The identification of environmentally sound technologies for healthcare waste management in Lesotho

Abstract

Waste resulting from healthcare activities is hazardous due to its potential risk of infection to healthcare workers, waste workers and the public. Many tools and approaches have been applied in waste management in developed countries, but are not suitable for application in developing countries due to their complexity and extensive data and resource requirements. WasteOpt was therefore developed and applied as an appropriate decision-making tool in the developing country context. WasteOpt comprises of the Analytical Hierarchy Process (AHP), costing and Life cycle management (LCM). The purpose of this study was to identify environmentally sound technologies (ESTs) that minimise the risk of infection by healthcare waste (HCW) in rural clinics. Rural clinics were selected because apart from financial constraints, they are challenged by the lack of procedure, infrastructure and technologies to develop reasonable waste management plans that can be implemented within a practicable time frame. WasteOpt was applied to aid in identifying ESTs in relation to the infection risks and costs of the technologies. Experts in waste management in Lesotho were involved in a workshop for the ranking of technologies. The overall weighting values of the rankings were converted to risk factors for individual options and for alternatives (combination of options). Risk factors were classified as low, medium and high risk. The technologies within a single class were differentiated by analysing the cost of acquiring and running the technology to qualify as ESTs. The ESTs identified for Lesotho are Engineered containers, Refrigerated engineered facility, engineered wheeled transport, detailed procedures, multi chamber incinerator, engineered pit and landfill. Ten (10) clinics in Lesotho were also assessed as case studies using the WHO RAT. The RAT was first modified to include questions on financial management at the clinics. The calculated risk factors were applied to the case studies to assess the risk under which healthcare workers operate in those clinics. The additive minimum risk for the overall life cycle of waste was 4.0 (excluding central treatment and disposal). The clinic workers were found to be at a risk of between 1.1 x 10-4 and 7.8 x 10-5, which proves that rural clinics in Lesotho are still using inappropriate technologies. In terms of financing for waste management, public clinics were found to have little decision-making powers over funds and had less accountability measures. CHAL clinics which are managed by churches in Lesotho had more control of funds and exhibit more accountability. All clinics had no targets for saving funds from waste management activities. WasteOpt can be applied as a decision-making tool for HCW in Lesotho since it overcomes the barriers that inhibit environmentally sound management of HCW in developing countries. In conclusion: WasteOpt can be applied as a decision-making tool for different types of waste by replacing HCW options with respective ones and designing a relevant questionnaire for qualitative data capture. WasteOpt can then be applied in a developing country to aid sustainable waste management decision-making. Informed decision-making helps resource poor managers to select cost-effective but low-risk options, which will be sustainable in the future.