**2. HCW generation in developing countries**

#### **2.1 Definition of HCW**

First, the term HCW used in this chapter will be clarified in detail based on the WHO definition [1]. HCW is a broad concept and can be classified into 2 main categories, hazardous and non-hazardous HCW. According to the definition by WHO [1], the hazardous HCW can be subdivided into 6 subcategories, as follows (**Figure 1**).


*Technical Cooperation for Enhancing Infectious Healthcare Waste Management DOI: http://dx.doi.org/10.5772/intechopen.102604*

#### **Figure 1.**

*Classification of healthcare waste (HCW) based on the definition of [1]. About 15% of HCW generated is hazardous while the remaining 85% is the same as general municipal waste (MSW).*

blood and other body fluids; dressings, bandages, swabs, gloves, masks, gowns, drapes and other material contaminated with blood or other body fluids; laboratory cultures and microbiological stocks; and waste including excreta.


Among these 6 subcategories, (1) sharps, (2) infectious, and (3) pathological wastes are at risk of disease transmission, which are often collectively referred to as 'infectious waste' in the broad sense of the term. In general, around 10% of HCW is infectious waste in the broad sense, 85% of HCW is non-hazardous general waste, and 5% are the other hazardous ones ((4) pharmaceutical, (5) chemical, and (6) radioactive) those must be distinguished from other HCW and properly treated and disposed based on the national regulation and standard.

#### **2.2 Increase of HCW generation according to economic growth**

The characteristics of HCW generation depend on economic and social conditions, public health conditions, healthcare service systems, and solid waste management systems in each country.

According to the World Bank [19], the global average of HCW generation is 0.25 kg/capita/day, which is a very small part of the total special waste generated. **Figure 2** shows the relationship between the level of economic growth (GDP (USD)/ capita) and the HCW generation rate (kg/capita/year), using the data given by the World Bank [19] and JICA.

#### **Figure 2.**

*Correlation between economic growth (GDP/capita) and HCW generation rate (kg/capita/year). Each plot indicates country averaged data (2011–2017), and the dashed line is the trend. Both horizontal and vertical axes are on a logarithmic scale.*

HCW generation data in 105 countries/regions are available and are plotted in the diagram as a cross-country analysis (**Figure 2**). As is clear from this diagram, the level of economic growth (GDP/capita) and HCW generation rate (kg/capita/year) show a weak positive power correlation (r2 = 0.3705). In relatively low income countries (GDP/capita <10,000 USD), HCW generations are often less than 1.0 kg/ capita/year.

A similar correlation can be observed for the relationship between the total amount of municipal solid waste (MSW) generated in each country/region and the total amount of HCW generated, as shown in **Figure 3**, in which the data set used was the same as **Figure 2**.

The total amount of MSW generated and the total amount of HCW generated are in a positive power correlation (r2 = 0.5277), which is stronger than

#### **Figure 3.**

*Correlation between HCW and municipal waste (MSW) generations. Each plot indicates country averaged data (tons/year; 2011–2017), and the dashed line is the trend. Both horizontal and vertical axes are on logarithmic scale.*

the above-mentioned correlation with economic growth. The diagram indicates that the generation status of MSW has a strong influence on the generation status of HCW.

It has been reported that the amount of MSW generated increases year by year due to factors such as economic growth, diversification of life, urbanization, and population growth, in which the rate of increase in developing countries is higher than that in developed countries [19]. This indicates that enhancing HCW management capacity is a strong need in developing countries.

#### **2.3 HCW and waste management capacity**

Recognizing the necessity of HCW management by government authorities means understanding its risks and considering the need for proper collection, treatment, and disposal. In that sense, it can be said that the increase in official reporting of the amount of HCW is related to the improvement of authorities' concerns on HCW management.

**Figure 4** shows the MSW collection service coverage rate (%; based on the target population or the total amount of waste generated) and the amount of HCW generation (kg/capita/year) that is officially recognized by each government authority. The MSW service coverage rate can be used as an index for the quality of MSW management services.

As is clear from this figure, the HCW generation rate is generally very low, if the MSW service coverage rate is less than 83%. In other words, it shows that government authority and given administration system cannot properly respond to HCW generation unless the services for MSW management are in place to some extent. Conversely, in countries/regions where the service coverage rate is more than 83%, the necessity of enhancing HCW management is emphasized as the high priority issue for relevant authorities.

As we have seen earlier, the amount of HCW generated is closely related to the degree of economic development and also to the state of the MSW management services. It shows that socially recognizing HCW as hazardous waste and implementing necessary treatment and disposal will gradually develop in accordance with the enhancement of the capacity of MSW management service as well as economic development.

#### **Figure 4.**

*Correlation between MSW collection service coverage (% in population or total waste basis) and HCW generation rate (kg/capita/year).*
