Helena Bergman of ISWA speaks with Yves Chartier, World Health Organization (WHO) public health engineer (top) and Alexander von Hildebrand, WHO regional advisor (bottom) about healthcare waste, the role of WHO and ISWA–WHO co-operation
Healthcare waste (HCW) is a small fraction of the total waste stream, but poor management of it can be dangerous. What are the main problems with HCW management today?
The need to manage waste in such a way that it does not affect our health and our environment is quite a new concept in many countries, especially in the rapidly growing urban centres of the developing world. The lack of awareness can be immense in some cases, and this is reflected in the lack of resources allocated to set up robust waste management systems.
The insufficient availability of resources is reflected in a lack of budgets and mostly untrained staff. The poor management of waste presents a major public health risk.
Beyond these challenges, access to affordable waste treatment technologies suitable for low income countries is restricted. Model policies, regulations and national plans are still rare and where available, are often not put into practice.
Finally, the duty to ensure sound management of HCW often falls to two or more key ministries, often the Ministry of Health and Ministry of Environment, with no clear lines of responsibility.
What are the key challenges to progression in the management of healthcare waste?
The challenges are to present sufficient evidence to raise concerns about the adverse health impact of badly managed healthcare waste management, as a first step. The awareness work needs to be done at all levels, from waste handlers up to policy makers, with particular emphasis on medical professionals, such as nurses, to bring about the necessary behavioural change. There is a need to inform the public too. As consciousness increases, developing and implementing sustained national strategies becomes more viable. Then it becomes key to mobilize the necessary resources. Progress in the management of healthcare waste also requires the appropriate technologies to be selected based on needs, efficiency, safety, maintenance and to be environmentally friendly.
What is the most important course of action?
A proper separation of wastes into infectious and non infectious categories will drastically reduce the volumes of waste needing special treatment and the cost thereof. For this to happen a coordinated approach needs to be in place at the health facility.
What are your views on the issue of waste treatment in connection with epidemics?
Particular attention needs to be given to waste produced by infected patients during an epidemic. The waste, solid or fluid, must be considered as highly infectious and must be handled and treated as infectious waste and kept in containers or bags with the bio hazard symbol. No preparation plan for epidemics is complete if the waste management is not addressed properly.
What is the role of WHO?
The World Health Organization (WHO) works to support countries, in this case emphasis is given to low income nations. WHO"s activities include developing guidance to assess quantities and types of waste produced in different healthcare facilities and providing tools for developing and implementing national action plans based on specific guidelines. The national plans aim at capacity development in the area of HCW management and advocate an allocation of resources.
WHO is co-leading a major project with the aim of demonstrating and promoting best techniques and practices for reducing healthcare waste and avoiding environmental release of highly toxic substances such as dioxins and mercury.
WHO provides technical and financial support to 72 countries to safely manage waste generated during immunization activities, with support from the Global Alliance for Vaccine and Immunization.
We have been speaking about the future and leadership. What role do you see for ISWA in the future?
The International Solid Waste Association (ISWA) being an international association promoting sustainable waste management worldwide, by supporting research and development and providing information, training and professional advice, could provide direct support to countries in central and eastern Europe and expand its network to all countries, and particularly in low income countries. There are currently no ISWA members in Africa. ISWA could advocate good allocation of resources and generate appropriate and affordable technologies for low income countries. Specific country projects could be targeted, supported by ISWA, and become success stories which could be duplicated.
Interviewer for the International Solid Waste Association (ISWA) Helena Bergman, ISWA Project Manager
e-mail:hb@iswa.dk
