Healthcare waste management in Istanbul: improving decision making

Turkey's accession to European Union requires compliance with the EU legislation. Healthcare waste is one waste stream which will be affected by this accession. Currently, in Turkey, especially in large provinces (such as Istanbul) there is an increasing pressure on the government authorities to develop a sustainable approach to healthcare waste management and integrate strategies aiming at pursuing sustainable society. In this respect, the purpose of this research was to develop a framework to support selection and planning of the future healthcare waste treatment systems in Istanbul. In this study, an Istanbul-scale system dynamics model was developed to estimate future healthcare waste generation to 2040 and it was identified whether any of the assumptions made, because of the data gaps, have any significant influence on the outcomes of the model. The study found that more precise data are required on treatment types (acute or chronic), patient episodes (inpatient and outpatient figures in an age spectrum) and waste generation profiles (e.g. anatomic, genotoxic, sharps, etc.) of healthcare institutions. The model also determined a high potential in decreasing healthcare waste amounts (up to. 10,000tpa) through implementing effective segregation along with a significant proportion of the healthcare waste (77%) which being incinerated could, in principle, be treated through alternative technologies. The data generated by the model was used in the context of Multi-Criteria Decision Analysis (MCDA) by identifying various criteria, measuring them and ranking their relative importance from the point of key stakeholders via a questionnaire within four future scenarios. It was found that autoclave/hydroclave technology option for the treatment of healthcare waste suitable for alternative treatment (HCW SAT) and then their disposal through landfilling with energy recovery has potential to be an optimum option and these alternative treatment methods along with an efficient healthcare waste segregation scheme should be given more attention by the authorities in Istanbul. The methodology used in this project has been developed based on the primary aim of the project which is to enable the decision makers in Istanbul to gain an improved perception of the decision problem.