COVID-19: Kerala model stands out, as states struggle to deal with mountains of rising Bio-medical waste

There is yet another Kerala model, which is showing the way.

At a time when Bio-medical waste management is turning out to be a major problem in the wake of the rising pandemic, the state, popularized as God’s Own Country, is demonstrating a way out of this mess.

While in the rest of India, private companies are managing the waste, Kerala is the only state where the Indian Medical Association (IMA) is directly handling a Common Bio-medical waste Treatment and Disposal Facility (CBWTF) for the treatment of this highly contaminated waste.

The model is turning out to be a boon for more than 16,900 health centres in the state, as the treatment charges for both COVID and non-COVID wastes is the lowest in Kerala, compared to the rest of the country.

According to IMA, while COVID waste in Kerala is treated at a rate of Rs 30 per kg, most states are charging anywhere between Rs 60-100 per kg.

Not surprisingly, the per bed handling charges in Kerala for non-COVID Bio-medical wastes is as low as Rs 3.5 per kg for government hospitals and Rs 6.5 per kg for private hospitals, while it ranges between Rs 9.5- Rs 27 a kg in the rest of the Indian states.

Kerala’s success story has come to light when the rest of the country is struggling to manage the rising waste pile, diverting it to hazardous waste management units and opting for the deep burial method to get rid of the waste safely.

Says J A Jayalal, president of the IMA: “Kerala is a unique model for the rest of the country. IMA is directly handling waste management in only one state. Soon after COVID broke out, we doubled the capacity in Kerala.”

IMA’s foray into waste treatment

In 2004, the Indian Medical Association – Kerala branch – started a CBWTF in Palakkad for the treatment of bio-medical wastes, christened IMAGE or the Indian Medical Association Goes Eco-friendly.

The IMA unit in Kerala is also the largest CBWTF in India. It is also the only CBWTF in the state.

There are a total of 200 authorized CBWTFs in 28 states, the majority of which are handled by private companies.

When it started in 2004, only 50 hospitals were sending their waste to IMAGE, which has since then gone up to 16,900 hospitals, clinics, labs, a few Ayurveda units and research centres.

“Before COVID, we had a capacity of 37 tonnes a day, while we were handling anywhere around 32-35 tonnes a day. However, when COVID broke out, this increased and we immediately pushed up the capacity to around 62 tonnes a day, investing around Rs 4-5 crore,” said a senior IMA official from Kerala.

Now, the State Pollution Control Board (SPCB) has given it the clearance to work at a capacity of 57 tonnes a day. The facility is currently handling around 50-54 tonnes a day of waste now.

What makes the Kerala model different is that in the rest of the country, there are multiple treatment facilities run by private parties, while Kerala has only one IMA unit.

Apart from common facilities, India also has 12,296 captive treatment and disposal facilities installed by healthcare facilities.

Hospitals with such captive facilities in Kerala include the Pushpagiri Medical College Hospital, Amrita Hospital, Jubilee Mission Hospital and the Little Flower Hospital.

Other than this, all the remaining 16,900 facilities are dependent on IMAGE.

How is IMAGE managing COVID waste?

Once demand picked up, IMA decided to increase the capacity and made the project a reality by the end of 2020.

In Kerala, regular Bio-medical wastes are managed through a barcode-based system through which IMAGE picks up the waste directly from hospitals. Once the pandemic broke out, it linked all the hospitals separately with the Central Pollution Control Board’s (CPCB) mobile application. In addition, it appointed separate staff, vehicles and assigned independent treatment units for wastes from COVID care centres.

“We immediately hired more staff, assigned more vehicles and also gave separate guidelines to hospitals for segregation of COVID-related wastes separately,” said the IMA official.

In addition, now the plants are running 24 hours to cater to the rising demand.

How different is it from other states?

The major private companies involved in biomedical waste management nationally include Ramky Energy and Environmental, Medicare Environmental Management and Rainbow Environment.

In the rest of the country, there are multiple waste treatment units, unlike a single facility in Kerala.

Kerala also has the cheapest rate in terms of managing biomedical wastes. “In the state, we are handling wastes at between Rs 3.6-4.5 per bed for government hospitals and Rs 6.5 per bed for private hospitals. On the other hand, this rate comes between Rs 7.5 to Rs 23 per bed in other states for both private and government hospitals. In Pondicherry, it goes up to as high as Rs 22 per kg,” said the IMA source.

For COVID related biomedical wastes, the rates for Kerala government hospitals comes to the tune of Rs 22 per kg for government hospitals and Rs 30 per kg for private hospitals.

“This goes to as high as Rs 60-100 per kg in several states. In Maharashtra and Gujarat, it is over Rs 60 per kg,” the source said.

A major reason why Kerala rates are low is that IMA's waste treatment model works on a no-profit, no-loss model. In addition, around 60-odd doctors from IMA are pitching in as volunteers for waste management across the 14 districts in Kerala.

IMAGE generates a revenue of around Rs 2.25 crore per month, out of which around Rs 2.1 crore goes as its expenses.

Prior to COVID, the waste coming out from private hospitals in Kerala was around 158 gram per bed and 660 gram per bed from government hospitals, which has increased to over 300 gram per bed for private and around 800-900 gram per bed for government hospitals after the second wave.

A major challenge for IMA is the segregation of waste, as a large quantity of food waste is also becoming a part of biomedical wastes.

If this gets segregated properly, the rising issue of Bio-medical wastes in the country can be managed. The IMAGE experiment stands out as a template for other states to emulate.