It often seems that waste management is a last minute add-in to most management plans. An irritating afterthought which sits uncomfortably with established operations, planning of new or reconfigured services often omits the financing and pracicalities of waste management until far too late.

A current paper in PLOS Medicine corrects this imbalance, putting watse managememt into focus with plans for a large scale circumcision ‘drive’ in Swaziland. The global HIV prevention community is implementing voluntary medical male circumcision programs across eastern and southern Africa, with a goal of reaching 80% coverage in adult males by 2015. It is a proven technique in reducing transmission rates for HIV.

This list of commodities identified in planning of the 1 year program, to circumcise 152,000 adult men in Swaziland is immense; commodities and services for for waste management cannot be ignored. The approximate costs for the procurement of commodities, management of a supply chain, and waste disposal, were determined for the Swaziland program using current market prices of goods and services.

The authors’ calculations indicate that depending upon the volume of services provided, supply chain and waste management, including commodities and associated labor, contribute between US$58.92 and US$73.57 to the cost of performing one adult male circumcision in Swaziland. That’s over US$ 10 million for the entire program, a nice little earner for someone but a eye-wateringly huge drain on the respoursces available for public health protection.

Edgil D et al. Voluntary Medical Male Circumcision: Logistics, Commodities, and Waste Management Requirements for Scale-Up of Services. PLOS Medicine November 2011; Volume 8, Issue 11: e1001128