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Home , Al Amarat, Dibba, Muscat Governorate, Provinces of Oman

be’ah Efforts in Healthcare Waste Management

be’ah Efforts in Healthcare Waste Management

His Majesty His Majesty Sultan Sultan Qaboos Bin Said May Allah protect him May Allah rest his Soul in peace

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Table of Contents

Introduction 5 CEO’s Message 6 1 Institutions benefitting from the collection, transportation and treatment of health- 8 care waste services by sectors 2 Private healthcare institutions (Clinics & Medical Complexes) 9 3 Total amount of healthcare waste treated from 2012 to 2018 10 4 Treatment and disposal technologies of healthcare waste 11 5 Healthcare waste treatment in Treatment Facility 15 6 Healthcare waste treatment in Liwa Treatment Facility 17 7 Healthcare Waste treatment in Thumrait Treatment Facility 17 8 Ministry of Health 18 9 Department of Agriculture and Fisheries 23 Financial Independence 24 At the level of secondary and tertiary healthcare institutions 24 Company’s Achievements 25 Introduction An environmental study recently revealed the annual production rate of healthcare waste throughout the Sultanate that amounts to about 4,500 tons, with Governorate generating the bulk of the wastes as it is home to a large number of reference and specialized hospitals, in addition to private healthcare institutions, followed by the North & South Al Batinah Governorates, Al Dakhiliyah and Dhofar at similar rates. Although the company has, since its foundation, pursued a policy of laying down the infrastructure, which can serve as a foundation for transforming waste management in the country; it only took over the management of the healthcare waste sector on January 1, 2012, after the administration of the sector has been transferred from the Ministry of Health to be’ah. Since then, the company has enacted and put in place ambitious plan to manage healthcare waste treatment facilities in , including expansion strategies to service a broader customer base by increasing the capacity of the healthcare waste treatment facility at Al Amarat State in , and inaugurating two treatment Facilities at Liwa State, North Al Batinah Governorate, and Thumrait State in , as part of a strategic plan to cover all the regions of the Sultanate in 2018. The company followed the management policy on a commercial basis, in order to support the company's operating income and reduce government support, which is considered to be one of the company's most efficient policies. In addition, reasonable prices have been set for all beneficiaries of the service in proportion to the size and work nature of these government and private institutions, in addition to the amount of waste they produce. In this light, the company, represented by the Healthcare Waste Facility, expanded the scope of the service and started reaping the benefits, covering all government and private health institutions under the Ministry of Health as well as health institutions under government military agencies, security and civil authorities such as the Ministry of Defense, the , Diwan of Royal Court, Diwan Of Royal Court Affairs, Sultan Qaboos University and the Public Authority for Water across all , thus, the Healthcare Waste Treatment Facility covers approximately 99.9% of the total waste output of healthcare institutions all over The Sultanate. In 2020, the company seeks to cover healthcare waste generated by the Ministry of Agriculture and Fisheries and the Ministry Of Regional Municipal And Water Resources, which accounts for 1.1% of the total healthcare waste produced in Oman.

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CEO’s Message Since its inception, be’ah has played a prominent role in implementing the National Strategy of waste management; particularly healthcare waste. Since the company took over the management of healthcare waste treatment in 2012 from the Ministry of Health, be’ah has continued its commitment to achieving long-term economic value and sustainability of its operations, making enormous efforts to improve the infrastructure and operational efficiency of healthcare waste treatment facilities across Oman. We have made significant progress in our strategic agenda over the years, and have developed a clear vision of our objectives guided by the National Strategy adopted to manage Oman's healthcare waste sector. Likewise, we have succeeded in providing services to all government and private health institutions by more than 99% across Oman’s provinces. We have also established three main facilities sprawling across prime locations for the treatment of healthcare waste, bringing about the latest international standards and technologies to ensure safe disposal of healthcare waste. This milestone is the result of our commitment to protecting the environment by eliminating unplanned disposal and management of healthcare waste in accordance with the latest international practices and standards. be’ah recognizes the importance of continuous communication with all public and private stakeholders in the field of healthcare and commends the efforts of all government agencies concerned, particularly the Ministry of Health and the Ministry of Environment and Climate Affairs in supporting the management of this type of waste. Hence, be’ah will continue to work closely with all stakeholders in implementing its strategy in order to expand its services in all medical and health sectors across the Sultanate; providing the necessary training to improve the level of service and ensure environmental sustainability. It should also be noted that these achievements would not have been realized without the efforts of our employees and their positive interaction with development and training initiatives, which contributed to the success in achieving the company's goals. We are also proud to achieve a high level of Omanization with most of the key positions occupied by Omani employees who have proven to be highly competent in achieving outstanding successes at all levels. In conclusion and above all, we would like to express our gratitude to His Late Highness Sultan Qaboos bin Said (may his soul rest in peace) as we recall his good will and his great vision in prioritizing environment and its management and placing it at the top of the ladder by granting be’ah the legal formula that enables it to accomplish this success. be’ah started its journey during the reign of His Late Highness (may God rest his soul) and took the responsibility of fulfilling the aspirations of citizens and residents of the good land of Oman within this significant sector, committing itself to proceeding at a rapid pace during the auspicious era of His Majesty Sultan Haitham bin Tariq and pledges to spare no effort in preserving the environment and sustaining its resources for future generations within the scope of its responsibilities and powers. I invite you to read through this report which addresses the most significant efforts and achievements we have made in the field of waste management so far, as well as a full summary of our operations at our service facilities.

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1) Institutions benefiting from the collection, handling, transportation and treatment of healthcare waste service by sectors The total number of healthcare institutions in the Sultanate covered under the service until the fourth quarter of 2019 was 1,477, as illustrated below:

Number Of Health Organization Institutions Covered Percentage Under The Service

Government Health Institutions of The 284 19% Ministry Of Health Health Institutions of Other Government 57 4% Agencies Private Health Institutions (Private 1,103 75% Hospitals & Small Clinics) Private Pharmacies 33 2% Total 1,477

Table (1)

2) Private healthcare institutions (Clinics & Medical Complexes The company has made prompt efforts in order to be able to provide its services to private clinics and medical complexes through continuous coordination with all relevant departments in the Ministry of Health, so that all private clinics operating in Oman are obliged to conclude contracts with be’ah for the treatment of healthcare waste. The company has succeeded in concluding 1,062 contracts with all private clinics and medical complexes spread across the provinces of Oman until the end of the fourth quarter of 2019, as described below: Number Of Contracts Province Concluded Until The End Percentage Of 2019

Muscat 479 45%

South Al Batinah 68 6%

North Al Batinah 156 15%

South Al Sharqiyah 32 3%

North Al Sharqiyah 36 3%

Al Dakhiliyah 82 8%

Dhofar 78 7%

Ad Dhahirah 71 7%

Al Wusta 23 3%

Al Buraimi 31 2%

Musandam 6 1%

Total 1,062

Table (2)

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Number of contracts concluded until the end of 2019

Al Buraimi 3% Al Wusta Musandam 2% 1% Ad Dhahirah 7%

Dhofar 7%

Al Dakhiliyah Muscat 8% 45%

North Al Sharqiyah 3%

South Al Sharqiyah 3%

North Al Batinah South Al Batinah 15% 6%

3) Total amount of treated healthcare waste from 2012 to 2018 Total amount of treated waste from 2012 to 2019 was 23,432.38 tons; the graph displays the amount of waste treated annually. Thumrait facility was operated in August 2016

Musandam and Al Buraimi provinces have been added to Al Liwa facility was oper- the service ated in August 2016 ٩ 201 2018 2017 2016 2015 2014 2013 2012

4,300.81 4,218.48 4,260.65 4,161.67 2,463.31 1,709.35 1,299.66 1,018.63

4) Treatment and disposal technologies for healthcare waste At first, be’ah introduced the sterilization treatment process through (Autoclave) in Oman in 2015, which relies on reducing reliance on the thermal treatment mechanism (incineration) in handling healthcare waste as it is environmentally friendly and guarantees lower operational cost. Consequently, the company offers two types techniques for the treatment of healthcare waste – namely thermal treatment (incineration) and sterilization (Autoclave) treatment.

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1) Waste Incinerators (Burning) 2) Autoclave (Sterilization of Healthcare Waste)

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The following map highlights the locations of healthcare waste treatment facilities in Oman:

Khasab under construction

Liwat Waste treatment via sterilization – 6 tons per day

Al Amerat

Waste treatment via Autoclave – 5.5 tons per day

Waste treatment via sterilization – 9 tons per day

Treatment via sterilization – 6 tons per day

Thumrait 5) Healthcare waste treatment in Al Amarat Healthcare Waste Treatment After relocating and managing of the Amarat Facility in Muscat Governorate, the company put in place within its strategic plan to increase the capacity of Al Amarat Facility from 5.75 tons/ day to 14.5 tons/day. Autoclave (sterilization) was introduced in July 2015; another Autoclave machine was added in January 2016 in order to accommodate the increased amount of waste generated by all the institutions that are serviced by the facility. In light of this expansion, the service has been extended to all government healthcare institutions and private hospitals of Muscat, North and South Al Sharqiyah, Al Dakhiliyah, Masirah Hospital, Al Jabal Al Akhdar Hospital and Mahout Province due to its proximity to . The service is provided to these institutions at the treatment facility in Al Amarat State. It is worth mentioning that the operation and maintenance of the two healthcare waste treatment facilities in Al Amarat State in Muscat Governorate and Liwa State in North Al Batinah Governorate were assigned to Averda Waste Management (LCC) according to contract No. (C/27/2015). The total amount of healthcare waste treated at Al Amarat facility in 2019 was approximately 3,000 tons, as described below:

Amount Of Waste Collected Organization From Health Institutions Of The Organization In 2019 Government Health Institutions of the 1,791.87 Ministry of Health Health Institutions of Other Government 636.80 Agencies Private Health Institutions (Private 422.43 Hospitals & Small Clinics)

Pharmacies 163.15

Total 3,014.24 Tons

Table (4)

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The following table shows the amount of waste treated per ton by the treatment technique at the treatment plant in Al Amarat State (2012-2019):

5,000.00

4,500.00

4,000.00

3,500.00

3,000.00

2,500.00

2,000.00

1,500.00

1,000.00

500.00

2019 2018 2017 2016 2015 2014 2013 2012 0.00

3,058.37 2770.24 2907.61 1,758.94 721.59 179.88 0.00 0.00 Autoclave

1,242.45 1,448.25 1,351.02 1,711.14 1,741.54 1,529.38 1,299.66 1,018.63 Waste Incinerators

Autoclave (Liquid Sterilization of Waste Incinerators (Burning) Healthcare Waste) 6) Healthcare waste treatment in Liwa State The healthcare waste treatment facility in Al Liwa was inaugurated in December 2015 and accordingly, services of collection, transport and treatment of healthcare waste generated by hospitals and health institutions in North and South Al Batinah, AD Dhahirah, Al Buraimi and Musandam. The total amount of healthcare waste collected at Al Liwa State treatment facility was 811 tons in 2019, as shown below:

Amount Of Waste Collected Organization From Health Institutions Of The Organization In 2019 Government Health Institutions of the 718.45 Ministry of Health Health Institutions of Other Government 1.40 Agencies Private Health Institutions (Private Hospitals 91.33 & Small Clinics) Total 811.18 Tons

7) Healthcare Waste treatment in Thumrait Treatment Facility The healthcare waste treatment facility in Thumrait was inaugurated in August 2016, where the contract for the operation and maintenance of the healthcare waste treatment facility inThumrait State in Dhofar Governorate was assigned to Taqa International Trading and Contracting Co LLC according to contract No. (C/09/2016). The service covered all government and private health institutions across Dhofar Governorate and Al Wusta Region. In 2019, the total amount of healthcare waste collected at the treatment plant of Thumrait was 517 tons, as shown below:

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Amount Of Waste Collected From Organization Health Institutions Of The Organi- zation In 2019 Government health institutions of the 434.67 Ministry of Health Health institutions belonging to other 38.66 government agencies Private health institutions (private 44.52 hospitals and small clinics) Total 517.85 Tons

Table (5) 8) Ministry of Health Al Wusta Governorate: Among its strategic ideas for 2020, the company has planned to establish a waste treatment facility healthcare in Duqm State to provide its service to the health institutions in Al Wusta Governorate , however, after thoroughly reviewing and reassessing the plan, the company saw that the estimated construction cost would be insignificant economically and incompatible with the small amounts of healthcare waste produced by health care institutions in this region during this period, while waiting for the completion of the economic zone projects and the establishment of the infrastructure for those projects is completed as well. Considering the inappropriate processing and dumping of hazardous healthcare waste on uncontrolled sites and the importance of finding quick and effective solutions to halt this practice, which can pose contamination risks to both people and the environment, the company was able to develop a flexible action plan through which it was able to provide and expand the service to all government and private health institutions across Al Wusta Governorate by collecting, transporting and processing healthcare waste at the treatment facility in Thumrait. By August 2017, all institutions in the governorate were covered, where the safe disposal of healthcare waste across the governorate is carried out at Thumrait healthcare waste treatment facility in Dhofar Governorate, except in Mahout State, where healthcare waste is safely disposed of at Al Amarat waste treatment facility in Muscat; the service was distributed between the waste treatment facilities in accordance to the locations of those states.

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Al Buraimi Governorate: In 2016 and 2017, the company has exerted great efforts in introducing the service at all health institutions of . The challenge was to primarily find solutions to work out the mechanism of transporting healthcare waste in trucks via Wadi Al Jazi border port along with and the issue of customs duties imposed on the company's trucks. These efforts have resulted in the coverage of all government and private health institutions in the Governorate, thanks to tremendous support of the Ministry of Health and the Royal Oman Police during the first quarter of 2018. The service is provided to these institutions according to the following table:

Number Of Health Institutions Organization Covered By The Service Government Health Institutions of the 9 Ministry of Health Private Health Institutions 31 Total Health Institutions 40

Tables (6) : Musandam Governorate was not part of the current plan in the agreement concluded with the Ministry of Health, given its location that is interspersed with border areas and its topography.The company, however, put it within its strategic plan to establish a healthcare waste treatment facility in State, where the company attempted to inaugurate the facility after the construction completion of the new Khasab Hospital due to the increased amount of waste generated versus the estimated amount. Considering the inappropriate processing and dumping of hazardous healthcare waste on uncontrolled sites and the importance of finding quick and effective solutions to halt this practice, which can pose contamination risks to both people and the environment, the company was able to develop a flexible action plan through which it was able to provide and expand the service to all government and private healthcare institutions by transporting healthcare waste from Musandam Governorate and processing it at Liwa treatment facility of North Batinah Governorate. By the beginning of May 2018, the company began transporting the first shipment of healthcare waste to government institutions from Khasab & to Shinas State by sea, and then transported for processing at the treatment facility in Liwa State with the support of the National Ferry Company. It is worth mentioning that the company is in the process of evaluating the development of an appropriate mechanism for the disposal of healthcare waste from health institutions in State.

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Small Clinics in Oil Fields: There are small clinics distributed across the oil fields, a number of which are under the management of the Oman Oil Development Company (PDO) that generate small quantities of healthcare waste. In cooperation with the Ministry of Health, the company has been able to conclude contracts and provide services to 56 small clinics in the oil fields, where an authorized healthcare service company was assigned to collect healthcare waste and transport it to the treatment facility for safe processing. Similarly, the company aspires to cover all small clinics under the management of PDO during 2020. 9) Department of Agriculture and Fisheries The 298 state and private veterinary clinics, veterinary laboratories, research and quarries fall within the jurisdiction of the Ministry of Agriculture and Fisheries, where the Ministry grants the necessary permits to these institutions to carry out their activities in protecting livestock from pests and diseases. Since these institutions generate hazardous healthcare waste as a result of these activities, be’ah has been in constant contact with Ministry officials since April 2017 in attempt to make decisions on contracts for safe disposal of these wastes across all government and private veterinary clinics, veterinary laboratories, research and medical quarries, with the contracting process to be completed in several stages. Although the Ministry is still awaiting the official response from the Ministry of Finance on the financial allocation to provide service to government veterinary clinics, the company has begun concluding contracts with private veterinary clinics to ensure safe disposal of these wastes in accordance with relevant laws and regulations. The following table highlights the number of private government veterinary clinics, veterinary and agricultural quarries located in Oman until the end of 2019 to be serviced immediately after concluding an agreement with the Ministry:

Type Number Of Institutions

Government Veterinary Clinics 72 Private Veterinary Clinics 212 Veterinary and Agricultural Quarries 14 Total Institutions 298

Table (7)

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Financial Independence: Due to the company's strategic plan for managing healthcare waste in Oman, and on the commercial foundations established to provide the service, which included setting appropriate prices for all the beneficiaries of the service in proportion to the size and work of these facilities, the amount of waste generated and the great efforts made to cover all government and private health institutions across all provinces of Oman in a record time, the facility was capable of becoming financially independent, thus reducing government support. In future, this enables managing and covering the operational costs of treatment facilities while fulfilling the responsibilities towards operators of those facilities. Achievements of Oman’s Healthcare Waste Treatment Facility:

At the level of secondary and tertiary healthcare institutions: • The company conducted a pilot project at Sultan Qaboos University Hospital to implement the correct mechanisms for the isolation of waste, especially cytotoxic & Genotoxic waste. • The company has intensively conducted lectures and workshops for medical and paramedical staff in secondary and tertiary health care institutions of government institutions in various sectors as well as for private health institutions with regard to the implementation of waste isolation policy. • Reduced the amount of waste of tertiary healthcare institutions by 20% to 50%, i.e. 2 kilos per bed. • Reduced the amount of waste of secondary healthcare institutions by 20% to 30% at a rate of 1.8 kilos per bed. • Conducted a comprehensive survey on the quality of waste generated by various healthcare institutions and included optimal methods of processing them according to f techniques. • The company has supported a number of events such as conferences and workshops for a number of leading healthcare and educational institutions. • Produced a documentary on the healthcare waste sector achievements. • Creating and promoting the Ramadan campaign for the second year in a row with regard to the safe disposal of household healthCare waste (damaged or expired medicines and insulin needle waste). Company’s Achievements: • The facility was awarded first place at the Middle East Waste & Recycling Awards in the category of Medical Waste Management Best Practice Award on a regional level. • The annual participation in international conferences held by the International Solid Waste Association. • The company received an exclusive invitation from the World Health Organization to represent The Sultanate at workshops held in The Hashemite Kingdom of Jordan and to highlight the Sultanate's pioneering experience in safe management of healthcare waste

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