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March 2002

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Reports from the sharp end

1: Cambodia: safe, non-polluting incinerators

SINCE Cambodia’s Ministry of Health adopted an injection safety policy in 2000, the immunization programme has moved fast. It has to: from 2003 the introduction of AD syringes into the routine immunization system will mean 3 million extra syringes each year for the system to dispose of, says Keith Feldon, technical officer for Cambodia’s Expanded Programme on Immunization. This number does not include AD syringes already being introduced for supplemental immunizations, nor hospital injections.

The country has chosen to use small-scale "auto-combustion" incinerators, which usually use dry combustion materials such as leaves, paper or coconut husks, and are easy to operate and maintain. With land scarce, the incinerators are also preferable to burial sites, and safer for workers to manage. So far, 14 of 24 provinces have installed them and trained operators, and instructions on use of the incinerators have been circulated. "This incinerator seems to be appropriate in terms of cost, training, land space and potential risk to health workers and the population," says Feldon.

  A Sicim incinerator, the type widely used in Cambodia for syringe disposal

Encouragingly, early findings from WHO tests of the incinerators show that when they are used properly, they do not emit harmful amounts of pollutants such as dioxins or furans. And, although the country has had to invest significant capital in buying the incinerators, studies suggest that they are cost-effective with sustained use. Feldon hopes that costs will fall as local manufacturers of components such as safety boxes and AD syringes gradually replace expensive imports. He also believes that equipment manufacturers should take some responsibility for the costs of disposing of their products.

"It must be remembered that there is no perfect disposal solution, and that whatever technology is selected is only an intermediate path until there are improvements in both vaccine delivery methods and disposal systems."

Phyllida Brown


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