Managing Health Care Waste in the Push to 2020

“I was asking this question last week. The hospital waste…who takes care of it?” A staff worker at a Nigerian waste management agency in River State wonders what his role is in ensuring that hazardous health waste is handled and disposed of properly.

It might not seem obvious, but for nations striving to eliminate new HIV infections and reach the UNAIDS’ 90-90-90 goals, this question is an important one. Drilling down to the day-to-day health-clinic tasks required to get people to know their status, to move onto a proper antiretroviral therapy regimen, and to reduce their viral load, there are a lot of syringes, needles, and other sharps, and other forms of infectious health care waste involved. If it is not properly handled and disposed of, health care waste poses tremendous risks, including HIV transmission, to health workers, waste handlers, the community, and the environment.

Health care waste management (HCWM) entails a number of moving parts. Building sustainable systems and policies is one of the most essential. In the past year, the AIDSFree Project has been working closely with seven of Nigeria’s 36 states to safeguard health care staff, clients, and communities by doing exactly that. AIDSFree’s work builds off of infection prevention and control (IPC) activities under previous USAID-funded, JSI-led projects, namely, Making Medical Injections Safer and AIDSTAR-One.

Another important part of creating sustainable HCWM systems is assessing knowledge, attitudes, and practices. Lack of understanding increases the risk of HIV and other disease transmission. AIDSFree conducted HCWM assessments in three Nigerian states in 2016, which revealed insufficient knowledge of proper waste management among health facility staff. For example, 38 percent of clinical service providers and 9 percent of environmental health workers in Cross River State reported needlestick injuries in the six months prior to the study.

In response, AIDSFree developed HCWM and injection safety training manuals for health workers and waste handlers. Creating a pool of expert trainers and conducting cascade-style training can go a long way toward sustainable policies and systems. In 2016 alone, AIDSFree provided 12,000 health workers and waste handlers in Nigeria’s Federal Capital Territory and six states with basic skills in IPC and HCWM.

HCWM also requires essential commodities, including color-coded waste bins, bin liners, and personal protective equipment (boots, aprons, gloves) for waste handlers. AIDSFree adapted an existing commodities training manual to focus on HCWM; trained pharmacy and storeroom staff; and procured and distributed seed stock of essential IPC/HCWM commodities to the facilities with trained staff members.

To further support a sustainable environment for HCWM, AIDSFree helped states in drafting their own state-specific policies in line with Nigeria’s 2013 National HCWM Policy. As of August 2016, Benue State had approved and signed IPC and HCWM policies; and Cross River and Rivers states signed state IPC policies.

Good HCWM means increased health worker safety, better-quality patient care, reduced environmental degradation, lower costs, and opportunities for profit. States still struggle to establish systems for managing waste—but opportunities exist. As they move toward 2020, states and nations must examine the realities that health facility staff encounter as they expand services; commit to a dedicated budget for HCWM training, supervision, and commodities; and test innovative approaches for treating and disposing of waste.

Written by Jennifer Pearson