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Understanding the National Healthcare Waste Management Plan

[By Stanslous Ngosa]

Healthcare waste (HCW) is one of the most hazardous garbage globally second only to radiation waste. 
Waste generated by health care activities includes a broad range of materials: from used needles and syringes to soiled dressings, body parts, diagnostic samples, blood, chemicals, pharmaceuticals, medical devices and radioactive materials. 

Poor management of healthcare waste potentially exposes healthcare workers, waste handlers, patients and the community at large to infections, toxic effects and injuries; and risks polluting the environment.  HCW management needs to be prioritised because of the devastating effects on human health and the environment if not well managed. Health workers play a crucial role in the management of HCWs.

Realising the hazard healthcare waste poses to both the environment and humans, government has come up with a road map to deal with this matter. The National Healthcare Waste Management Plan (NHCWP) for 2019 to 2024 is a roadmap that aims at putting in place a sustainable healthcare waste management (HCWM) system in Zambia. The plan recommends safe, efficient, sustainable, affordable and culturally acceptable methods for the treatment and disposal of healthcare waste, both within and outside health-care facilities. 

According to Ministry of Health assistant director of environmental health Cheleka Kaziya-Mulenga, the plan is based on the principles of the National Solid Waste Management Strategy (NSWMS) for Zambia (2004); environmental management Act (EMA) No. 12 of 2011, public health Act (PHA Cap 295), occupational health and safety Act No. 36 of 2010 and solid waste regulation and management Act No. 20 of 2018.

And according to three comprehensive studies on HCWM that were conducted in Zambia by the World Bank (2006); Auditor General’s Office (2009); and Ministry of Health (2013); demonstrated that the country requires well-funded sustainable strategies and safe systems that support the development agenda for appropriate HCWM. 

Further, studies conducted this year by the Ministry of Health in Luapula, Muchinga, Northern, North-Western and Western provinces revealed that five per cent of respondents used closed bins with bin liners whilst 22.1 per cent used closed bins without liners and 7.9 per cent used open containers. 

The World Health Organisation (WHO) estimates that 85 per cent of generated waste is non-infectious while 15 per cent is infectious or hazardous waste. The composition of infectious waste in a waste stream is as follows: sharps one per cent, body parts one per cent, chemical or pharmaceutical three per cent and radioactive and cytotoxic waste or broken thermometers less than one per cent.  

An assessment conducted by WHO in 22 developing countries revealed that 18 to 64 per cent health care facilities do not use proper waste disposal methods.   

To address minimal exposure to Healthcare waste, attention is paid to basic processes and technologies, though sophisticated or advanced methods are often addressed in less detail. 

It is recommended that health centres in remote locations or with very limited resources may wish to confine to options that are suitable for them. 

The selected practices should ensure that health and safety requirements are met, and acceptable levels of hazard protection are achieved. However, the recommendations should not be viewed as a substitute for ideal procedures for HCWM in large health institutions. 

Due to inadequate resources, health facilities have often struggled to maintain good HCWM practices. 
Under adverse circumstances where resources (financial, human and material) are limited, planning is hampered and health facilities resort to using inappropriate methods to manage waste. In addition, healthcare providers work without personal protective equipment in treatment and waste disposal.  

To ensure that the standards for HCWM is raised in Zambia, there is need for a significant budget allocation for capacity building, procurement, maintenance and repair of equipment. Further, involvement of private public partnerships and technical support would be key to the successful implementation of the HCWM system. 

Additionally, HCWM will be strengthened through multisectoral coordination anchored into the coordinating committee on WASH in Health care facilities. This is in line with the global resolution to accelerate the implementation of WASH in health care facilities. 

Zambia has adopted HCWM recommendations from different resources such as the Centre for Disease Control and Prevention (CDC), WHO, United Nations Children’s Emergency Fund (UNICEF) and Médecins Sans Frontières (MSF). 
This has contributed to the development of the HCWM guidelines in line with the EMA No.12 of 2011 by the Zambia Environmental Management Agency (ZEMA) in collaboration with MoH.
 
The development of this plan therefore, was based on the assessment done in previous evaluations by WHO (2011), Auditor General’s Office and MoH (2009) assessment (2013).  The aim of this plan is to provide both long- and short-term goals for safe HCWM. Broadly, this plan suggests that funding be mobilised under the treasury and stakeholders to comprehensively resolve the problems of planning and resource allocation. 

The implementation of this plan will require the involvement of key stakeholders, namely private sector, cooperating partners such as UNICEF, the World Bank, WHO, line ministries such as the Ministry of Local Government and the Ministry of Fisheries and Livestock, and other institutions like ZEMA.
The author is head of media relations at the Ministry of Health.

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