Health care waste management in community-based care: experiences of community health workers in low resource communities in South Africa

Abstract

BackgroundIn South Africa, community health workers (CHWs) working in community-based care (CBC) programmes provide care to patients most of whom are living with HIV/AIDS and tuberculosis (TB). Although studies have shown that the caregiving activities provided by the CHWs generate health care waste (HCW), there is limited information about the experiences of CHWs on health care waste management (HCWM) in CBC. This study explored HCWM in CBC in Durban, South Africa from the perspectives CHWs.MethodsWe used three ethnographic approaches to collect data: focus group discussions, participant observations and informal discussions. Data was collected from 85 CHWs working in 29 communities in the Durban metropolis, South Africa. Data collection took place from July 2013 to August 2014.ResultsCHWs provided nursing care activities to patients many of whom were incontinent or bedridden. Some the patients were living with HIV/AIDS/TB, stroke, diabetes, asthma, arthritis and high blood pressure. These caregiving activities generate sharps and infectious waste but CHWs and family members did not segregate HCW according to the risk posed as stipulated by the HCWM policy. In addition, HCW was left with domestic waste. Major barriers to proper HCWM identified by CHWs include, lack of assistance from family members in assisting patients to use the toilet or change diapers and removing HCW from homes, irregular waste collection by waste collectors, inadequate water for practicing hygiene and sanitation, long distance between the house and the toilets and poor conditions of communal toilets and pit latrines. As a result of these barriers, HCW was illegally dumped along roads or in the bush, burnt openly and buried within the yards. Liquid HCW such as vomit, urine and sputum were disposed in open spaces near the homes.ConclusionCurrent policies on primary health care (PHC) and HCWM in South Africa have not paid attention to HCWM. Findings suggest the need for primary health care reform to develop the competencies of CHWs in HCWM. In addition, PHC and HCWM policies should address the infrastructure deficit in low resource communities. In order for low-and-middle-income-countries (LMICs) to develop effective community health worker programmes, there is a need for synergies in PHC and HCWM policies.

A Review of Medical Waste Management in South Africa

“…Recent study conducted in a community based clinic in Durban where care is given to highly dependent patients many of whom are incontinent and/or bedridden reveals a gross misconduct as far as medical waste management is concerned [17]. The health workers were observed to sometimes expose themselves to hazardous waste by not wearing Personal Protective Equipment (PPE) like gloves while carrying out their caregiving roles.…”

“…In South Africa, incineration is the most common method being used in the disposal of toxic medical waste; however, incinerators are known to pollute the air by releasing toxic metals to the atmosphere, polluting soil and surface water and the use of incinerators has been implicated in the disruption of human hormonal, immune and reproductive systems and cancers [16]. The lack of sufficient equipment to deal with the ever-increasing burden of medical waste has resulted in the dumping of a large quantity of the waste in illegal sites and sometimes burning within the premises of the health facilities (17). Uncontrolled burning of these waste may result in air pollution and toxic emissions from incomplete combustion which is both harmful to the public [16].…”

Challenges Facing Home-Based Caregivers in the Management of Health Care Risk Waste

“…The waste is considered to be very hazardous and is ranked the second most hazardous after radioactive waste because it has the potential to cause adverse health effects and significant pollution in the environment [16]. In South Africa, the waste generated by home-based caregivers is managed in the same manner as general domestic waste [17]. The waste is either discarded in an open field, burnt, buried in shallow graves or collected by or on behalf of the local authority to be disposed of in solid waste land fill sites [17].…”

“…In South Africa, the waste generated by home-based caregivers is managed in the same manner as general domestic waste [17]. The waste is either discarded in an open field, burnt, buried in shallow graves or collected by or on behalf of the local authority to be disposed of in solid waste land fill sites [17].…”

Nomenclature for Healthcare Waste in the Healthcare Sector and Its Alignment with the Provisions Made by The World Health Organization’s Manual for Healthcare Waste Management: A Scoping Review

“…The main factors attributed to poor HCWM practices in LMICs include: lack of financial investment and clear policies to manage HCW by most governments [3][4][5][6], low levels of knowledge by healthcare staff on how to handle HCW properly [7,8], poor segregation practices among healthcare workers [9], and inappropriate transport for transporting HCW, which is driven by untrained drivers who are also not registered to handle HCW [10]. More so, there are inadequate technologies for treating HCW [11][12][13][14]; as a result, HCW is often illegally dumped, openly burnt, and buried in poorly managed dumpsites [10][11][12][13][14][15][16][17].…”