Health Care Waste in Southern Africa: A shift from waste disposal to waste management

Health Care Waste is a mounting problem in South Africa, Mozambique, Swaziland and Uganda as in many other countries. Over recent years there have been numerous press statements of medical waste being disposed of in an incorrect manner. The people that have been most affected by medical waste have been the poor disadvantaged members of society. The incineration of medical waste has also caused much concern. Numerous studies indicate that incinerators have been associated with a wide variety of health problems such as disrupting the bodies hormonal, immune and reproductive systems, and have caused cancers. Previously, civil society had not been given a platform to voice their concerns regarding the health impacts that health care waste and incineration has had on their quality of life, and only recently has civil society taken a stand to state that “enough is enough”, and have to sort ways to voice their concerns in a legitimate manner.

Desktop studies show that almost half of health care waste generated in the province of KwaZulu-Natal alone cannot be accounted for, suggesting that it is being illegally dumped, buried or burnt somewhere, thus affecting the health of people and the environment. Wastes from health care facilities pose a risk to health care workers, patients and local communities. While there is much concern about the possible spread of disease (especially from contact with “sharps” such as needles), the treatment of those wastes, through incineration, releases an array of hazardous pollutants into the air and water, thus affecting the health of our communities. There is also the lack of capacity in South Africa to properly dispose of the large unnecessary amounts of health care waste being generated. There have been numerous instances where health care waste has been dumped in residential areas, thus posing a hazard to the community and environment.

Health Care Waste project

Due to the fact that health care waste and incineration problems in South Africa have reached uncontrollable proportions, groundWork a young South African NGO committed to the process of reducing the impacts of health care waste and incineration and the potential impacts that it poses towards enhancing a sustainable society decided to initiate the Healthcare waste and incineration project. This project uses the twin prong strategy of working both with medical waste institutions to assist them in reducing their wastes, as well as with communities affected by the unsafe dumping or burning of health care waste.

This project aims to reduce and, where possible, eliminate the harmful effects of both health care waste and incineration on human health and the environment in Southern Africa. groundWork has since 2001 worked with two under-resourced hospitals to make them model institutions for other hospitals to follow. The aim was to help the institutions to reduce the amount of waste produced thereby saving costs and increasing occupational health and safety. The hospitals initially identified for greening are Ngwelezane hospital at Empangeni as well as Edendale hospital in Pietermaritzburg. This had commenced with a skillshare by groundWork and the international network Health Care Without Harm (HCWH ) in 2001 for the two hospitals so as to provide insight into proper health care waste management.
Improvements at Ngwelezane and Edendale hospitals

The number of red bags (containing infectious medical waste) generated at Edendale Hospital daily has dropped from an average of between 250 to 300 to around 70 bags a day. This has resulted in a cost saving for the hospital of between R35 000 and R40 000 a month compared to the R90 000 that was spent before the program was started. At Ngwelezane hospital, costs have reduced from R55 000, 00 per month to R35 000,00 per month. These have been significant cost savings for these government hospitals. Both hospitals, after the program was launched, now seem to see medical waste as a serious issue that needs to be tackled, and hold regular meetings to discuss progress and discuss further methods for improvement.

National Health Care Waste workshop and manual launch

It was on the 5-7 May 2004, that groundWork hosted a health care waste (HCW) and incineration workshop, which took place at Edendale hospital in KwaZulu-Natal. The intention of this gathering was not only to highlight the problems regarding HCW and incineration but also to launch groundWork’s HCW manual regarding waste management. Over 130 participants from hospitals all over the KwaZulu-Natal province had attended. This excellent turnout was not only an indication of the serious concerns that health care waste poses to hospital staff and their surrounding communities, but also that health care institutions are committed to reducing the potential impacts that HCW poses to enhancing a sustainable society.

The manual launched was a culmination of the work conducted at the model institutions. With the manual, health care institutions would be able to install an appropriate waste management system that could provide benefits such as an improved regulatory compliance, protection of human health by reducing the exposure of employees to hazardous waste, enhance community relations by demonstrating a commitment to environmental protection, economic benefits resulting from pollution prevention products that reduce and recycle waste, and the avoidance of long-term liability. The intention is to use this manual for a roll-out campaign for other hospitals in South Africa with the aim of establishing improved HCW management practices. The manual is available for free to any individuals and institutions wishing for improved waste management.

Conclusion
It is a fact that every health care facility can take immediate steps to reduce the environmental harm that results from purchasing and waste disposal practices. This must be seen as a front-end solution to the waste problems that are being experienced in our societies. The idea is to tackle the root of the problem by moving away from incineration and implementing the three R’s (reduce, reuse and recycle). This would have to firstly be followed by prevention. Once a proper waste management plan has been implemented at institutions it would pay handsomely (i.e. financial benefit, improved staffed morale, increased occupational health and safety, improved regulatory compliance and the strengthening of relationships with the surrounding community). It is, however, important to stress that the problems of health care waste are greatest in rural areas that are constrained by a lack of resources and it is at these levels that immediate intervention is required. It is essential that we tackle the root of the problem if any positive long-term sustainable solution is to be reached.

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