10/10/2016
In the past years, environmental management in health sector has made significant achievements, in particular in completing institutions and developing policies and legal documents in medical waste management. Year 2014 marked an important change in environmental regulations in general and environmental regulations for the health sector in particular. Law on Environmental Protection (LEP) 2014 was enacted by the Việt Nam’s National Assembly on 23rd June 2014 and took its effect on 1st January 2015. The Government then issued decrees providing guidance on implementing the LEP. Line Ministries issued circulars guiding the implementation of the decrees in environmental protection and medical waste management.
LEP 2014, Chapter XIV, Article 142 regulates responsibilities of authorities of state management on environmental protection including Ministry of Natural Resources and Environment (MONRE), Ministry of Health, other line Ministries and people’s committees. According to this regulation, Minister of Health shall lead and coordinate with Minister of Natural Resources and Environment, Ministers and Heads of Governmental level agencies and Chairs of Provincial People’s Committees in organizing the implementation of environmental protection in medical activities, waste inventories, pollution assessment, treatment of wastes from hospitals and medical facilities and other related activities.
Regarding to medical waste management, Article 72, Chapter VII, of LEP 2014 regulates that hospitals and medical facilities shall collect and treat medical wastewater in compliance with environmental technical regulations; segregate waste at source; collect, transport, store and treat medical waste in compliance with environmental technical regulations; develop plans and equipment for preventing and responding to environmental incidents caused by medical waste; preliminarily treat medical waste so that contagious elements shall be removed from the waste before the waste is transported to centralized treatment plants; and treat emission properly. In particular, the LEP 2014 regulates that investors of hospitals and medical facilities shall be responsible for allocating sufficient budget for building sanitation facilities, waste collection, and treatment systems in compliance with environmental regulations. In the meantime, heads of hospitals and medical facilities shall be responsible for complying with environmental regulations and related regulations.
To provide guidance for implementing LEP 2014, Government has issued Decree No. 38/2015/ND-CP dated 24/4/2015 on waste and scarp management. Article 49 regulates that Minister of Natural Resources and Environment shall provide details on medical waste transport and treatment, and that Minister of Health shall lead and cooperate with Minister of Natural Resources and Environment in guiding segregation, storage and management of medical waste within health facilities. Decree No. 38/2015/ND-CP regulates that medical waste, except for wastewater which goes into wastewater treatment systems of health facilities, shall be segregated into hazardous waste (contagious waste, non-contagious hazardous waste and radioactive waste) and normal waste (domestics solid waste and wastewater). In particular, contagious waste shall be strictly managed at the highest alerting level, ensuring that contagious elements shall not be spread and affect human health and the environment. In case contagious waste is mixed with domestic waste, it shall be treated as hazardous waste. In treating hazardous waste, priorities shall be given to environmentally - friendly and non-incineration methods which ensure environmental compliance. After being sterilized, contagious waste shall be treated as domestic waste with suitable methods.
On the 3rd June 2013, at the 7th session of Party’s 11th Standing Committee, Resolution No. 24/NQ-TW on proactively responding to climate change and enhancing natural resources and environmental management was approved. According to this Resolution, environmental protection objectives are by 2020, there shall have been no additional serious environmental polluters, and 100% of medical waste and 85% of hazardous waste shall have been treated. Then, on 1st October 2013, Vietnam’s Government approved an action plan for radically dealing with serious polluters by 2020 which requests that all serious polluters shall have been properly treated. During the treatment process, serious polluters shall immediately apply mitigation measures under close monitoring of state management agencies for environmental protection and the public. According to this plan, the Prime Minister assigns provincial people’s committees with a task of directing the treatment process and allocating local budgets for treating public service serious polluters and allocating environmental expenditure for regular environmental inspection and supervision and reviewing lists of serious polluters.
With a task of being responsible to the Government in unifying state management of environmental protection nationwide, MONRE shall be responsible for leading the development and submission to the Government and Prime Minister for issuing legal documents, policies, strategies, master plans, plans, programs and national projects on environmental protection; leading the development and issuance of other legal documents including national technical regulations and technical guidance documents. MONRE has issued Circular No. 36/2015/TT-BTNMT dated 30th June, 2015 on hazardous waste management in which technical requirements, management processes and waste owner registration were specified. MONRE is responsible for issuing permits and managing transport and treatment of hazardous waste, including medical waste. In addition, MONRE has issued Viet Nam’s Technical Regulations on medical waste, including QCVN 28:2010/BTNMT - National Technical Regulation on medical waste water, QCVN 02:2012/BTNMT - National Technical Regulation on medical waste incinerators and QCVN 55:2013/BTNMT - National Technical Regulation on medical waste autoclaving.
To enhance cooperation between health and natural resources and environment sectors in state management of environmental protection of health facilities, Ministry of Health and MONRE have developed and issued Joint Circular No. 48/2014/TTLT-BYT-BTNMT on 22nd December 2014 which specifies responsibilities and cooperative mechanism between the two Ministries as well as between Provincial Departments of Health and Departments of Natural Resources and Environment. On 31st December 2015, the two Ministries issued Joint Circular No. 58/TTLT-BYT-BTNMT on medical waste management, which specifies segregation, collection, temporary storage, transport and treatment of medical waste, and responsibilities of heads of hospitals and health facilities and related agencies in medical waste management.
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| Segregating sharp medical waste at source in hospitals |
Ministry of Health has also proactively developed and submitted to Prime Minister for approval of a master plan for medical waste treatment for the period of 2011 - 2015 and vision to 2020. According to this master plan, by 2020, 100% of health facilities shall have treated medical waste in compliance with environmental regulations. To further strengthen medical waste management in hospitals, Ministry of Health issued Directive No. 05/CT-BYT on 6th July 2015 which states that hospitals shall assign a task of waste management and environmental protection to a specific department/division; appoint one staff member in charge of waste management and environmental protection to assist a hospital director in managing medical waste; allocate budget for purchasing equipment for collection, transport, temporary storage in hospitals and purchasing materials for waste treatment and other expenditures for waste treatment to ensure compliance; strictly handle individuals and units violating regulations on medical waste segregation, collection, transport and treatment; regularly inspect and supervise medical waste management to ensure full control of hazardous waste; and integrate medical waste management and environmental protection into annual rewarding criteria.
To increase mobilization for investments in forms of public private partnership (PPP), Government issued Decree No. 15/2015/ND-CP on 14th February 2015 on PPP investment. To implement this Decree, Ministry of Health is developing a special mechanism for PPP investment in medical waste management. Government also issued Decree No. 85/2012/ND-CP on 15th October 2012 on operating and financing mechanism for medical public service enterprises as well as check up and treatment pricing in public health facilities. According to this Decree, since 2018, health check-up and treatment prices will include expenditure for medical waste treatment and sanitation.
In general, regulations on medical waste management are fairly complete. To increase effectiveness of medical waste management, it is necessary to concurrently implement the following measures: Continuing to improve regulations on medical waste management, in particular special mechanism and policy for PPP in medical waste management and amending environmental technical regulations and standards related to medical waste management in compliance with LEP 2014 and practical requirements; Mobilizing resources for investment in building medical waste treatment systems. The budget sources include earmarked state budget for provinces, ODA loans from World Bank and other donors and PPP; Increasing inspection and supervision of environmental compliance in health facilities; Strictly handing environmental violation in health facilities and holding heads of health facilities for responsibilities, specifying responsibilities of heads of health facilities in managing their medical waste, integrating medical waste management and environmental protection into criteria for annual performance rewarding of the facilities as well as heads of facilities;
Increasing propaganda and dissemination on environmental regulations in health facilities, raising awareness of different management levels, medical staff, patients and their accompanies, rewarding good compliance and performance and strict punishment of violations.
Dr. Nguyễn Thị Liên Hương - Director General
Health Environment Management Agency
Ministry of Health
