The main objective of this monitoring and evaluation was to assess the hospital waste management practices in Rajshahi City Corporation area after providing training and implementation of in-house MWM partnership pilot. Specific objectives of the monitoring survey were to: i. Evaluate the status and practice of in-house waste management after training, ii. See the change in waste generation and quality after training and in-house management implementation, iii. Assess the improvement in waste collection and disposal system by Rajshahi City Corporation, and iv. Find the reasons behind improper medical waste management during the pilot phase. Based on this evaluation, an implementation strategy, final disposal option, and the partnership model will be evaluated. Almost all hospitals/clinics/ diagnostic centers of Rajshahi City Corporation area were surveyed during the monitoring period (April-June 2006). Data were collected by field observation and interview through checklists. Data on waste generation and category were collected by three days weighing of waste in selected hospitals. Those were selected according to the size of hospitals/clinics and service delivery.
Two rounds of data collection during April-June 2006 showed a remarkable improvement in certain stages of in-house medical waste management. Use of different bins for different kinds of waste, destruction of sharp waste, separate space or room allocation for temporary storage of waste, use of personal protective uniform and disinfectants as safety measure, etc. are some positive changes observed during the study. Overall perception, knowledge and practice have been improved after the training provided during the pilot project. Few respondents also mentioned that Rajshahi City Corporation did not have proper waste collection system for hospitals/clinics. However, after providing training and implementing the pilot in-house management system, respondents mentioned constraints those were different form baseline findings. They also mentioned that proper collection and disposal system by Rajshahi City Corporation is very much needed. It is quite clear from their discussion that they are conscious about the final collection, transport, and disposal of medical waste. There are lots of obstacles related to total medical waste management system, hence, any kind of positive changes would take time. More time and much effort are needed to change practice and implementation of proper medical waste management at all healthcare facilities and capacity development of all level of stakeholders. Few more things are needed be done to establish the partnership model, these are: Finalization of final disposal option at Rajshahi City Corporation; Organizing a seminar involving all city corporations to understand their involvement and capacity and develop strategy to incorporate MWM in their policy and planning; and Evaluation of partnership model by discussion, meeting, and consultation with all stakeholders.