Health Environment and Climate Action Foundation (HECAF 360): Actions define us

Interview with Mahesh Nakarmi by Dan Abril

Mahesh Nakarmi, professionally a Disaster Risk Management Specialist, with a qualification of Masters degree in Civil Engineering  underwent a transformative experience that led him to embrace Zero Waste. While as a co-founder of the National Kidney Center, he personally encountered the improper disposal of hazardous waste, posing significant risks to communities and waste workers. Witnessing this first hand, he felt an urgent need to take action and promote improved methods for health care waste management which was neglected during those days.

He co-founded Health Care Foundation Nepal (HECAF) in 1994 to address this and ultimately, Mahesh’s efforts in advocating for proper health care waste management prevailed. In 1999, through his efforts, the NKC became the first hospital in Nepal to disinfect the waste generated during care of the kidney patients by using autoclave as a non burn technology. So when he developed a complete health care waste management system at the center, it ultimately  resulted in the reduced quantity of waste  being sent to the landfill. His path took another turn upon meeting GAIA Asia Pacific and Health Care Without Harm. Through these organizations, Mahesh learned about non-burn and no harm approaches including Zero Waste principles and realized that what he was doing is already  Zero Waste. 

In 2020, HECAF became the Health Environment and Climate Action Foundation (HECAF360) and today has a team of 20 people coming from diverse backgrounds such as engineering, environmental science, environmental engineering, biomedical engineering, nursing, public health, and healthcare. 

We had the opportunity to chat with Mahesh and we discussed HECAF360’s journey in becoming a Zero Waste pioneer in Nepal. 

The HECAF360 Team. (Photo courtesy of HECAF360)

What are HECAF 360’s top priorities?

We work on a lot of areas and we address the gaps. These include Zero Waste, healthcare waste, hygiene, and climate resilience. It’s all interrelated. When we talk about menstrual hygiene management, we talk about women’s health and also talk about waste management. But mainly it’s all about Zero Waste and advocating for zero toxins and zero burn approaches to waste management. 

We understand that waste management is a long-term process that cannot be resolved within a short period but by adopting a Zero Waste approach we will achieve our ultimate goal of not having to send any waste to landfills. To realize our objectives, we are trying to define the role of individual citizens in the management of the waste that they generate daily, so we are exploring smart waste management solutions. Through this, we ensure that different types of waste are appropriately handled: recycling is directed to designated recycling centers, landfill waste is appropriately disposed of in landfills, and food waste is routed to food processing facilities to be converted into compost. 

An essential aspect of this system is it provides employment opportunities to waste pickers and integrates them into the waste management process.

Photo courtesy of HECAF360

What are HECAF360’s ongoing campaigns?

We have campaigns on plastic waste and water-related campaigns but everything leads to Zero Waste. You simply cannot advocate for Zero Waste without taking these issues into account. When we conduct our education campaigns in hospitals and government offices, we talk about Zero Waste and we talk at all levels from kindergarten and up, as well as from municipality to federal ministries.

What are HECAF360’s biggest accomplishments/achievements?

We have a lot of stories to share! We’re proud to have introduced Zero Waste not only in hospitals but to the rest of Nepal. We are continuously creating Zero Waste coalitions. We do not only collaborate with hospitals but through coalitions, we also bring together schools, businesses, INGOs, the government, and those working on recycling and upcycling. 

Photo courtesy of HECAF360

What challenges are you currently facing and how is the organization impacted by the COVID crisis?

In 2020, we only had a staff of about 6 to 8 people. At that time, Nepal had not yet experienced the impact of COVID-19. Then, the Minister of Health reached out to us for assistance during the evacuation of 175 students studying in Wuhan, where the pandemic began.

We responded to the call and we took on the challenge and designed a comprehensive waste management system in collaboration with the army, police, the civil aviation authority, and airlines. Our efforts extended from managing waste at airports and handling quarantine centers. 

In this endeavor, we partnered with the Tzu Chi Foundation in Taiwan to facilitate the donations, which involved 10 charter flights. However, there are several challenges in the process. To provide support for waste management in hospitals and donate essential items like ventilators, oxygen concentrators, High Flow Nasal Cannula, and personal protective equipment (PPEs), we were required to have special permission from the government. Though it was a significant challenge, we persevered, and worked closely with authorities and handed over all these items to the Ministry of Health and Population.

With the leadership of the Ministry of Health and Population and with the support of the World Health Organisation (WHO) in Nepal, GiZ Nepal, and the Swiss Government; the HECAF360 team worked at the government health facilities around the clock to improve waste management systems.  Working around these challenges not only strengthened our resolve but also made life more interesting. Despite the risks brought by the pandemic, our staff felt a sense of fulfillment in being able to contribute to the community by providing food relief for needy people in different communities. It provided an opportunity to learn and collaborate with our waste pickers. We were successful in providing a little support to the waste pickers.

Overall, the experience of managing waste during the COVID-19 crisis offered unique learning experiences as we worked closely with both government offices and local communities.

Photo courtesy of HECAF360

What are the main environmental issues your country or region is facing?

The current waste management situation is connected with various environmental issues, including landfills, air pollution, and river pollution, these are related to the broader problem in waste management. Our specific concern now are the chemicals leaching out of Nepal’s landfills, this has worsened the waste management issue. This has directly impacted the public health of the people residing in surrounding communities near the landfill sites. So we need to find a better solution to minimize the quantity of waste to be disposed of at the landfill by integrating waste into a circular economy through the Zero Waste Cities program. And we are actively collaborating with the local, provincial, and federal governments in search of solutions.

How do you see your HECAF360’s work evolving in the next years? 

We have identified numerous areas to focus on, and we still have many plans in progress, including improving the way we communicate our work. Our goal is to be more proactive in implementing Zero Waste systems throughout the country.

Recently, the Ministry of Health began discouraging the use of incinerators in hospitals and encouraged the use of non-burn technologies. This indicates a growing awareness and commitment to the Zero Waste approach. As such, in the coming years, we look forward to Nepal becoming more Zero Waste.

Do you collaborate with partners in other regions? If so, how?

We establish partnerships wherever we go. We want to learn from partners and they want to learn from us. One example is when we went to Penang in Malaysia. At the Tzu Chi Dialysis Center in Penang,  Tzu Chi Foundation Volunteers run a waste recycling program  and the income from this program supports the operation of center and their outreach to communities in need. 

How does your work on waste relate to social justice?

We call on our right to health and a clean environment and we are also advocating for a just transition for waste pickers. Despite the challenges, we continue to push for the government to act. 

Who do you admire most in the environmental work (in your country or in the world)?

There is a lot of good environmental work being done in other countries. I have a lot of admiration for environmental groups in the Philippines for succeeding in banning incineration. There is also a lot of work being done in reclaiming rivers and bringing them to life again. That is commendable. 

HECAF360 always believes in action. That’s why we have action in our name. We don’t do a lot of writing or publishing. We don’t post a lot on social media but we have action. We have zeal for what we want to do and we will continue to do so until we bring the smile back. 

Call for funding: 

Currently, HECAF360 lacks the necessary resources to fund their policy work. Support HECAF360 and their goal of achieving a Zero Waste Nepal, email HECAF360 at or visit their website at