A certain number of healthcare institutions, as determined by inspections, dispose of medical waste together with municipal waste, which is strictly prohibited and extremely dangerous to public health. The state currently does not even have data on the total amount of medical waste produced in healthcare institutions, even though it represents the most dangerous waste after radioactive waste.
This was told to "Vijesti" yesterday by a senator from the State Audit Institution (DRI). Branislav Radulović, who led the performance audit “Success of medical waste management in Montenegro”.
The overall conclusion of the audit, Radulović claims, is that medical waste management in Montenegro requires urgent systemic solutions, strengthening control and improving records in order to reduce environmental and health risks.
It is not known who creates the waste and how it is disposed of.
"The importance of reviewing medical waste management is that, according to the World Health Organization, it represents the most dangerous waste after radioactive waste. Adequate disposal of medical waste (pathoanatomical waste) is particularly important, because it can be said to be 'alive', because it contains bacteria and other organisms that can spread early diseases and cause dangerous epidemics, if not disposed of in a strictly prescribed manner. Pathoanatomical waste is a type of medical waste that is generated in health institutions, laboratories and autopsy rooms and consists of tissues, organs, body parts, fetuses, placentas and other biological materials that have been removed during surgeries, biopsies, autopsies or other medical procedures," explains Radulović.
He told "Vijesti" that a particular problem identified by the SAI is that the Ministry of Health does not have data on which health institutions, with the exception of public health institutions, generate this type of waste and how they dispose of it.
"Unfortunately, Montenegro currently has no data on the total amount of medical waste produced in healthcare institutions. The largest number of inspections by the (former) Directorate for Inspection Affairs was directed at private dental clinics, but not private healthcare clinics," claims Radulović.
He also points out that the Ministry of Health has not established records for other types of medical waste, except for the waste collected by the OMP Ekomedika consortium, in accordance with the concluded concession agreement.
No waste management plan
Asked what the key shortcomings in the field of medical waste management in Montenegro were that were identified by the auditors, Radulović cited the lack of strategic documents, poor implementation of activities, ambiguities in the concession agreement, problems with pathoanatomical waste, insufficient inspection control, and inadequate records and reporting. The SAI audit showed that waste management plans had expired and new ones had not been adopted, which resulted in the absence of clear goals, guidelines, and models for the disposal of certain types of waste, especially pathoanatomical waste.
The audit also showed that most of the activities from the previous medical waste management plan were not implemented, while the implementation monitoring system was inefficient.
"The Ministry of Health has not established an appropriate system for monitoring the implementation of the Medical Waste Management Plan in Montenegro for the period 2016-2020, which has resulted in poor implementation of planned activities. According to information from the Ministry of Health, 52 percent of activities have not been implemented, while the level of implementation for 28 percent is unknown," the final report states.
The audit findings also show that there are ambiguities and disagreements regarding the validity period of the concession contract for medical waste disposal.
In 2011, the government concluded a concession agreement with the OMP Ekomedika Consortium, which established the exclusive right to finance, build and manage medical waste in Montenegro for a period of 15 years.
"Based on the minutes of the meeting held on 3 February 2 between representatives of the Ministry of Health and representatives of Ekomedika, it can be concluded that there is a different interpretation of the contracting parties regarding the time of commencement of the contract. The Ministry of Health's position is that the term of validity of the Concession Agreement begins on 2016 March 12, while Ekomedika's position is that the term of validity of the Agreement begins on 3 January 2013," the report states.
The environmental inspection did not cover all entities, and a significant number of private healthcare institutions do not submit waste reports. The DRI report states that the largest number of inspections from 2020 to 2024 were carried out at private general dental clinics and that the environmental inspection determined that a certain number of them do not hand over the medical waste generated by the clinics to an authorized collector, raising the question of where the waste is disposed of.
The report also shows that there are discrepancies in data on the amount of waste produced, and the competent authorities do not have complete information on medical waste outside the public healthcare sector.
Graves filled, hospitals without solutions
The DRI's findings show that public healthcare institutions that generate pathoanatomical waste have expressed concerns about the quantities and methods of management. These institutions have previously handed over pathoanatomical waste to a local funeral home, however, they state that the burial grounds where the waste is disposed of are almost full and they do not know how they will solve the problem of disposing of this type of medical waste in the future.
The report states that the Ministry of Health has held talks with the leaders of the surrounding municipalities (Danilovgrad, Cetinje, Nikšić) in order to immediately resolve the problem of disposing of pathoanatomical waste that exists at the Clinical Center of Montenegro (KCCG), but they were informed that the cemetery's capacity is full and that they cannot meet the request.
"In 2021, KCCG approached the Ministry of Health, informing that department of the problem of disposing of pathoanatomical waste and requesting consent to purchase a burial site in order to overcome the aforementioned problem. The Ministry of Health gave its consent," the report states.
About twenty recommendations for the authorities
The report states that the Ministry of Health submitted to the competent ministry for ecology Reports on the implementation of the Medical Waste Management Plan for the period 2016 - 2020, but for the period 2021 - 2023. it did not submit any type of report on the state of medical waste management in Montenegro. The audit findings show that a large number of health institutions do not submit annual waste reports to the Environmental Protection Agency.
"Medical waste management in public health institutions, with certain exceptions, is generally carried out appropriately. The Capital City Health Center and the Institute of Public Health of Montenegro stand out as examples of good practice that should be applied. However, PHIs have not ensured continuous monitoring that would result in a report or recommendations for improving medical waste management," the audit shows.
The DRI has sent 20 recommendations to the Ministry of Ecology, Sustainable Development and Northern Development, the Ministry of Health and certain health institutions, and they are required to submit an action plan for their implementation by April 21st.
Bonus video:
