Harmonizing Public Health with Health-Care Waste: A Systems-Approach to Biomedical Waste Governance in India

Roopashi Khatri   | 2024


In light of rapid urbanisation and population growth, one of the most significant challenges that India will face in the coming decades is the effective management of public healthcare systems, waste management and sanitation. The overarching challenge of public health cannot be addressed without the management and effective disposal of biomedical waste, ensuring simultaneously that: biomedical waste does not contribute to the spread of infections, and can be tracked in a timely manner to determine trends in infectious diseases; the materials used in healthcare and medical products are environmentally sustainable and economically accessible for all.

The objective of this paper is to identify the shortcomings in biomedical waste management system across Indian States and the factors impeding the effective implementation of the relevant legal and regulatory regime. This regime includes the Bio-Medical Waste Management Rules, 2016, related regulations and guidelines of the Government of India, and the directions of Supreme Court of India and other courts to government authorities to implement specific measures in biomedical waste and solid waste management (particularly in the cases of BL Wadhera v. Union of India, 1996; Municipal Council, Ratlam v. Shri Vardhichand & Others, 1980; and MC Mehta v. Union of India & Ors., 2020). The author will analyse the following factors relevant to the success of this legal and regulatory regime:

(a) The historical, colonial legacy that has shaped waste governance in India;

(b) The social, legal, political, economic, equitable and institutional considerations of relevant stakeholders (including waste pickers, recyclers, private and government hospitals, and informal generators of biomedical waste such as households, quarantine camps and nursing homes);

(c) Practical (including spatial-temporal), ethical and environmental considerations for adopting technology-based solutions and other best practices for biomedical waste management (including biomedical waste-barcoding and GPS tracking, non-disposal and other “green” medical and healthcare products, and plasma pyrolysis).

The author proposes that the legal and regulatory framework for biomedical waste management should be analysed using a comprehensive, interdisciplinary systems approach. This approach explains how various external factors create a feedback loop for stakeholders, informing their decision on whether to comply with relevant sanitation and waste management laws; and how the legal and regulatory framework itself may create new incentives (for instance, the sale of biomedical waste to recyclers instead of mere disposal). Using this approach would allow the expansion of the legal and regulatory framework to hidden issues in biomedical waste management (such as identifying untreated medical waste in public sanitation systems). While this research includes an examination of literature in respect of biomedical waste management systems across India, particular emphasis is given to the extensive work and learnings from the Tamil Nadu Urban Sanitation Support Programme in Chennai, a large-scale sanitation support programme in collaboration with the Government of Tamil Nadu, which provides a blueprint for innovative solutions to solid waste management and highlights the shortcomings to be addressed in the national and sub-national legal and regulatory framework.