LEVY MWANAWASA MEDICAL UNIVERSITY

SCHOOL OF PUBLIC HEATH AND ENVIRONMENTAL

SCIENCES

PROGRAMME: ENVIRONMENTAL HEALTH TECHNOLOGY

COURSE: HEALTH-CARE WASTE MANAGEMENT
LECTURER: MR NGENDA
STUDENT NAME: BOWA BRIGHT
STUDENT ID: 20172139
ASSIGNMENT NO: 2
DATE GIVEN: 14th OCTOBER, 2019
DUE DATE: 21st OCTOBER, 2019
QUESTION: Discuss factors contributing to poor medical waste management
in most developing countries.

EHT 2017
HCWM ASSIGNMENT 2
LECTURER: MR NGENDA
STUDENT NAME: BOWA BRIGHT
STUDENT ID: 20172139
 INTRODUCTION
According to the Healthcare Waste Management Monitoring Plan, healthcare waste is defined as
all the waste hazardous or not, generated by health institution during medical activities,
preventive, curative and/or diagnostic (MOHSW 2006). Medical waste is any solid waste
generated in the diagnosis, treatment, or immunization of human beings or animals, related to
research, production or testing of biological from all types of healthcare institutions, including
hospitals, clinics, dental or veterinary and medical laboratories. Therefore, healthcare waste has a
high potential of carrying micro-organisms that can infect people who are exposed to it, as well
as the community at large if it is not properly disposed of. The lack of segregation between
hazardous and non-hazardous waste, an absence of rules and regulations applying to the
collection of waste from the hospital wards and the on-site transport to a temporary storage
location, a lack of proper waste treatment, disposal of hospital waste along with municipal
garbage, insufficient training of personnel, insufficient personal protective equipment and lack of
knowledge regarding the proper use of such equipment are among the problems highlighted as
prominent factors contributing to poor medical waste management.

EHT 2017
HCWM ASSIGNMENT 2
LECTURER: MR NGENDA
STUDENT NAME: BOWA BRIGHT
STUDENT ID: 20172139
 FACTORS CONTRIBUTING TO POOR MANAGEMENT OF MEDICAL
WASTE IN MOST DEVELOPING COUNTRIES
There are a number of factors that contributes to poor medical waste management in most
developing countries and among them, the following are discussed in this article.
1. Number of workers in the facilities: Medical waste management in all health facilities
depends on the number of workers in different departments. If the number of workers in
the health facilities is not satisfactory the healthcare workers may devote most of their
time in attending the patients with little attention paid to medical waste management.
Hence, extra costs have to be incurred to pay for laborers. On the other hand, this is
directly related to poor medical waste management.
2. Protective gears for medical waste management: The main protective gears
recommended to be used in health facilities are gloves, boots, aprons, coats, masks etc.
Gloves are the most protective gears used to protect hands from infectious materials. The
types of gloves to be worn depend on the handling activity to be conducted. Apron is
made of rubber or plastic to provide a waterproof barrier along the front of the health
facility worker’s body. The percentage of the health facilities in most developing
countries who uses the protective gears is low compared to the importance of the
protective gears in blocking hazards posed by medical waste generated in most
developing countries. Thus, enough personal protective gears should be supplied to the
health facilities so as to rescue the life of service providers’ and patients.
3. Waste segregation: In most developing countries, medical waste is segregated into
infectious and non-infectious, hazardous and non-hazardous etc. in some facilities even
though segregation is performed, sharp wastes are later found mixed with general waste
during incineration. In most facilities, segregation is not properly performed, despite the
availability of specific containers for waste collection. Proper segregation of healthcare
waste must follow the standardized procedures, according to national guidelines.
Segregation of medical waste is important because it reduces the risks of healthcare
workers, and enhances cost control for hazardous waste disposal by decreasing treatment
costs. In some of the health facilities the bins are overfilled and are not frequently
collected transported to the disposal sites.
4. Color coding: color coding practices in most of the health facilities is poor. This implies
that wastes are segregated into infectious and non-infectious wastes but the process does
not put into consideration color of the containers or bags attributable to poor management
in developing countries. The recommended color coding states that yellow color should
be applied to the safety boxes used to collect sharp wastes, needles and syringes and also
radioactive waste; red color should be used for containers used to collect infectious
wastes and blue color should be used for containers used to collect non-infectious wastes.
Thus monitoring healthcare waste management should be a continuous process involving
generation or production, segregation, transportation, and disposal of healthcare waste.
Bags and containers of waste collected must be replaced immediately by new ones of the
EHT 2017
HCWM ASSIGNMENT 2
LECTURER: MR NGENDA
STUDENT NAME: BOWA BRIGHT
STUDENT ID: 20172139
 same type. Thus, a supply of fresh waste collection bags or containers must be readily
available at all times where waste is produced.
5. Medical waste transportation: transportation of medical waste is another major problem
in most developing countries. Most of the facilities they do not have public medical waste
treating unit, so that they rely on on-site disposal. Some health facilities with off-site
transportation/treatment have supporting companies to facilitate the process. Problems
hindering off-site transport include lack of designated vehicles for waste transportation.
Off-site transportation is required when hazardous healthcare waste is treated outside the
healthcare facility. Other facilities in some developing countries they perform on-site
disposal of the medical waste using wheelbarrow as the means of transporting medical
waste. This is basically due to the poor management and financial crisis for both private
and public facilities. In some facilities, medical waste is carried on hands to the disposal
areas of which this is a hazardous process because it can harm the waste collectors if not
well packed and treated. This can easily lead to transmission of infectious diseases to the
health workers. During on-site transportation, healthcare waste should be transported
within the hospital by means of wheeled trolleys, containers or carts that are not used for
other purposes.
6. Waste storage: The standard time for storing medical waste recommended by the World
Health Organization should not exceed 24 hours. Storage areas should be fenced, big
enough and well ventilated and should be accessible by the authorized personnel only.
The main problem with storage is that the storage premises are not big enough to handle
the medical waste generated. It is suggested that, non-risk healthcare waste should always
be stored in a separate location from the infectious or hazardous healthcare waste in order
to avoid cross-contamination. The storage area should be big enough and well ventilated.
It is also important to weigh the waste and keep the records of the waste generated. This
is also the management problem in most developing countries because the amount of
waste generated in all facilities should be weighed and recorded in order to know the
amount of waste generated per day so as to be able to plan for the management of such
wastes. Furthermore, it is just few of the health facilities in most developing countries
that have the Standard Operating Procedures (SOPs) for medical waste management.
Lack of Standard Operating Procedures (SOPs) in the facilities implies that those
facilities work through experience and not due to laid down guidelines. It is also a
management problem because the guidelines for good practices on medical waste
management should be developed by all health facilities.
7. Treatment and disposal of medical waste: The most effective means of preventing the
transmission of blood borne pathogens is to prevent exposure to needle stick injuries.
Some of the health facilities have specific areas for medical waste disposal and others do
not have this means that some of the waste is disposed of in open areas and some into
latrines and in rubbish pits. None of these practices are adequate in medical waste
management. Majority of the health facilities disinfect sharp wastes and syringes after
use and some health facilities do not disinfect sharp wastes. If sharp wastes are not
EHT 2017
HCWM ASSIGNMENT 2
LECTURER: MR NGENDA
STUDENT NAME: BOWA BRIGHT
STUDENT ID: 20172139
 disinfected after use and yet these facilities have no specific areas for medical waste
disposal, most of the infectious diseases affecting people in the municipality might have
been transmitted through infected sharp wastes. The main disposal mechanism for
medical waste in most developing countries are incineration, burying, autoclaves etc. In
some areas where health facilities are located the water table is so shallow that pits for
burying cannot be made instead they use incineration. If the incinerated ashes contain
heavy metals, the latter can easily access the groundwater, if the ashes are not properly
managed. Alternatively, some health facilities use autoclaves, liming and chemical
method for the medical waste treatment. Majority of the disposal sites are not fenced and
they are situated in close proximity to the human settlement areas. It is more interesting
to note that in these open places the wastes are not usually completely burnt, some pieces
of sharp wastes and other wastes are left and these can be picked up by children to play
with. If these wastes are not properly treated there is a greater risk of transmitting
infectious diseases to the community. In some health facilities wastes are left in their
containers in the disposal sites for several days before treatment, which is unsafe practice.
8. Incineration: Majority of the facilities in most developing countries incinerate medical
waste and most of the incinerators are present within the respective health facilities. Most
of the incinerators are not in good operating condition, they have worn out chimneys or
are made without chimneys and most of the incinerators lack covers for the waste feeding
door and in the ashes removing door. Furthermore, most of the incinerators are small and
not enough to handle amount of medical waste generated, others are not fenced and
located in close proximity to the human settlement areas. This results in air pollution
hazards to the surrounding area due to the relatively low operating temperatures and the
lack of emission control systems. For this purpose, only well trained staff should operate
the incinerators and proper operation procedures must be followed to ensure high
temperatures are adequately reached. In highly populated areas, high temperature
incinerators (900°C) should be used for infectious wastes disposal. Improper or
incomplete combustion by incinerators can produce pollutant gases which are not
environmentally friendly.

EHT 2017
HCWM ASSIGNMENT 2
LECTURER: MR NGENDA
STUDENT NAME: BOWA BRIGHT
STUDENT ID: 20172139
 CONCLUSION
It can be concluded that, medical waste management in most developing countries is still poor.
Awareness should be raised among workers of health facilities on proper management of
medical waste to ensure environmentally sound management which involves taking all practical
steps to protect human health and the environment from hazardous waste, like medical waste.
Most developing countries should collaborate with various sectors to help achieve the goals of
reducing waste to zero.

EHT 2017
HCWM ASSIGNMENT 2
LECTURER: MR NGENDA
STUDENT NAME: BOWA BRIGHT
STUDENT ID: 20172139
 REFERENCES
 African Journal of Environmental Science and Technology Vol. 4(5), pp.
304-318, May 2010Available online at
http://www.academicjournals.org/AJEST ISSN 1991-637X © 2010
Academic Journals
 Factors affecting medical waste management in low level health facilities in
Tanzania (S. V. Manyele* and T. J. Lyasenga)
 Coker et al. (2009). Medical waste management in ibadan, Nigeria:
Obstacles and Prospects. Waste manag.,,29(2),804-811
 Poor medical waste management (MWM) practices and risks to human
health and the environment: a literature review (Babanyara Y. Y., Ibrahim
D.B., Garba T., Bogoro A.G., Abubakar, M.Y.) SS

EHT 2017
HCWM ASSIGNMENT 2
LECTURER: MR NGENDA
STUDENT NAME: BOWA BRIGHT
STUDENT ID: 20172139