How the government replaces state institutions with private companies

Hazardous medical waste in containers, together with other garbage, and unsafe burning of body parts - until 15 years ago, this was something that was quite normal at health institutions in Nis. Then the European Union started investing millions of euros to help Serbia finally organize this area.

The Clinical Center and the Health Center in Niš were among those that received facilities for the treatment of infectious medical waste. "Vreme" reveals the "scheme" according to which the current government has been "cleaning the field" in recent years, emptying state facilities. Several of our interlocutors think that the reason is "filling the pockets of a private company that has a monopoly in this area", which the company denies.

The appearance of serious infectious diseases on an epidemic scale, as written in one of the official documents, was one of the alarms for Serbia to start seriously dealing with the problem of medical waste. In order to establish that system, the European Union helped, and from 2007 to 2013, as stated, it donated as much as 13,5 million euros.

The largest health institutions in the south, the Clinical Center and the Health Center in Niš, were among the first to receive a donation - facilities for sterilizing infectious medical waste. For years, they were the central place for its collection and processing. Waste generated in other state health institutions was also treated in them, free of charge, while services of this type were paid for by private companies, but far less than today.

Our research and several interlocutors who have been dealing with the topic of medical waste for years showed a "scheme" according to which the government emptied state facilities in favor of the private company "Remondis Medison" from Zrenjanin.

Withdrawal and non-renewal of permits, as well as changes in regulations - among which is the one that requires health institutions to register as a transport company - were the most common forms of this "scheme". In practice, this means that for several years, money has not been returned to the citizens by investing in healthcare, but the private company's "pockets are being filled", which many interlocutors consider to have a "monopoly" in this area. However, the aforementioned company denies such claims and points out that the state is the largest operator of medical waste.

photo: jovana stojanovic

HOW IT WAS ONCE UPON A TIME

Until 2007, medical waste was not particularly taken care of in Serbia. In Niš, this meant that it was mostly in containers together with other communal garbage, and in the incinerator located on the site of today's boiler house in the old part of Klinikki, body parts were burned, but in an unsafe way.

After "Batuta", the Niš Clinical Center was the first in the south of the country to receive a facility for the sterilization of infectious waste. Since 2009, when it was opened with the help of EU donations, it has been located opposite the aforementioned incinerator, which was demolished in those years. The facility received four autoclaves and three shredders, as well as one vehicle used to transport waste from all clinics. Once sterilized, the waste becomes environmentally safe, packed in black bags and disposed of in containers emptied by the local utility company.

Medical waste in this institution is dealt with by the Security Department, in which they confirm that for ten years they were the central place for transporting and sterilizing medical waste. In that facility, infectious waste from state health institutions that are in the Network Plan, as well as those from private practices, were treated.

"We disposed of waste from the Emergency Department, Transfusion, Student Polyclinic, Department of Forensic Medicine, Dental Clinic, "Niška Banja" Institute, Gornja Toponica, and the Institute for Workers' Health Protection. The Fund recognized this for us, and we did not charge those state institutions, nor did they receive money from the Fund for those services. These were expenses for the consumption of electricity, energy sources, repair of autoclaves, and the like. Until July 1 In 2019, we also provided transport, which was mandatory on our part. According to the decision of the Board of Directors, we only charged private individuals," the Clinical Center explains.

The second largest facility in Niš for the disposal and sterilization of medical waste, which is not used at full capacity, is located in the village of Trupale, ten kilometers from the city. It was also equipped with a donation from the EU and the only institution using it since 2010 is the Health Center.

Those responsible for waste management at DZ Niš sent the journalists a document explaining the procedures, from which it is clear that the facility in Trupal has not been used for the amount of waste it was designed for for years.

"The capacity of the treatment equipment is estimated at 129 tons per year, but in reality, far less waste is treated. In 2022, it was 36 tons, in 2023, 20 tons, in 2024, 16 tons. The waste is treated daily, which is a mass of 50-90 kg of infectious waste per day. Infectious medical waste undergoes a sterilization process in autoclaves at the Trupal plant, which eliminates infectivity and becomes communal waste, which is taken over by PUK Mediana for further processing", says the document of DZ Niš.

CONDITIONING OF HEALTHCARE INSTITUTIONS

A system that was put in place 15 years ago, and which those who deal with medical waste say has worked well for years, has begun to fall apart, especially in the last five years.

The main "scheme" for emptying state and filling private capacities - as interpreted by "Vremen" interlocutors from this area - was precisely the non-extension of permits.

The first is "problematic" for both institutions in Niš. Because of her, they stopped cooperating with others, and we are talking about transport. Back in 2018, the Health Center sought, but did not receive, a permit to transport medical waste, although it received two vehicles as part of the EU donation.

This was previously warned by private dentists, who for years paid this institution to use the autoclave in Trupal. When they could no longer do that, they were forced to look for a private person and according to their testimonies, they pay much more for the same service.

Why less and less waste has been treated in this facility over the years, and last year only slightly more than 12 percent of the capacity was used, they explained precisely by the fact that they only treat waste generated in the Health Center and its clinics.

"The amount of waste is determined by the number and type of health services we provide at the Niš Health Center. The Niš Health Center deals exclusively with its own medical and infectious waste. We do not collect or process waste from other health care institutions, as this requires a special permit," said the Health Center.

They have the same explanation in the Niš Clinical Center - according to the new Law on the Transport of Hazardous Materials, they would have to register as a road transport company, which is practically impossible for health institutions and they believe that no one would allow it.

Thus, they were also left without the mentioned permit for transport. This meant that government institutions from the Network Plan had to hire private companies to transport medical waste to their facilities. They mostly hired companies from Leskovac and Nis, whose licenses have since been revoked or expired.

Nevertheless, the Niš Clinical Center was able to sterilize medical waste from private practice and health institutions from the Network Plan until July of last year.

"However, according to the inspection decision we had in June 2024, care from private surgeries and clinics was abolished, only the state ones from the Network Plan remained. This all lasted until February 26, 2025. At that time, the Ministry did not extend our license, although we included the Network Plan and private institutions, but we were granted a license only for our own needs. There is no explanation, it just says that we were granted a license only for our own needs," said the Security Department of the Niš Clinical Center.

What does it look like in practice? In the past, the central places for sterilization of medical waste in Niš, which have the capacity for it, are not allowed to accept other people's waste. While their plants "stand still", others are forced to call for tenders and instead of getting the service for free, they pay a private person for the same work.

One of the examples that illustrate this is Transfusion in Niš. Instead of sterilizing their waste almost free of charge in autoclaves in Klinikko, which are 300 meters away from them, according to the current tender from January this year, they will pay, in just eight months, more than five million dinars to "Remondis" and "Morel", which are hundreds of kilometers away.

NEW REGULATIONS AND THE MINISTRY'S SILENCE

The Ministry of Environmental Protection did not provide specific answers to the journalist's questions about why the regional centers in Niš once lost their permits for the management of "other people's" medical waste, as well as whether they are aware that their facilities are not being used at full capacity and whether there are plans to solve this problem.

Instead, they mention some other regulations that operators need to meet.

"In the process of submitting requests and other documentation, health institutions that have not carried out the environmental impact assessment procedure and the procedure for changing the purpose of facilities in which they treat waste, decide and submit requests exclusively for the treatment of their own waste generated in those institutions and their organizational units", is part of the Ministry's response.

The Clinical Center responded to such explanations from the Ministry by explaining that they also met those conditions, but that they still do not have a permit, and neither does the Health Center.

Can the City of Niš, which officially owns the "privatized" plant in Trupal, which was handed over to the Health Center for use in 2016, somehow solve the problem by giving it to other institutions in the city? Not only would it be used to its full capacity, but the state would also save money that it now gives to private individuals through tenders.

It seems, however, that it was neither considered nor asked for, because an identical answer arrived from the Property Administration and the City Assembly - a document on the transfer of ownership, almost ten years old.

Everyone who deals with medical waste at the Clinic concludes that, despite meeting the requirements, the official decision from this year is that they can only sterilize their own medical waste, and they believe that only the ministry knows the reasons.

"In 2014, we all received permits for everything, for third parties, for transport and treatment, and the Network Plan. When the permits expired in 2019, we received the answer that we could not drive, and then we were not even extended the permit for other people's waste," say the interlocutors from the Clinical Center. They add that they do not expect anything to change even when the public learns about this situation, because they believe that "one company's monopoly is behind everything".

EVERYONE LOSE, ONE GETS

One of the interlocutors says that this is an example that illustrates the situation at the level of the whole of Serbia, because he claims that "everyone lost their licenses because of one".

"Remondis", which has been operating in Serbia for 15 years, denies allegations of a monopoly and says that they are not the only, nor the largest operator of medical waste.

"In the state of Serbia, the largest operator for the disposal of medical waste is the state system that operates under the Ministry of Health, and it is estimated that 80% of the generated medical waste is disposed of through it, while the other 20% is divided among private operators. By looking at the data available on the website of the Environmental Protection Agency, it can be concluded that a part of the medical waste ends up in landfills untreated and that a part of the medical waste generators do not dispose of the waste in accordance with the Law", they reply from "Remondisa".

To questions related to the fact that in recent years more and more private operators are "losing" their licenses, and "Remondis" is also taking over the work of state plants that are therefore not working at full capacity, they answer by explaining that the regulations have changed and that everyone must respect them.

The example from Aleksinac clearly illustrates the decline of a state plant, while at the same time the profit growth of "Remondis" and their partner. The health center, which includes the General Hospital and the Health Center, is the only one in the Nišava district outside the City of Niš that, also thanks to an EU donation, received an autoclave and a vehicle for the treatment of medical waste. Not only is that facility not being used at full capacity, but for the last two years it has not been used at all.

"The Aleksinac Health Center does not have a space that meets the legal and technical requirements for the treatment and disposal of medical waste, because according to the Law on Waste Management, waste treatment can only be carried out in facilities that have the appropriate permit. The Integral permit for the treatment of medical waste for the Aleksinac Health Center organizational unit expired at the end of 2023," answered ZC Aleksinac. And since they don't meet the conditions and the donation they received falls through, they state that their "only solution" was to conclude a contract with authorized operators, in order to ensure legal and safe handling of waste.

Although they cooperated with the company "Remondis" when they used their autoclave in Aleksinac, because of the waste they were not allowed to treat in it, the documentation they sent to journalists clearly shows that the growth of costs for medical waste in this institution has increased significantly in the last two years.

In the period from 2020 to 2023, they set aside a little more than one million dinars (1.005.725) for the use of their facility, more precisely for repairs and maintenance of equipment, as well as fuel and vehicle service. At that time, they paid "Remondisa" almost 2,7 million dinars (2.699.960) for the treatment of waste that they were not allowed to treat themselves. In those four years, they spent a total of 3,7 million dinars (3.705.685 dinars) on medical waste, while now in less than two years, that is, during 2024 and until August of this year, as they wrote in the response to the Request, that cost for the services of the companies "Remondis" and "Morel" amounted to almost three million dinars (2.973.852 dinars).

This shows the growth in the income of private companies, which in one year and eight months earned more money than in the previous four years, and that only in this health facility in a small municipality in the south.

WHO ALL SENDS WASTE TO THE SAME COMPANY

The Niška Banja Institute used to be in the cooperation system with the University Hospital Niš, as one of the institutions from the Network Plan that treated medical waste free of charge in a state facility. They also cooperated with private companies from Leskovac and Niš, which lost their transport licenses in 2023 and 2024. From the documentation they sent, it can be seen that this year alone they paid more than a million dinars to the companies "Remondis" and "Morel" for pharmaceutical and infectious waste.

It is similar with the Psychiatric Hospital in Gornja Toponica, which used to be in the Network Plan, and they confirmed the cooperation with "Remondis" in the last five years. As of 2020, they allocated an average of two million dinars per year for the export of medical waste. In January of this year, they terminated the contract with a company from Nis whose license was revoked. They also have a current contract with companies from Zrenjanin and Ćuprije, which usually appear together as a group of bidders for tenders.

None of the institutions had an answer to the question of whether it is worthwhile for them to send medical waste more than 300 km away, as well as what would be the solution to save money in this regard. They say that they do not have such information or that they are not competent to assess it.

"Since the Aleksinac Health Center does not meet the legal requirements for using its own plant for the treatment of medical waste, our health institution is forced to cooperate with private authorized companies that deal with specific activities", answered ZC Aleksinac.

Even the current government, which is emptying state plants, opened 15 years ago thanks to European Union money, does not seem to think about savings and profitability, while the revenues of private companies apparently continue to grow.

Executive director of "Remondis": I know who you work for

The executive director of "Remondis", Bojan Sudarev, contacted the journalist before the official answers and said that nowhere in Europe and the region do state centers work as operators of hazardous waste.

"I know that you are receiving instructions from a partner whom we refused to sign the contract, so that it is clear what a monopoly is, what is the definition of a monopoly. We hold about 20% of the market - just to be clear," Sudarev said in a phone call to the author of the research.

Journalist: Jovana Stojanović

Mentor: Jovana Gligorijević