India: Medical Waste Management
Large healthcare institutions operating in urban areas and centralized waste treatment facilities are the prospective buyers for medical waste treatment technologies. Locally manufactured equipment is available as an option to the buyers. Some local companies prefer to fabricate the equipment under license from the principals. Design and supply of hardware for medical waste or hazardous waste landfills is another promising sub-sector.
The Government of India passed the ‘Biomedical Waste (Management & Handling) Rules, 1998, under the Ministry of Environment & Forest Act (MOE&F). With two amendments – the last one in 2002 – the law is now in place, but its effective implementation is what will make the difference.
India has a fairly comprehensive healthcare system comprising of government and private service providers. But it reaches barely 50 percent of the population effectively, mainly on account of general infrastructure bottlenecks. Indian families are now willing to spend more provided the service they get is of a high standard.
The healthcare industry is growing rapidly in India and has emerged as one of the largest service sectors. According to India’s Ministry of Health & Family Welfare, healthcare spending is expected to grow at 15 percent per annum to $60 billion by 2010. The growth is largely fuelled by private investment in healthcare. Medical tourism is expected to become a $2 billion industry by 2010, whereby people from all over the world can visit the country for their medicinal and relaxation requirements. The reason for India being a favourable destination is because of its health infrastructure, skilled professionals and technology.
Health care costs in India are about one-tenth of those in the U.S. or the UK. The average cost of a cardiac surgery at the best hospital in India is only $4500, with a success rate of 98.5 percent. A single tooth filing costs $10 against $300 in the United States. Most common treatments for medical tourism are heart surgery, organ transplants, eye surgery, knee transplant, cosmetic surgery and dental care.
Government’s spending on healthcare is around 20 percent, while the remaining 80 percent comes from the private sector. India’s health care industry contributes 5 percent to the GDP and employs approximately 4 million people. By 2012, this industry is projected to contribute 8.5 percent of GDP.
A joint study “Healthcare in India: The Road Ahead” done by the Confederation of Indian Industry (CII) and McKinsey & Company in 2002 mentions that India has 1.5 beds per 1,000 people while China, Brazil and Thailand have an average of 4.3 beds. The density of doctors is also low with only 43 doctors for a population of 10,000. There are about 200 recognized medical colleges spread throughout the country and approximately 20,000 medical graduates pass out each year.
India generates around three million tons of medical wastes every year and the amount is expected to grow at eight percent annually. The Ministry of Environment and Forests, Government of India notified the Bio-Medical Waste (management and Handling) Rule on 27th July 1998; under the provision of Environment Protection Act 1986.
Accordingly, all the hospitals in the public and private sector are now bound to follow these rules to evade legal action. It regulates the disposal of biomedical wastes and lays down the procedures for collection treatment and disposal and standards to be complied with. These rules apply to all persons, who generate, collect, receive store, transport, and treat or handle biomedical wastes in any form. Biomedical wastes mean any waste, which is generated during the diagnosis, treatment or immunization of human beings or animals or in research activities.
According to Bio-Medical Waste (Management and Handling) Rule – 1998 and subsequent amendments till 2002, all the biomedical waste shall be treated and disposed according to the rule with the help of requisite bio-medical waste treatment facilities like incinerator, autoclave, microwave system for the treatment of waste, or, ensure requisite treatment of waste at a common waste treatment facility or any other waste treatment facility.
Infectious and hazardous waste constitutes about 15 percent of the total hospital waste. However, if not segregated and treated effectively, the entire quantity would be categorized as biomedical waste. Segregation has started in most of the larger hospitals in India. However, the smaller hospitals still need to do more. Treatment is done either by hospitals at site, or is being done through waste treatment contractors in some large cities such as Kolkata and Hyderabad.
The demand for centralized waste treatment is growing. Market demand for bio-medical waste treatment technology comes from either the centralized waste treatment providers or from the large healthcare institutions that want to treat its waste on-site. Preference is however for centralized waste treatment facility. It appears cost effective to establish one large facility, rather than establishing multiple small facilities.
Some of the best prospects for export in the medical waste management sector are:
- Encapsulation techniques
- Chemical treatment methods
- Centralized treatment and disposal facility equipment, supplies and services
Key Suppliers and Prospective Buyers
The sourcing of foreign technology is primarily done by the centralized waste treatment companies or by the large healthcare institutions directly and from various different sources in U.S. and Europe. No single foreign company has significant market share in the sector.
Private players have made significant investments in setting up state-of-the-art private hospitals in cities like Mumbai, New Delhi, Chennai, Kolkata and Hyderabad. They have introduced latest medical technology and have created a competitive environment. The government’s share in the healthcare delivery market is 20 percent while 80 percent is with the private sector.
Emergence of corporate hospitals has led to increased professionalism in medical practices and use of hospital management tools. Some of the leading private healthcare institutions are owned by Indian industry groups. Several foreign investors and non-resident Indians are also investing in Indian healthcare sector.
Market Issues & Obstacles
The regulations of medical waste management are in place, but compliance has been slow and erratic. If properly implemented, the rules should pave the way for export of technologies in a big way.
However, while some states have moved forward in implementing the Rules and catalyzed creation of centralized treatment and disposal facility, many others are lagging behind. Also, India does not have adequate number of private sector players coming forward in creation of centralized facilities. Once these obstacles are removed, the market for medical waste management technologies would be higher.
Excerpts from “India: Medical Waste Management”, U.S. Commercial Service, June 2007.