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More than Health Care Waste Management
Working in 3 Program Areas:

Once solely a provider of health care waste management services, Health Care Foundation Nepal (HECAF) has evolved into HECAF360 and is today the leading provider of clean, green, climate-smart appropriate technology solutions for environmentally sound healthcare waste systems in Nepal and other low-resource countries.


Working closely with various international development agencies as well as national and international NGOs, HECAF360 today manages an array of projects across 3 program areas: Health, Environment and Climate.

HECAF360 designs and implements innovative Zero Waste management systems in hospitals, schools, and municipalities. We encourage safe non-burn technology, support plastic waste management schemes on both institutional and community levels, and widely encourage the 3Rs of waste management: reduce—reuse—recycle.

HECAF360 also plays an important public health role in supporting the Ministry of Health and Population. Nepal was badly affected by SARS-CoV-2 (Covid-19) and HECAF360 contributed significantly to Government of Nepal efforts to sustain the population and contain the virus. HECAF360 interventions included: securing life saving international donations of ventilators and PPE;  assisting the Ministry of Health and Population in the management of hospitalised Covid-19 patients; conducting training workshops in infection control; and the clean-up, handling and safe disposal of potentially hazardous Covid-19 waste.

Read more about these interventions on the Covid Response page.

Recent Developments and Events

Gabriella Jóźwiak is an award-winning journalist based in London who writes extensively on international development issues. In February 2023 she interviewed HECAF360's Mahesh Nakarmi and Ruth Stringer of Health Care Without Harm about their collaboration on the development of a custom-designed multi-chambered biodigester at Kathmandu's Tribhuvan Teaching Hospital. The following is lifted from her online article.

The Teaching Hospital is a 700-bed facility that produces on average a ton of waste per day. Prior to the digester, staff incinerated pathological and anatomical waste such as placentas. However since placentas are composed of about 60% water, workers added paper and plastics to fuel the fire, which caused air pollution. Workers would also pile up hospital food waste outside the building where, awaiting waste collectors to eventually haul it away to a municipal dump, it would attract rats and flies.


Nakarmi, an engineer by background, worked with a biodigester expert to create the digester. Hospital staff load the waste into the digester through two inlets above ground. The waste falls into the first of two chambers where it mixes with cow dung to stimulate the process and water to keep it flowing. 

The placentas are potentially infectious but decompose over a period of about six months in the digester – by which time any dangerous pathogens are eliminated. The “digest” – or waste – flows into a sewer connected to the tank. “There are no mechanical issues,” Nakarmi said. Gravity moves the mixture along. The digester uses no power and is low-maintenance.

For more on HECAF360's work with biodigesters click here For the full text of Gabriella Jóźwiak's article click here.

New Agreement with Health Care Without Harm
and the German Development Agency GIZ 
HECAF360, Health Care Without Harm and the German Development Agency are working on fostering environmental resilience and improving health care waste management practices in Nepal.

HECAF360 and Health Care Without Harm have partnered with the Deutsche Gesellschaft für Internationale Zusammenarbeit (German Development Agency, GIZ) for a 22 month project to foster environmental resilience and improve health care waste management practices as part of German Development Cooperation (GDC)’s support in the health sector in Nepal. For more on this new project click here.

Important new case study launches...
Health Care Waste Management
Towards the Circular Economy

This case study reports on the development of a healthcare waste management system at Tribhuvan Teaching Hospital (TUTH) in Kathmandu Nepal produced in collaboration with HECAF360, Health Care Without Harm and WHO Nepal.


This case study is supported by the United Nations Environment Programme – International Environmental Technology Centre (UNEP-IETC) with financial assistance from the Ministry of Environment Japan (MOEJ).


The report describes factors at TUTH that acted – both for and against – making the necessary procedural changes toward safer healthcare waste management.


By enhancing waste separation at source, distributing needle cutters throughout the hospital, installing a biodigester to treat organic waste and investing in autoclaves to treat infectious waste, levels of hygiene have risen and risk of exposure to infectious disease and injuries associated with waste handling have been reduced. What’s more, emission of air pollutants and greenhouse gases caused by incinerators has been minimised through non-burning treatment technology.


By designing-out waste and pollution and by keeping products and materials in use as much as possible (recycling), this project is actively promoting the concept of “the circular economy” in Nepal. You can access the full case study here.

HECAF360 participates in...
A Special Session of
The 8th 3R International Scientific Conference
organized by the Japan Society of Material Cycles and Waste Management 
This special session featured a mix of presentations from researchers, practitioners and business entrepreneurs in the field of HCWM who shared recent research findings and work experiences. 
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