Rapid urbanization all over the world makes solid waste management (SWM) a daunting task for urban authorities in developed and developing countries alike. Management of all wastes excluding liquid and gases from households, institutions, and industries comprise the solid waste management. In SWM, healthcare waste management (HCWM) is of particular importance as it includes management of sharp, infectious, chemical and radioactive wastes with high potent to cause diseases. The number of healthcare entities (HCEs) is inadequate in Chittagong City Corporation (CCC) area while their distribution is highly uneven with most of the HCEs clustered around the Chittagong Medical College Hospital. In CCC, most of the HCEs belong to small to medium size and are private while only a few public healthcare facilities are large. Evidently, majority of financially ill-off patients are served at public HCEs where healthcare workers are ill-paid and less educated. We exclude physicians and include support staffs of HCEs in our definition healthcare workers. In comparison, a smaller number of financially well-off patients get better services, but may not be better treatment, at private healthcare entities having relatively highly paid healthcare workers. Therefore, we hypothesized that there should be noticeable variation in healthcare waste management between public and HCEs in Chittagong. Consequently, we aimed at comparing the differences between public and private HCEs in their management of HCWs. We conducted this study based on actual field observations, photographic image analysis and semi-structured questionnaire survey of healthcare workforce of public and private HCEs at CCC area between Decembers to May, 2012. We observed that the public HCEs do have more workers but due to lacks in proper regulation and worker management their HCW handling is improper. In contrary, private HCEshave smaller but more effectively managed workforce under better regulation and higher payment. Our study reveals that in case of public HCEs, HCW generation rate at Chittagong Medical College Hospital is 0.94 kg/bed/day; at Chittagong General Hospital it is 0.48 kg/bed/day; at Memon Maternity Hospital it is 1.13 kg/bed/day; at Mamata Naga Shasta Kendra it is 0.08 kg/patient/day and at Fateyabad City corporation dispensary it is 0.05 kg/patient day. On the contrary, HCW generation rate at private HCEs is completely different such as at Bangabandhu Memorial Hospital 1.52 kg/bed/day; at National Hospital 1.79 kg/bed/day; at Chittagong Diabetics Hospital 1.56 kg/bed/day; at Chittagong Eye Infirmary Hospital 0.9 kg/bed/day; at Surjer Hasi Clinic 2.4 kg/bed/day and at Metro Diagnostic center 0.08 kg/test/day. These differences are probably owing to socio-economic and cultural conditions along with living standard of taking service from them. It was found that in public hospitals color coding drums are used for temporary storage of waste but not properly. In contrary, private hospitals and clinics don’t follow any color coding rather they separate HCW into two categories such as general and clinical waste. Nevertheless, diagnostics and NGO running clinics use covered box. Workers of both categories of HCEs collect and segregate HCW manually without wearing any protective gears again they mix up during final disposal. All public hospitals, clinics and a few private hospitals burn major parts of HCW behind their premises and others discharge their generated HCW directly nearby CCC dustbins or roadside area. Inspite of having incinerator facilities, they never use them to save cost. Some small clinics and diagnostic centers are contacted with Innovation Sheva Sangstha (ISS) for managing their generated waste but a few of them still discharge HCW to near roadside area. It was also found that some staffs and workers are involved in selling HCW at BDT 20-50/kg to recycling shop without any treatment. Considering all our gathered experiences from filed survey it is stark clear that the over all process of HCWM scenario of private is better than public and the best management was seen in NGO-run HCEs in CCC
