A recent community cleanup video from Indonesia went viral after a local group's effort to clear trash took a horrifying turn. During their work, they discovered a blood-filled intravenous tube and a discarded syringe that injured one of their members. The shocking footage became a powerful public service announcement, exposing the critical and dangerous problem of improperly managed medical waste in Indonesia and serving as a stark reminder of the serious risks it poses to public health. Improperly managed medical waste can pose significant health risks not only to sanitation workers and the general public but also to the environment.
Recently, AMANA, in collaboration with KATADATA Green, hosted a workshop themed "Addressing the Challenge of Medical Waste Management in Indonesia." Together with the Ministry of Environment and Forestry (KLH), PERSI (Indonesian Hospital Association), PT ARAH Environmental, and KEBUMI, this workshop explored the root causes of medical waste management issues and the collaborative steps we need to take to tackle this challenge in Indonesia.
Medical Waste Management Regulations in Indonesia
Indonesia has implemented regulations to manage medical waste, including PP 22/2021 and Permen LHK No. 6/2021, which focus on the management of hazardous and toxic waste (B3). However, many healthcare facilities lack the capacity to manage their own medical waste, relying on third-party waste management services. To operate, these services must meet technical standards and obtain an Operational Feasibility Certificate (SLO), which requires technical evaluations and environmental impact assessments.
Logistical and Infrastructure Challenges in Medical Waste Management
The primary challenge in medical waste management involving third parties lies in infrastructure and logistics, which continue to hinder progress. Indonesia’s diverse geography presents varying challenges across different regions. In large cities, numerous clinics with different medical waste collection needs, such as collections every 1-2 days, make it difficult to streamline the process. The amount of waste generated per clinic is minimal, which makes it essential to consider cost-effectiveness in the collection and transportation process.
On the other hand, in rural areas and remote islands, the distances between healthcare facilities can be vast. This results in high transportation costs for medical waste and limited infrastructure, creating a significant barrier to efficient waste management.
Plastic and Biohazard Labeling: Hidden Challenges in Medical Waste Management
Medical waste management cannot be separated from the plastic economy. According to research conducted by KEBUMI in 2021, over 50% of medical waste consists of plastic. This finding aligns with similar studies conducted in other countries.
However, the main challenge often overlooked is the misapplication of biohazard labeling on many types of medical plastic. Most medical waste, including plastic, is immediately categorized as biohazard and disposed of in yellow bags, even though not all plastics are hazardous.
For example, in the process of administering infusions, there are several components: plastic wrapping for the infusion bottle, the infusion bottle itself, the infusion tube, and the syringe that directly contacts the patient. Often, all of these components are thrown into the yellow biohazard bag, even though some types of plastic could be separated from the start.
With proper waste segregation, we can reduce the volume of medical waste categorized as biohazard, lower disposal costs, and minimize environmental impact. This separation is crucial to creating a more efficient and sustainable medical waste management system.
Steps Toward a Collaborative Solution
Rethink Procurement Process: Sustainability from the very start
It is essential to start by rethinking the procurement process of medical equipment and supplies. Before waste is even generated, we need to reassess the tools and materials being used. This includes selecting recyclable materials and eco-friendly options. By adopting this approach, we can reduce waste from the very beginning, lighten the burden of medical waste management, and minimize environmental impact.
Continuous Oversight: From segregation to disposal
The government must ensure that oversight of medical waste management does not end once the waste management license is granted. Continuous oversight will help ensure that service quality and public safety remain safeguarded. One recommendation is to utilize information systems to track and match the waste generated by healthcare facilities with the waste that is processed and disposed of. This would enable more real-time monitoring, ensuring that the entire process, from waste segregation to disposal, is properly executed and in line with established standards.
Comprehensive Waste Management Planning: Beyond the Bin
Medical waste in healthcare facilities is not limited to what is discarded in the trash. During the construction phase of healthcare facilities, it is essential to consider the entire waste management system, including the design of pipe systems and other waste disposal channels. Furthermore, effective mitigation measures for potential contamination—such as airborne disease transmission—must be incorporated. For example, installing spool hooks for liquid waste can prevent contamination, and regular checks (such as using fish to test for contamination in water) should be part of the routine monitoring process. This proactive approach ensures that hospital waste is managed safely and efficiently, reducing health risks and environmental impact.
Better Coordination Among Stakeholders
Collaboration between the government, hospitals, waste management providers, and local authorities is key to improving medical waste management, as the issue is more complex than just collecting and processing waste. Each healthcare facility has different needs, and waste collection logistics vary widely depending on location, waste type, and regulations. A more detailed and coordinated approach is necessary, where all parties work together to create tailored solutions. This includes defining clear roles and responsibilities and improving communication to ensure that waste is properly segregated, transported, and disposed of efficiently.
To explore how we can collaborate in building a better medical waste management system together, contact pras@amana.id.
