Given rising spend on the provision of healthcare services, the sustainable management of waste from healthcare facilities is increasingly becoming a focus as a means of reducing public health risks and financial costs. Using data on per capita healthcare spend at the national level, as well as a case study of a hospital in Italy, this study examined the relationship between trends in waste generation and the associated costs of managing the waste. At the national level, healthcare spend as a percentage of gross domestic product positively correlated with waste arisings. At the site level, waste generation and type were linked to department type and clinical performance, with the top three highest generating departments of hazardous healthcare waste being anaesthetics (5.96 kg day -1 bed -1 ), paediatric and intensive care (3.37 kg day -1 bed -1 ) and gastroenterology-digestive endoscopy (3.09 kg day -1 bed -1 ). Annual overall waste management costs were $US5,079,191, or approximately $US2.36 kg -1 , with the management of the hazardous fraction of the waste being highest at $US3,707,939. In Italy, reduction in both waste arisings and the associated costs could be realised through various means, including improved waste segregation, and linking the TARI tax to waste generation.

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Abstract:Selecting actions for improvement of solid waste management in low and middle income countries and understanding how a specific decision choice will fit and impact on a local context is key to identifying sustainable solutions. Assessment of the choice (be it technical or managerial) and assessment of the local enabling or disabling conditions are both important steps in the decision making process. Various assessment tools and methods are currently available to support decision-making in solid waste management. Assessment can be used to identify weaknesses or strengths of existing systems in a structured way and hereby highlight factors of success and failure. Assessment methods can also evaluate and compare different possible choices as in project scenarios. This overview describes established and innovative assessment methods serving both these purposes. A range of assessment tools are often designed to assess a specific sustainability domain (technical, environmental and health, economic and financial, social and institutional, organizational aspects), others attempt to provide a more holistic picture by integrating different sustainability domains into the same tool. This paper reviews a number of methods describing and discussing each of them, and referring to their use in low and middle-income countries if published in scientific literature. The overview concludes that in low-and middle-income countries the use of comprehensive assessment methods is yet very limited. We hypothesize that most formal methods of assessment are OPEN ACCESS Sustainability 2014, 6 546 still too complex and generally overburden the weak local capacities intended for their usage. The few applications identified, were conducted by academia for scientific purposes. Lack of resources to collect the vast data required for some assessment methods is a further restriction to their practical application. Future development is suggested to improve user friendliness of existing tools or to simplify certain approaches and develop more appropriate methods. A user-oriented focus in the development of assessment tools would enhance their application, provide sound data for informed decision making and foster a dialogue between technicians and policy makers in low-and middle-income countries.