Development of Intervention Strategies for Management of Medical Waste in Vhembe District, South Africa

Abstract

Medical waste is a special type of hazardous waste generated from healthcare facilities. Mismanagement of this waste has a negative impact on healthcare workers, patients and their relatives, medical waste handlers and the community. South Africa, like many other developing countries, is resource-constrained in the management of medical waste and poor practices have been reported across the country, especially in the urban health facilities that have received more attention from researchers. This study was conducted to explore the practices and challenges of medical waste management in Vhembe District, a largely rural district in Limpopo province and develop intervention strategies for better management of the waste in the District. A convergent parallel approach of mixed method design was adopted to achieve the objectives of this study. The target population included the main stakeholders of medical waste management in the district: the Department of Health, healthcare facilities and the waste management company responsible for the treatment and disposal of medical waste in Limpopo Province. The study population from the Department of Health included representatives from the medical waste management section while the waste management company was represented by the manager of the company in Limpopo Province. The samples for the healthcare facilities were drawn from fifteen randomly selected healthcare facilities in the district and included the administrative heads, medical waste generators and medical waste handlers. The study was conducted in three phases. Phase 1 was a qualitative study during which the administrative heads of the selected healthcare facilities, personnel directly involved in medical waste management at the healthcare facilities as well as the representatives from the Department of Health and waste management company were engaged in in-depth interviews. This phase also involved voice recording, observations, field documentation and taking of relevant pictures. Thematic content analysis was used to analyze the data obtained. During phase 2 (quantitative study), a semi-structured questionnaire was employed for data collection from medical waste generators and handlers at the healthcare facilities. A total of 229 questionnaires were retrieved from the participants and were analyzed with the Statistical Package for Social Sciences version 25.0. Descriptive statistical analyses were performed; Chi-square and Cramer’s V tests were used to determine the associations between dependent and independent variables, as well as the strength of association where significant relationships exist. Statistical significant level was set at p<0.05 and the results are presented in tables and graphs. The results from both phases were interpreted and discussed simultaneously. Respondents and participants were assured of anonymity of their identities and confidentiality of the information they provided. They were given adequate information about the study and only those who volunteered participated in the study after appending their signatures on the informed consent form. In phase 3, the Medical Research Council Framework was used to develop intervention strategies for improved medical waste management in Vhembe District based on the Strength, Weakness, Opportunity and Threat (SWOT) and Political, Economic, Social, Technological, Environmental and Legal (PESTEL) analysis techniques. The study revealed inefficient practices of medical waste management in all the healthcare facilities. Rate of medical waste generation was 338.15kg/day, 19.2kg/day and 15.5kg/day of HCRW from the hospitals, community health centers and clinics respectively. Segregation practices were poor, and only 28.4% of respondents rated their healthcare institutions as being excellent with medical waste segregation. The type of occupation was found to be significantly associated with exposure to training (p=0.000) and the level of knowledge about medical waste management (p=0.000). Also, the use of personal protective equipment was found to be significantly associated with training (p=0.011). Transportation and temporary storage were not done according to the recommendation in the guidelines and incineration was the main means of treatment of the waste. The final product of waste treatment is being disposed into an hazardous waste landfill. The challenges encountered in the process of managing medical waste include lack of adequate funding and budget for medical waste management, ineffective and irregular training of healthcare workers, non-compliance to medical waste management guidelines, insufficient bins, substandard central storage rooms, insufficient personal protective equipment and unavailability of Hepatitis B vaccine. The strength, weakness, opportunities and threats of medical waste management in Vhembe District were analyzed and specific intervention strategies were developed to improve on the strength, minimize the weakness, take advantage of the opportunity and combat the threats. The developed strategies were validated. This study provides the evidences of poor management of medical waste in Vhembe District, and shows the need for urgent intervention measures to be put in place. We therefore recommend that the intervention strategies proposed here be evaluated and implemented to mitigate the untoward effects of poor medical waste management among healthcare workers and the community as a whole.