10/10/2016
Public - private partnership (PPP) investment in medical waste treatment is a model applied by many countries to encourage every economic sector to participate in it. The experience of other countries shows that waste collection and treatment through the PPP model is effective, thus stimulating every economic sector to spend funds on renewing infrastructure facilities and technology and training human resources to improve the quality of healthcare services at health centers.
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| Mobilizing all economic sectors to participate in medical waste treatment |
Over the years, great attention has been given to environmental protection by the Việt Nam’s Communist Party, National Assembly and the Government. This was emphasized in the Politburo Resolution No.41-NQ/TW on environmental protection taking into account the country’s accelerated pace of industrialisation and modernization. To protect the environment effectively, the State encourages every individual, organisation and community to participate in relevant activities, particularly in services such as waste collection, reuse, transport and recycling, besides waste disposal.
Medical waste treatment under the PPP model was developed nearly 10 years ago, and piloted in accordance with Government’s Decision No.71/2010/QĐ-TTg, dated September 1st, 2010. In 2015, the relationship between “public and private” was recently legalised by Decree No.15/2015/NĐ-CP, dated February 14th, 2015, regarding investment in the PPP models.
Investment: Medical waste treament system at health centres
According to statistics of the Ministry of Health, the total amount of solid waste generated by health centres is about 450 tonnes a day. Of this figure, 47 tonnes per day are hazardous waste, while the volume of medical wastewater generated is 125.000 m³ per day.
However, about 15% of the health centres in Việt Nam do not yet handle medical waste treatment in accordance with regulations; 42% of health centres’ wastewater treatment systems are degraded, damaged or have not been operated properly; and some do not have any medical waste treatment system. About 172 health centres are on the black list for causing serious environment pollution that needs to be treated thoroughly. In general, medical waste treatment is being processed in various forms:
Medical wastewater: Health centres have invested in building waste treatment plants and waste collection systems. An unpopular model to collect medical waste is to hire authorised private companies to treat wastewater by investing and operating a wastewater treatment system.
Health centres have to reserve some land and pay fees to these companies (the contracts signed are for 10 years and then the project is handled by the health centres).
Finance sources: Health centres use state funds for medical waste treatment. However, the funds are very limited and several health centres have to borrow capital to invest in wastewater treatment plants under the build-operate-transfer (BOT) model. In Hồ Chí Minh city, hospitals such as Nhi Đồng I, Hùng Vương, Nhân Dân 115 and Hồ Chí Minh’s National Hospital of Odonto-Stomatology have applied this method by investing in wastewater treatment plants, with an average capacity of treating 250 m³ to 1,000 m³ per day for an average 10,000 VND per m³.
Private companies, who want to sign the BOT contracts, will be offered preferential loans of up to 60 percent of the total investment capital at zero percent interest for seven years from the funds of the Hà Nội People’s Committee.
Medical solid waste: There are two forms of treatment
The first form is to process it on site: health centres at grassroot levels will treat solid waste on site by burning it or hiring authorised companies to process it.
According to statistics, most waste incinerators fail to reach Vietnamese standards or technical regulations on environmental protection such as QCVN 02:2012/BTNMT. In some places, the condition of incinerators is deteriorating, posing a high risk of environment pollution or generating hazardous waste.
The second model is to hire authorised companies to use centralised waste treatment units. This model is commonly applied in health centres in urban areas.
Financial mechanism: Health services centres pay the transport fee and handle the volume of solid waste arising from daily use. In addition, the centres do not have their own facilities for treating biological waste. On the other hand, they still use rudimentary vehicles to transport medical solid waste that pose a high risk of environmental pollution.
Medical waste treatment under PPP-advantages and disadvantages
Over the years, the increasing number of health centres and inappropriate waste treatment equipment or systems have made it difficult to conduct waste treatment activities and environmental protection at the centres. In addition, there is limited regular funding for waste management activities of health centres, leading to the risk of environment pollution and affecting the health of patients, medical staff and the community.
To deal with this situation, the Ministry of Health, in collaboration with Ministries, branches and people’s committees of cities and provinces, has taken the initiative of implementing solutions, socialised projects as well as mobilising and effectively using every finance source for healthcare services and medical waste treatment activities
Health centres have started investing in medical waste treatment facilities under the PPP model. Medical waste treatment, particularly of wastewater, has always been strictly in compliance with current regulations and environment standards. On the other hand, health centres have rights and obligations to invest in medical waste treatment facilities under the PPP model, involving no conflict of interest.
The financial mechanism of health centres under the PPP model is quite feasible to minimise their financial burden. Under this model, 7, 310 VND is needed for medical waste treatment per patient bed per day, which includes solid waste and wastewater. In addition, health centres have the right to manage medical waste treatment facilities and are capable of receiving or attracting preferential investment capital.
Companies conducting PPP projects on medical waste treatment facilities need to ensure that they provide continuous, stable and quality services to meet the demand of health centres. Private investment in medical waste treatment facilities will particularly help to reduce the heavy financial burden on them and the state budget.
Apart from advantages, PPP projects in medical waste treatment facilities have to deal with difficulties such as: Many health centres are not highly aware of their responsibility to protect the environment and fight diseases and epidemic outbreaks. They still rely on State’s investment for building medical waste treatment facilities.
In addition, expenditure on construction, equipment purchase and operation of medical waste treatment facilities is quite high, while investment in these facilities under the PPP model requires long-time capital redemption and several administrative procedures.
To boost the PPP model in medical waste treatment, the Ministry of Health will soon improve its policy on medical waste treatment. It will work with Ministries and relevant agencies to develop and submit for the Prime Minister’s approval a special mechanism for medical waste treatment, making it suitable for the current situation. In addition, the Ministry of Health wants to generate a legal corridor and a fair, transparent and effective mechanism to encourage investors to invest greatly in medical waste treatment facilities under the PPP model.
Nguyễn Hữu Hùng
Ministry of Health
