Biomedical Waste in India: Trends, Challenges, and Data Insights

Biomedical waste management in India is improving, with treatment rates rising from 91.5% in 2022 to 93.4% in 2023. However, gaps remain. Discrepancies in reporting and the use of unregulated disposal methods like deep burial suggest that the often-cited estimate of 15% untreated waste may still hold true. State-level data reveals zonal patterns: Western and Northern states lead in infrastructure, while some Southern states underperform relative to capacity. Kerala has emerged as a fast-growing outlier, tripling its healthcare facilities in just one year. As the climate crisis intensifies, effective biomedical waste management is essential, requiring investment, transparency, and enforcement to ensure no medical waste goes unmanaged.

Here are some terms to know before we get into the nitty gritty of biomedical waste:

For this analysis, I classified the states into the following zones:

Poor management of medical and hazardous waste poses serious ecological risks. BMW consists of hazardous chemicals, various infectious organisms, and expired medicines. More than 15 percent of bio-medical waste is estimated to go untreated. Let’s look into the data and find out!

India's healthcare system is vast and growing, with 434,966 healthcare facilities spread across the country. The management of waste from these facilities presents a significant environmental challenge.

Let’s understand what each type of healthcare facility means:

Non-bedded healthcare facilities make up a significantly larger portion than bedded healthcare facilities. This disparity likely reflects the ease of setting up non-bedded facilities, as opposed to the more complex resource requirements associated with bedded facilities.

Maharashtra tops the list with 76,413 HCFs. Meanwhile, the South zone has the maximum number of states in the top 10 by the number of HCFs, with Telangana being the only southern state not in the top 10 states with the most HCFs. This is reflected in the zonal rankings.

Uttar Pradesh (23,856) has the highest number of bedded HCFs, followed by Maharashtra. Kerala is the only Southern state outside the top 10 for bedded HCFs.

Now that we have a better picture of the distribution of HCFs across states, let’s see how states and zones fare in the waste generation sector.

Wondering which states generate the most waste?

Uttar Pradesh coming in first is no surprise, given that it is the most populated state in India. Delhi shows up in the list, which could be because of the large number of people coming to Delhi to get treated at AIIMS Delhi.

Most states in the top 10 list are ranked among the 10 most populous states. The southern zone generates the most waste daily, while the northern and western zones are neck to neck.

Despite Bihar being the second most populous state, it comes in 10th place. The lack of healthcare infrastructure could be a reason for this, since we did not see Bihar coming in anywhere in the top 10 with regard to treatment facilities.

Let us examine whether the treatment facilities can keep up with the generated waste.

To better understand the roles of these facilities, here's a brief explanation of their treatment processes:

The pie chart demonstrates that CBWTFs are the most common type of treatment facility in India, while CTFs are the least common. Other treatment facilities fall between these two in terms of representation.

This distribution may be attributed to several factors. CBWTFs, serving multiple healthcare facilities, often benefit from economies of scale, making them a cost-effective solution. Additionally, centralised treatment at CBWTFs can be easier to monitor and regulate. In contrast, CTFs, located on-site at individual facilities, can be more expensive to set up and operate, and may present challenges in terms of space requirements and operational complexity.

Apart from Daman and Diu & Dadra and Nagar Haveli, which uses Gujarat’s CBWTFs, the following charts show the top states and zones with the most treatment facilities.

Maharashtra has the highest number of CBWTFs (30). The South and West zones are most represented in the top 10 states for CBWTF count, with Kerala being the only Southern state outside this top 10 list for CBWTF count.

The North zone has the highest number of CTFs overall. Notably, the Northeastern states show a significant presence in the top 10 states for CTF numbers, with four states represented.

Northeastern states dominate entirely here, with 5 of 7 states in the top 10 states list. We also start to see Union Territories in the top 10, while they didn’t show up before.

This dominance of the Northeastern states in CTFs and Captive Incinerators could be due to the difficulty of building and maintaining CBWTFs due to cost, challenging terrain, and regulatory enforcement. In areas where CBWTF infrastructure is less developed or enforcement is less stringent, HCFs might opt for CTFs, Captive Incinerators, or other treatment facilities.

What’s the final verdict on the number of HCFs accessing treatment facilities? Any guesses?

Maharashtra takes the top spot, and all the Southern states are in the top 10, possibly due to the high number of HCFs.

Does the number of treatment facilities in a state affect the treatment of waste that the state has generated?

The north-east and a couple of eastern states like Bihar and Jharkhand show up in the bottom 10 states by treatment rates. The northeastern zone lags behind the rest of the country regarding the average waste treatment rate.

Surprisingly, the Southern zone has a lower waste treatment rate despite ranking in the top 2 zones for CBWTFs, Captive Incinerators, and the number of HCFs having access to treatment facilities. Kerala and Karnataka come in the bottom 10 states in terms of treatment rates.

India generated 705 tons per day in 2023. Roughly 694 tons, or 93.4% of the waste, got treated and disposed of.

The gap between generation and treatment, and the HCFs that don’t use CBWTFs or CTFs, is due to HCFs using deep burials not submitted in the reports.

Enough of 2023. Let’s see how much things have changed since 2022.

Southern and Northern states dominate the list. Jammu and Kashmir also significantly improved by nearly doubling the number of HCFs in 2023.

The amount treated has increased while the amount untreated has decreased.

We see an increase in the number of HCFs with access to treatment across the board in the northeastern, eastern, central states, and union territories, with Punjab being the sole exception.

Six states improved treatment rates, but we must remember the gap. The improvement was greatest in the northeastern and eastern states. Assam showed the most significant improvement in treatment rates.

There is an increase from 705 tons per day in 2022 to 743 tons per day in 2023. This can be attributed to the 9.4% increase in HCFs.

Managing BMW is not just a healthcare issue. It’s also a climate and sustainability issue.

Waste treatment takes a lot of energy, land, and labour. Incineration of waste contributes significantly to local air pollution more than landfilling does. Plus, the heat produced in incineration can be used as an energy source. In reality, this potential is often untapped.

Deep burial of BMW is problematic due to various ecological reasons:

As the amount of waste generated increases, finding a sustainable way to recycle biomedical waste is becoming increasingly urgent. Sustainable solutions include:

Despite the estimates of more than 15% of BMW going untreated, the data suggests a lower untreated percentage. However, this may not reflect the whole picture.

The CPCB report highlights the discrepancy in many healthcare facilities not using authorised treatment facilities. Some HCFs may be using unreported disposal methods, such as deep burial, which creates a gap in the official statistics.

This gap suggests that the initial estimate of 15% of untreated BMW may still be accurate despite what the reported figures indicate. Even with the potential underreporting, treatment rates have improved from 91.5% in 2022 to 93.4% in 2023.

State-level unlocks insights of zonal patterns. Western and Northern states consistently lead in both healthcare and waste treatment infrastructure. Maharashtra stands out with 76,413 HCFs and 30 CBWTFs, making it the best-performing state.

While Southern states have a high number of HCFs and waste treatment facilities, their treatment rates are lower than expected, pointing to possible inefficiencies or reporting gaps.

Meanwhile, Kerala has made impressive progress, nearly tripling its healthcare facilities in just one year.

The climate crisis demands urgent and systemic action. Proper biomedical waste management is a crucial part of this effort, requiring continued investment in treatment facilities and stricter enforcement of waste management regulations.

Now is the time for policymakers, healthcare providers, and citizens to come together and demand transparency, support sustainable technologies, and ensure that no medical waste is unmanaged.