1. ENVIRONMENTAL AND FINANCIAL FEASIBILITY OF SELECTED HEALTH CARE WASTE MANAGEMENT SCENARIOS FOR GAUTENG PROVINCE Torben Kristiansen, MSc. Civ. Eng (Chief Technical Advisor, RAMBØLL A/S, Teknikerbyen 31, 2830 Virum, Denmark, Email: tok@ramboll.dk) John Clements, Pr. Eng. M.B.A., Email: johnc@ibex.co.za Dave Baldwin, PhD, Pr.Sci.Nat. Email: ecconsultants@mweb.co.za Kobus Otto, Pr.Eng (Civil), Email: jbotto@global.co.za DANIDA

2. Overview of presentation 1.Purpose of the Environmental and Financial Feasibility Study of Selected HCW Management Scenarios for Gauteng 2.Brief Description of the Selected Scenarios and Status Quo (Baseline) 3.Methodology, Approach and Consultations 4.Outcome and Key Findings 5.Recommendations 6.Source of further information and documentation DANIDA

3. Purpose of the Feasibility Study 1.Provide decision making basis for deciding which systems to test in the HCW Pilot Projects in Gauteng that in turn would inform the next HCW Tender for the Gauteng Department of Health 2.Provide information on Environmental, Financial and Socio-economic/Safety impacts of Status Quo compared to selected Scenarios DANIDA

4. Baseline & Alt. Scenarios

5. DANIDA SQ: Disposable cardboard boxes, poor incinerators Sc 1: Status Quo with improved Occ Health & Safety + treatment complies to new standards Sc 2: 240 litre wheelie bins, Source separation via Nurse Trolley, + treatment complies to new standards Sc 3: 770 litre wheelie bins, Source separation via Nurse Trolley, + treatment complies to new standards Sc 4: Reusable & stackable PP boxes or various size, Source separation via Nurse Trolley, + treatment complies to new standards Scenarios (baseline + Alternatives)

6. Status Quo (Baseline) In 2000 the first Status Quo study was undertaken by DACEL: –First time in South Africa that HCRW generation was determined by extensive weighing at selected institutions –All treatment plants were located, mapped and the technology evaluated –600 major and 9700 minor HCRW generators (90/10%) –50% of waste from private HC facilities –Approx. 1200 tonne/month of HCRW –70 incinerators at 58 sites (25 DEAT registered) –Poor performance, non-compliance –Not cost-efficient, cardboard boxes costly –Very manual system, unsafe, needle stick injuries –Poor segregation DANIDA

7. Generation

8. Disposal DANIDA 1 Location of Incinerators (on- site and regionalised)

9. Pictures of the Alt. Scenarios DANIDA

10. Methodology:Environmental Assessment of Scenarios 1.Selection of key relevant emission parameters only 2.”Cradle to Grave” inclusion of all indicator emission parameters (in principle). 3.Negligible contributions omitted 4.Emissions include: Manufacturing, transport, treatment, landfill impacts/decomposition of residues, washing of containers 5.Emissions exclude: construction of treatment plants, landfills and other secondary emissions (e.g. transporation of workers to/from work, supplies etc.) DANIDA

11. Methodology:Environmental Assessment of Scenarios DANIDA 1.Energy recovery potential: calculations were made with and without energy recovery. Assuming that only 33% of the calorific value can viably be recovered as energy from regionalised incineration plants only. However, at this scale it is not assumed financially viable to recover energy based on today’s energy prices in SA, etc.; 2.Fuel used for transport is South African quality diesel (high sulphur); 3.17% (w/w) bottom ash and air pollution control residues are assumed from incinerators; 4.100% (w/w) residue is assumed from non-burn technologies; 5.It is assumed that all residues generated are landfilled (no recycling); 6.Incinerators assumed to comply with DEAT Emission Guidelines. Equal to the average monthly emissions; 7.CH 4 contributes 25 times more towards global warming (green house gas impact) than CO 2 ; 8.50% of degradable carbon deposited in landfills is emitted as CH 4 based on current landfill practises; 9.Assuming 14 Nm3 wet flue gas per kg waste; 15% moisture; 9.5% CO2 in dry gas; 10.Dioxins/furans from transportation is not well investigated. Assume 2.5 pg TEQ-I Dioxin per kilometre driven for non-leaded petrol and diesel vehicles. In reality diesel vehicles may emit somewhat less dioxin/furan but there is little reliable data to substantiate that

12. Methodo- logy: Financial Assess- ment of Scenarios DANIDA

13. Results: Environmental Analyses DANIDA

14. Results: Environmental Analyses DANIDA

15. Results: Financial Analyses

16. DANIDA Estimated cost of Status Quo: R 1.8 mill. 4

17. Final Conclusions DANIDA 1.A new HCRW service concept is possible that, while complying to improved performance standards, cf. the Policy, will have the same budgetary impact as the current sub-standard HCRW services provided; 2.Regionalisation is clearly preferable compared to onsite treatment; 3.2-4 regionalised treatment plants result in the lowest overall costs due to economies of scale; 4.Reusable wheelie bins is more cost efficient than disposable cardboard boxes eventhough transport increases 7.Implementation of the Gauteng Policy (Nov. 2001) will significantly reduce the environmental impact of HCRW management in Gauteng; 8.The existing incinerators in Gauteng emit very significant amounts of pollutants compared to internationally available state-of-the-art incinerators. 9.Compared to non-burn technologies, incineration has the most adverse impact in terms of release of acid gases and dioxins/furans, whereas non-burn technologies have the most adverse impact on the emission of green house gases leading to global warming. Furthermore, the use of non-burn technologies increased the transportation of materials in the province compared to the use of incinerators. Hence, it is not clear if incinerators or non-burn technologies are overall (globally) most preferred environmentally.

18. Summery of Conclusions DANIDA 1.The use of on-site treatment plants, in particular on-site incinerators, should be discontinued over a period of time 2.There should be a move towards fewer and larger HCRW treatment facilities in Gauteng; 3.Internal and external handling of HCRW receptacles should be mechanised and the manual handling should be reduced to avoid damaging workers’ health and creating more meaningful and dignified jobs and working conditions; 4.It is not clear if incineration or non-burn treatment is environmentally significantly better than the other. Hence, both technologies are recommended for use provided that the stringent emission standards are enforced.

19. THANK YOU! Further information at: Documents available at : http://www.csir.co.za/ciwm/hcrw By email from: Torbenk@gpg.gov.za / DeeF@gpg.gov.za Fax: 011 4653616 Tel: 082 3323720 DANIDA