Cost per bed $/bed per year B B B S G G P P A European Union: $400 - $000 /bed per year (WHO reference document) Country Option Option Total Annual Cost per Capita $/capita per year B B B S G G P P A Low-Income: B, B, S Middle-Income: G, P High-Income: A Country Engineering and Environmental Option Services Option

15 WHO Costing Tools To get a copy of the Costing Tools, go to: For CAT: For ECAT: To comment on these tools or to send costing information that could help build the knowledge base, contact WHO: hcwaste@who.int Questions and Comments by Audience