This presentation is prepared as part of the course requirement, so may not be comprehensive to meet the reader's requirements and can be used as a reference document for reviewing environmental programs in Nepal shortly. The facts presented and content included, are as of available information till date 30 June, 2022. References are included at end of presentation. No conflict of interest associated. Presentation is prepared by Muskan Pudasainee, Sagar Parajuli, Arjun Poudel and Sita Aryal.

1. ENVIRONMENTAL
PROGRAMS OF
NEPAL IN
RELATION WITH
HEALTH
Prepared by:
Arjun Poudel
Muskan Pudasainee
Sagar Parajuli
Sita Aryal
2/7/2023 1

2. Outline
• List of Environmental Problems and
Programs against them.
• Link in Relation with Health
2/7/2023 2

3. Air Pollution
2/7/2023 3

4. Air
Pollution in
Relation
with Public
Health
Both short-term and long-term
consequences mainly on Young children,
elderly and vulnerable group
Effect not only on health but also on,
ecosystem, agriculture, forestry,
biodiversity, cleaning and laundry,
buildings and monuments, visibility
reduction, traffic accidents, tourism etc.
Diseases like ischemic heart disease,
stroke, chronic obstructive pulmonary
disease (COPD), lung cancer, and acute
lower respiratory infections in children.
2/7/2023 4

5. Major Programs
• Ambient Air Quality Monitoring (With Stations) - http://pollution.gov.com.np/
• Ban on Refuse Burning
• Vehicle Retirement program - Ban on old vehicles and 2-stroke engine vehicles, Ban
on import of three-wheelers
• Pollution Control Devices program – Control of vehicular exhaust emission
• Clean Fuel and Clean Vehicles program – Promotion of gas, electric, and hybrid
vehicles
• Ensure compliance of prescribed emission standards in brick klins
• Introduce standard on coal with high calorific value lowest feasible sulfur content and
low ash content
• No new registration of brick kiln industries inside the Kathmandu Valley
• Enforce the ban on the open burning of the hospital wastes
2/7/2023 5

6. Water
Sanitation
and
Hygiene
(WASH)
2/7/2023 6

7. Water
Sanitation
and Hygiene
in relation
with Public
Health
Nepal - Abundant water resources. Occupies
<0.04% of the world’s total land area, it possesses
2.7% of the available freshwater on earth (ADBI,
2019).
Diarrhea is the leading cause of illness and death-
Globally 88% of diarrheal deaths are due to a lack
of access to sanitation facilities together with
inadequate availability of water for hygiene and
unsafe drinking water
80% of all diseases may be attributed to water and
sanitation related causes and account for around
10,500 child deaths each year from diarrhea
diseases such as dysentery, jaundice, typhoid and
cholera (UNICEF 2011)
2/7/2023 7

8. Major Programs
• Ward WASH CC/M WASH CC etc.
in different Levels
• WASH in Health Institutions
• WASH in School (Free Pads, Toilet
with Incinerators etc.)
• Toilet Construction
• National Water Supply and
Sanitation Program
• Melamchi Drinking Water Project
• Bagmati River Basin
Improvement Project (BRBIP)
2/7/2023 8

9. 2/7/2023 9
Solid Waste Management Programs &
Practices in Nepal

10. Water
Sanitation
and Hygiene
in relation
with Public
Health
Status Quo- 170 grams/capita/day Household waste
generation rate, Household with monthly expenditure
more than NRs 40,000 generating double waste than
household with NRs 5000- SWM Baseline Survey 2012
Household waste contributes 50-75% of Municipal Waste
Household Waste comprise 66% organic waste, 12% plastic
and 9% paper and paper products
Municipal waste- 56% Organic waste, 16% plastics, 16%
paper and paper products
Environmental Risk- Air, water and soil pollution,
Biodiversity, Eco-system
Public Health Risks- Health Problems & Disease
Major on Urban Poor (World Bank Study), Exaggerating
social and economic inequalities
Solid Waste
Management
and It’s impact
on Public Health
2/7/2023 10

11. 2/7/2023 11
• Solid Waste Management Act 2011
• Municipal Waste Management Practices-
Collection, Segregation at source, transport and
final disposal area- landfill site (Local Self
governance Act 1999)
• Application to resource recovery methods to
some level- recycling and composting
• Public Awareness and Community Mobilization
• Special waste management-HCWM
Initiatives
• SWM Strategy by Kathmandu Metropolitan
City in 1998
Major Programs
• Commercial Initiatives- A load of rubbish,
Rupees from rubbish, Khaalisisi, Doko,
Nepwaste, Clean valley company
• Blue Waste to Private Limited- Providing
waste management services
• Nepal Pollution Control and Environment
Management Center (NEPCEMAC)

12. 2/7/2023 12
Best Practices at National Level
Strengthening Local Capacities in Integrated Solid Waste Management in small and medium municipalities of
Nepal”
Bhaktapur- Community Development Section, Bhaktapur composting facility & income generation (1984), City
inspector and 1 waste Inspector to each ward, Local group contractors (local employment), Street sweeping and
waste collection definite schedules (6AM, 12PM, 4PM) and tourist areas (One more time- 6 PM), Promoting HH
composting by selling subsidized compost bin
Other best practices at Bharatpur, Hetauda, Biratnagar (supposed to start first PPP Model), Kritipur
Public Private Partnership for Urban Environment (PPPUE), UNDP Nepal- National PPP Coordination
Committee established, PPP unit at local chambers
Suiro Program at Bharatpur- Exemplary Practice reducing generation of plastic waste, Plastic
Recycling & Women engagement (GESI)
Suiro Abhiyan at Hetauda
Urban Environment Management for Household Composting- Compost Trading
Women Environment Preservation Committee (WEPCO) for Urban Environments Protection- School
eco-clubs, environment training programs on composting and vermicomposting, campaigns, Green
Circle Initatives

13. 2/7/2023 13
Best Practices & Innovations at Global Level
Deposit- Refund Scheme for cans and drinking bottles in UK and EU
Kamilkastu in Japan, self-claimed zero waste region by 2020:
Categorization and segregation of waste into 34 categorizes by
residents and taken to recycling center (80% waste recycled)
Waste to Energy (WTE), Sweden 99% waste recycled
Eco-friendly robotic machine-USA, Biodegradable Leaf Plates-
Germany, Smart bins- Australia, Waste Bank-Indonesia,
Collaboration with informal sectors

14.  Promoting 4R’S (Reduce, Reuse, Recycle and Refuse)
at household and institutional level
 Social Behavior Change Communication Strategies-
NIC ASIAAd
 Landfill site development and operation guideline
 Reward for private initiatives turning “Trash
into Cash”
 Cost recovery approach & Incentives for staff-
performance based, benefit sharing
 Public-private partnership & strengthening local
bodies, Multi-stakeholder engagement
 Tax waiver and subsides
 Integrated Solid Waste Management
 E-waste management
2/7/2023 14
Recommendations

15. Health Care Waste
2/7/2023 15

16. Water
Sanitation
and Hygiene
in relation
with Public
Health
Status Quo- Among total Health Care Waste generated, only
15 % are Hazardous while 85% Non-Hazardous (WHO)
WHO Classification of HCW- 8
UNEP/SBC/WHO 2004 Classification
Public Health Concern- Injuries, Toxic Exposure to
pharmaceutical and cytotoxic wastes, Chemical burns,
Thermal burns and Radiation burns, Niddle Sick Injury (NIS),
Respiratory, gastroenteric, ocular, genital & skin infections,
anthrax, meningitis, Hep. A,B & C
Environmental Risk- Emission of Dioxins, Furans and
Particulate Matter on open burning and incineration
PTMI – 70 Picograms per kilogram of body weight, Annual
Release of Dioxin and Furan is 335.97 gTEQ and among 12
gTEQ is by medical waste- National Implementation Plan for
Stockholm Convention on POPs, 2007 Nepal
Health Care
Waste
Management in
relation with
Public Health
2/7/2023 16

17. 2/7/2023 17
Programs & Policies-National Act, Rules & Regulations
Solid Waste Management Act 2001- Provided legal basis and regulations for HCWM,
Medical Waste defined as “Hazardous Waste produced and discharged from hospitals,
clinics, pharmacies, dispensaries, blood banks, pathology laboratories, veterinary
institutions and health research centers”
Section 4 of Sub-section 1,2, and 3 focused on provisions for management of HCWM- by
local body, institution generating waste, in coordination with local body, Section 43 of
sub-section 1 and 2 of the act on Management of Medical Waste focused on granting
license to the institution with appropriate HCWM plan beforehand
1.Solid Waste Management Policy 1996- Provision for establishment separate unit at
municipality level concerning sanitation
Related- Town Development Act 1989, Local self-Governance Act 1989: Fine system for
haphazard dumping of wastes, Environment Protection Act and Rules 1997, Industrial
Enterprises Act 1992, Labor Act 1992; Use of PPE & Regular Health Checkup

18. Policies & Programs
2/7/2023 18
Programs & Policies-National Act, Rules & Regulations
Environment Health & Health Care Waste Management Section under Management
Division of Department of Health Services
Health Care Waste Management Guideline- MoHP Nepal 2014
Signatory of Basel Convention 1989 (Concept of Environmentally Sound Management &
inter-related life cycle approach), The Stockholm Convention on Persistent organic
Pollutants 2001- Eliminate and reduce release of POPs
Tort Policies & principles- Duty of care principle, Polluter’s pay principle, Precautionary
Principle, Proximity Principles

19. 2/7/2023 19
• HCWM at institutional level
• HCWMC chaired Chief/Director of
HCFs, Department Heads, Matron,
Waste Management Officer,
Representative from Support Staff,
Smaller HCWMC (Chief, Technical &
Support staff)
• Need to make HCWM Plan
• Ban of purchase and use of mercury
containing items at HCFs
• BAT & BEP Practice
• Zero waste concept implemented by
Civil and Bir Hospital
Major Programs

20. o Achieve the sound management of
chemicals throughout their life-cycle
so that, by 2020, chemicals are used
and produced in ways that lead to the
minimization of significant adverse
effects on human health and the
environment
o Incineration of Hospital Wastes
Program - Enforce the ban on the
open burning of the hospital wastes in
the complexes
o HCWM Practice by different
Municipalities
o National Workshop on HCWM
2/7/2023 20
Major Programs

21. 2/7/2023 21
Health Care Waste Management Initiatives
• 6 S system (Sort, Straighten, Shine, Systemize, Sustain and Safety”, Formation of
HCWM Committee and Plan, Zero Waste Program, Communication and Training
(Christmas Decoration from recycled items), Monthly Meeting, Waste
Management & Infection Week, monitoring and incident reporting, Potential
Waste Stream, purchasing policies and waste minimization, Ban Styrofoam, Re-
use and Recycle- Philippines
• National- Municipality Medical Waste Management System-Heatauda, Pokhara,
Nepalgunj
• Health Care Foundation Nepal working with different hospitals for HCWM
• Promoting Green Recovery project UNDP- Rapti, Narayani & Koshi Hospital

22. Climate Change
2/7/2023 22

23. Water
Sanitation
and Hygiene
in relation
with Public
Health
Long-term shifts in temperatures and weather
patterns. These shifts may be natural, such as
through variations in the solar cycle.
Public Health Concern- prolonged droughts and flash
floods, respiratory diseases like ARI, bronchitis and
asthma, Water borne diseases diarrhea, dysentery,
typhoid, giardiasis, amoebiasis, gastritis, jaundice,
and infectious hepatitis, Malnutrition, Food insecurity
Environmental Risk- More frequent and intense
drought, storms, heat waves, rising sea levels, melting
glaciers and warming oceans can directly harm
animals, destroy the places they live, and wreak
havoc on people’s livelihoods and communities.
Climate Change
in relation with
Public Health
2/7/2023 23

24. Major Programs
• Nepal Climate Change
Support Programme (NCCSP)
implemented local
adaptation plans (known as
LAPAs) to address the most
urgent and immediate needs
in 100 villages covering 14
districts from 2013 to 2017.
• Tree Plantation Program
• Capacity Strengthening of
Least Developed Countries
for Adaptation to Climate
Change (CLACC)
• Carbon Mitigation Projects
2/7/2023 24

25. Other Environmental Issues and Programs
Tobacco product control and
regulation act implementation
program
Replacement of Mercury
Thermometer by Digital
system (Based on Minamata
convention)
2/7/2023 25

26. • Save Soil Initiative by Sadhguru
• #UnmaskMyCity- UMC Campaign, Global
Climate & Health Alliance
• Increasing focus on Children’s Environmental
Health- Launch of CEHI
• Healthy China Initiative (2019-30)- 15 special
campaigns by Council of China; Healthy
Environment Promotion Campaign
• BreatheLife Campaign by WHO, UNEP, CCAC
• Waste Segregation Practice at Household Level
(Effective from Shrawan 01. 2079, KMC)
• Major Organizations working on Nepal: ICIMOD,
Water Aid, UNICEF, ENPHO, UNEP, USAID,
UNDP, GIZ, UKAID, China Aid and many more
2/7/2023 26
National &
International
Campaigns &
Initiatives

27. • Possible Alternatives- Efficient mass transit,
Promoting Cycling, Soot free vehicles, setting
emission standards and regulations
• Waste Management- Landfil gas recovery,
Waste water treatment, Management Practices
at household level, 4 R’S
• Household air & Pollution- Low emission
stoves & fuels, Improved lighting, Passive
building design principles
• Energy Supply- Diesel replacement,
Renewable power supply
• Industry- Improved brick kilns, Coke oven,
Fugitive emission control
2/7/2023 27
Alternatives
Environment-
Friendly options

28.  Strict laws to ban the high smoke emitting vehicles
Promote Electric Vehicles
Conduct a Feasibility Study to provide one house one tap rural and urban areas.
Provision of proper monitoring to ensure ODF Status.
Provision of Central Treatment Facility (3 Modalities) based on Public-private
partnership for waste disposal and treatment
 Training on HCWM to Hospital Administrators, HSPs and Support Staffs
 Monitoring of HCWM Practices at Hospital Level & Reward for best practice
2/7/2023 28
Recommendations

29. References
• Kathmandu to mitigate air pollution with UHI: First in Asia (who.int)
• Health Care Waste Management Guideline 2071
• World Health Organization Factsheet
• BreatheLife2030.org
• Solid Waste Management in Nepal; Current Status & Policy Recommendations
• Waste Management Baseline Survey 2020 Nepal
• Solid Waste Management in Nepal- ENPHO, WaterAid
• Best Practices on SWM of Nepalese Cities, EuropeAid, November 2008
• Best Health Care Waste Management Practices- Examples from Four Phillippines Hospital
• Public Private Partnership for Urban Environment, UNDP Nepal
• https://noharm-asia.org/articles/news/asia/nepal-transforming-healthcare-waste-management-nepal
• https://journals.sagepub.com/doi/full/10.1177/0734242X211013910
• https://www.undp.org/nepal/blog/need-healthcare-waste-management-system
• Projects | Nepal Climate Change & Development Portal (climatenepal.org.np)
2/7/2023 29

30. Thank You
2/7/2023 30