WHO Costing Tools - World Banksiteresources.worldbank.org/INTUSWM/Resources/... · WHO COSTING...
Transcript of WHO Costing Tools - World Banksiteresources.worldbank.org/INTUSWM/Resources/... · WHO COSTING...
Sadat Associates, Inc.Sadat International, Inc.
Engineering and Environmental Services
WHO COSTING TOOLS for
Health-Care Waste Management
TOPIC 6
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• Objective– To help estimate costs and annual budgets related to
health-care waste management• Intended Users
– Senior management or other trained personnel– Consultants– National policymakers
Note disclaimer
WHO Costing Tools
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• Approach–Calculations based on key indicative values–Costing done at facility and national levels–Equivalent annual cost method:
Annualized cost = annualized capital costs (ACC) +
annual operating costs (AOC)CC = capital cost, r = discount rate,
where n = equipment lifespan
WHO Costing Tools
( )
( )nr111
rCCACC
+−
⋅=
Sadat Associates, Inc.Sadat International, Inc.
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WHO Costing Tools
• Four Tools– Costing Assessment Tool (CAT)– Expanded Costing Assessment Tool for Low-income
countries (ECAT-L)– Expanded Costing Assessment Tool for Middle-
income countries (ECAT-M)– Expanded Costing Assessment Tool for High-income
countries (ECAT-H)
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CATSeven sections
–Introduction: Provides basic information–Tool A: Initial estimate of total annual cost–Tool B1: Costs for small HCFs–Tool B2: Costs for medium HCFs–Tool B3: Costs for large HCFs–Tool B4: Costs at national level and
Summary of costs at all levels–Tool C: List of items and average values
HCF = health-care facility
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CAT Tool A – Initial estimates
• Input– Total amount of waste generated per year– Total number of staff– Total beds– Total number of small, medium and large facilities
• Indicative values– Cost to treat 1 kg health-care waste, waste generation
per bed per day, staff/patient ratio, average number of beds for small (4 beds), medium (40 beds) and large (400 beds) HCFs, etc.
Calculates initial estimates for national costs
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CAT Tool B1 – Costs for a small HCF
• Input– Numbers of bins, personal protection equipment,
needle removers, treatment system, small pit– Annual numbers of safety boxes, bags, fuel, health-
care waste worker, maintenance, training• Indicative values
– Unit prices of each item above, fuel rate, wage rate, maintenance as % of capital cost
Calculates annual capital and recurrent costs for a small HCFTotal annual costs for all small HCFsCost per kg of treated waste
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CAT Tools B2 and B3
• Tool B2: Costs for a medium HCF– Add a wheeled bin, storage area, and large pit
• Tool B3: Costs for a large HCF– Add a larger treatment system, sharps pit, long-term training,
waste management officer, and cleaning productsCalculates annual capital and recurrent costs for a medium or large HCFTotal annual costs for all medium or large HCFsCost per kg of treated waste
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CAT Tools B4 and C• Tool B4: Costs at national level
– Office/equipment, vehicle, training set, staff, transportation, meeting per diem, maintenance
Calculates annual capital and recurrent costs at national levelSummary of total annual capital and recurrent costs for all small, medium and large HCFsGrand total cost and cost per kg of waste
• Tool C– Listing of unit prices of all items
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ECAT
• Expands the CAT– Differentiates between low, middle and high
income countries– Expands the size categories of HCFs– Allows several treatment options– Allows centralized and/or decentralized
treatment– Computes potential revenues from the sale of
sterilized plastic parts for re-melting
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ECAT
• Size Categories– Small HCFs: 0 to 4 beds– Medium HCFs: 5 to 99 beds– Large A HCFs: 200 to 499 beds– Large B HCFs: 500 beds or higher– Medium cluster: 300 to 1000 kg/day– Large cluster: greater than 1000 kg/day
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• Ten sections– Introduction: Provides basic information– Input: Input required data– Assumptions: List of assumed costs & average values– Small HCFs: Costs for small HCFs– Medium HCFs:Costs for medium HCFs– Large HCFs: Costs for large HCFs– Clusters: Costs at the facility level and costs at
the central facility level for the clusters– National: Costs at national level – Results: Tabulation of all costs– Summary: Summary table and graph
ECAT
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ECAT• Key indicative value
– “Infectious waste” generation rates• kg / bed per day
Low-Income Countries
0
0.10.2
0.30.4
0.50.6
Ban
glad
esh
Ban
glad
esh
Bhu
tan
Cam
bodi
a
Indi
a
Indi
a
Indi
a
Kyr
gyzs
tan
Lao
PD
R
Nep
al
Nig
eria
Nig
eria
Pak
ista
n
Pak
ista
n
Tanz
ania
Vie
tnam
Vie
tnam
Kg
per b
ed p
er d
ay
0.2 kg/b-d
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Middle-Income Countries
0
0.5
1
1.5
2
2.5
Bra
zil
Bra
zil
Bra
zil
Bot
swan
aB
ulga
ria
Bul
garia
Col
umbi
a
Col
umbi
aC
uba
Gua
tem
ala
Guy
ana
Iran
Jam
aica
Jord
an
Jord
an
Leba
non
Mal
aysi
a
Mol
dova
Per
u
Phi
lippi
nes
Phi
lippi
nes
Sou
th
Sri
Lank
a
Sri
Lank
aTh
aila
nd
Thai
land
Turk
ey
Kg
per b
ed p
er d
ay
High-Income Countries
0
0.5
1
1.5
2
2.5
Fran
ce
German
y
Hong K
ong
Italy
Japa
nJa
pan
Kuwait
Netherl
ands
Norway
Portug
al
Saudi
Arabia
Spain
Switzerl
and
United
Ara
b Emira
tes
United
King
dom
United
Stat
es
Kg
per b
ed p
er d
ay
“Infectious waste”
generation rates
0.5 kg/b-d
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ECAT• Key indicative value
– Sharps waste generation rates• kg / bed per day
Sharps waste generation rates
0
0.01
0.02
0.03
0.04
0.05
0.06
W. Euro
pe
Botswana
hosp
itals
Botswana
hosp
itals
Botswana
hosp
itals
Botswana
health
post
Botswana
clini
cs
Uganda
health
cente
rs
Kenya
hosp
ital
Bhutan
hosp
itals
kg p
er b
ed p
er d
ay
0.1 kg/b-d
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ECAT - L• Four options for low-income countries
1. Autoclave, sharps pit – small & medium HCFsAutoclave, reusable sharps container, sharps pit –large HCFsAutoclave, shredder – cluster or central plant
2. Incinerator, ash pit – small, medium & large HCFsIncinerator with pollution control that meets international standards – large central plant only
3. Same as Option 1 but with on-site needle removers at small, medium and large HCFs
4. Same as Option 2 but with on-site needle removers at small, medium and large HCFs
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ECAT - M• Higher infectious waste generation rate• Same basic four options as in ECAT – L• Option 1 and 3:
– Added shredders to the autoclaves of large HCFs as well as central plants
• Option 2 and 4: – Increased the level of pollution control for
incinerators of medium and large HCFs– Added stack testing of incinerators used in clusters
or central plants
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ECAT - H• Higher infectious waste generation rate• Includes cost of disposing hazardous chemical
waste• Replaces all safety boxes with plastic sharps
containers• Different four options:
1. Autoclaves for small and medium HCFs; Autoclave-shredders for large HCFs and central plants
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ECAT - H• Four options (continued)
2. Incinerators for large HCFs and central plants; autoclaves for small and medium HCFs
– All incinerator designs meet international standards (e.g., temperature control of primary and secondary chambers, high residence time, controlled loading, ash sump, etc.)
– Pollution control meets international standards– Parametric monitoring and periodic stack testing– Disposal of incinerator ash in hazardous waste
landfills
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ECAT - H• Four options (continued)
3. Small to large microwave treatment systems for small, medium and large HCFs as well as for central plants
4. Advanced steam treatment systems (e.g., double-walled autoclave with internal shredding, cooling and drying) for large HCFsand central plants; regular autoclaves for small and medium HCFs
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Questions and Comments by Audience
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ECAT-L Demonstration
184301P
11501U
18471T
11271102S
63002142R
14191272Q
571205302O
22291N
182525973M
4050442L
17271K
11501J
261311I
39501102H
18481G
44167872F
38402642E
1955352D
46422002C
32501B
243001A
Smallbedsbedsbeds# hosp.District
Low-income country
Total small HCFs = 452Total medium HCFs = 19
- average beds = 46Total large HCFs = 8
- average beds = 214Total very large HCFs = 0
Number of medium clusters = 1Total small HCFs in cluster = 77Total medium HCF in cluster = 1
- total beds = 19Total large & very large HCFs = 5
- total beds = 1291
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ECAT-L Demonstration• Population: 1765000 • Total beds: 3900• Annual health budget: $365355000 • GDP: $10317000• Wage – HCW worker: $ 3/day• Wage – WMO: $24/day• National staff: $4130/year• Electrical cost: $0.047/kWh• Water/sewage cost: $1.09/cubic meter
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ECAT-L
Demonstration
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ECAT-L Demonstration: Results with cluster
$821,558Needle removers, incinerators and lined ash pits for small, medium and large HCFs; transport vehicle(s), medium to large incinerators and lined ash pits for clusters; only the incinerator for large clusters meets international standards
4
$608,696Needle removers, autoclaves and small pits for small and medium HCFs; needle removers, autoclaves, reusable sharps containers and small pits for large HCFs; transport vehicle(s), medium to large autoclaves and shredders for clusters
3
$815,737Incinerators and lined ash pits for small, medium and large HCFs; transport vehicle(s), medium to large incinerators and lined ash pits for clusters; only the incinerator for large clusters meets international standards
2
$657,309Autoclaves and sharps pits for small and medium HCFs; autoclaves, reusable sharps containers and sharps pits for large HCFs; transport vehicle(s), medium to large autoclaves and shredders for clusters
1
Total Annual Costs ($/yr)
DescriptionOption
Summary of Results
$0
$100,000
$200,000
$300,000
$400,000
$500,000
$600,000
$700,000
$800,000
$900,000
1 2 3 4
Options
Tota
l Ann
ual C
osts
Potential revenues: $6,801
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Central vs. On-Site Treatment,
ECAT-M & Pollution Control
Country G
$0
$50,000
$100,000
$150,000
$200,000
$250,000
1 2 3 4
Options
Tota
l Ann
ual C
osts
Decentralized 1 cluster
ECAT-LLow-Income Country
ECAT-MMiddle-Income Country
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ECAT Sample ResultsCollect ion &
st orage
Treat ment & disposal
Labor & t raining
Collection & storage
Treatment & disposal
Labor & training
Facility collection &
storage
Central treatment and
disposal
Facility labor and training
Transportation
Central plant labor and training
ECAT-M: Country P
ECAT-L: Country S
Central/ClusterTreatment
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ECAT Sample ResultsTotal Annual Cost per bed
0200400600800
10001200
B1 B2 B2 S G G P P A
Country
$/be
d pe
r yea
r
Option 1 Option 2
Total Annual Cost per Capita
00.5
11.5
22.5
3
B1 B2 B2 S G G P P A
Country
$/ca
pita
per
yea
r
Option 1 Option 2
European Union:$400 - $1000 /bed per year
(WHO reference document)
Low-Income: B1, B2, SMiddle-Income: G, PHigh-Income: A
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WHO Costing Tools• To get a copy of the Costing Tools, go to:
For CAT: http://www.healthcarewaste.org/en/documents.html?id=217For ECAT:http://www.healthcarewaste.org/en/documents.html?id=218
• To comment on these tools or to send costing information that could help build the knowledge base, contact WHO: E-mail: [email protected]
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Questions and Comments by Audience