Clinical waste management in the context of the Kanye community home-based care programme, Botswana

Abstract

This study examines clinical waste disposal and handling in the context of a community home-based care (CHBC) programme in Kanye, southern Botswana. This qualitative study involved 10 focus group discussions with a total of 82 HIV/AIDS primary caregivers in Kanye, one-to-one interviews with the five nurses supervising the programme, and participant observation. Numerous aspects of clinical or healthcare waste management were found to be hazardous and challenging to the home-based caregivers in the Kanye CHBC programme, namely: lack of any clear policies for clinical waste management; unhygienic waste handling and disposal by home-based caregivers, including burning and burying the healthcare wastes, and the absence of pre-treatment methods; inadequate transportation facilities to ferry the waste to clinics and then to appropriate disposal sites; stigma and discrimination associated with the physical removal of clinical waste from homes or clinics; poor storage of the healthcare waste at clinics; lack of incinerators for burning clinical waste; and a high risk of contagion to individuals and the environment at all stages of managing the clinical waste.

Validating that palliative care giving is a stressful occupation: the case of the Kanye community home-based care programme, Botswana

“…This presents a human rights abuse and dilemma, as those who take care of others face risk from their volunteering occupations. 35 Literature abounds on the fact that a number of diseases and infections, including HIV infections, have been documented to be transmitted by mere contact with the body fluids and secretions of patients, and hospital waste abounds in substances soiled with the body fluids and secretions of patients suffering from such diseases. Unskilful handling and disposal of clinical or hospital waste could also be catastrophic to the health and wellbeing of the community.…”

“…36 Other studies have found that the management and disposal of clinical waste in many care programmes have continued to be a thorn in the flesh of the caregivers. 35,37,38 This is due either to a lack of policy, or the failure to operationalise it, inadequate community education on the subject, neglect, and a lack of adequate facilities, leading to unprofessional and ineffective ways of disposal and handling. This has borne grave hazards that compromise the quality of care in the programmes.…”

“…This is especially due to a lack of proper government machinery to ensure the availability of care package facilities in the medical health institutions, and also to a lack of money to buy these necessary inputs. 35 The Kanye caregivers were not given adequate counselling to enable them to overcome their care-giving stresses and dilemmas. The impact of psychological wellbeing has a great bearing on the caregivers' productivity and on a reduction of the stress and confusion that abound in care giving.…”

The Role of Incentives in Raising Care-Giving Productivity in Botswana Care Programmes as Exemplified in the Kanye Care Programme

“…This would possibly mean some of the desperate caregivers would have to wash their clients without any protective clothing. This exposes them to the challenge of infection (Kang"ethe, 2008). It is recommended that the government, working in collaboration with the CHBC authorities, institute and intensify monitoring and evaluation of the programme and ensure that the programme has adequate care package to ensure quality care giving.…”

“…These tasks include household chores, subsistence farming or other casual employment and looking after children, elderly people and other dependants. It is also common for such caregivers taking care of infected husbands or babies to contract the disease themselves, causing their health to deteriorate while they are expected to care for everyone else (Jackson, 2002;Kang"ethe, 2006bKang"ethe, , 2008. This article will discuss the importance of providing incentives to raising the morale and level of motivation and therefore the productivity of care programmes in Botswana.…”