Supreme Court (SC) directed the state governments to create effective hospital waste management systems in cities. This was followed by a notification from the Union ministry of environment and forests to the state governments. Despite this, few hospitals have taken the treatment of bio-medical waste seriously. In Ahmedabad, 90 per cent hospitals lack incineration plants, facilities for bio-medical waste segregation and their disinfection, this was stated in by Centre for Environment Planning and Technology (CEPT) after completion of a survey. According to Urban Infrastructure Representative USAID, P U Asnani, "The central notification may have given time till December 1999 to hospitals to put up such facilities, but it was necessary to act immediately since it involved the installation of plants and machinery.