Policy and practice of health care waste management in community-based care in South Africa.

Doctor of Philosophy in Health Promotion. University of KwaZulu-Natal, Howard College 2016.Health care waste management (HCWM) is a growing concern more especially in the low- and middle-income countries (LMICs). Improper management of health care waste (HCW) has negative effects on the environment and on the health of the people. Unfortunately, no study has been found so far that addresses policy and practice of HCWM in community-based care (CBC) in South Africa. This thesis begins to address HCWM issues through five manuscripts that use various methods and approaches to develop an understanding of HCWM in CBC. The main scripts in this thesis present: 1) a scoping review that highlights the terminologies of HCW, definitions, categories and its classifications; 2) analysis of international and national policies that govern HCW in South Africa; 3) media analysis which explains how the South African media frames the issue of HCWM; 4) results from interviews with policy makers and stakeholders regarding their opinions on the practices of HCW in CBC; 5) results from focus group discussions, informal interviews and participant observations from the community health workers (CHWs) indicating their experiences about HCWM practices. This study is the first to be conducted in CBC. The methodologies used in this study provide useful insights into HCWM and the findings are an addition to the body of literature on HCWM in CBC, environmental health and public health

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

Abstract Background In 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. Methods We 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. Results CHWs 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. Conclusion Current 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

Perspectives of policy-makers and stakeholders about health care waste management in community-based care in South Africa: a qualitative study

Abstract Background In South Africa, a new primary health care (PHC) re-engineering initiative aims to scale up the provision of community-based care (CBC). A central element in this initiative is the use of outreach teams comprising nurses and community health workers to provide care to the largely poor and marginalised communities across the country. The provision of care will inevitably lead to an increase in the amount of health care waste (HCW) generated in homes and suggests the need to pay more attention to the HCW that emanates from homes where there is care of a patient. CBC in South Africa is guided by the home-based care policy. However, this policy does not deal with issues about how HCW should be managed in CBC. This study sought to explore health care waste management (HCWM) in CBC in South Africa from the policy-makers’ and stakeholders’ perspective. Methods Semi-structured interviews were conducted with 9 policy-makers and 21 stakeholders working in 29 communities in Durban, South Africa. Interviews were conducted in English; were guided by an interview guide with open-ended questions. Data was analysed thematically. Results The Durban Solid waste (DSW) unit of the eThekwini municipality is responsible for overseeing all waste management programmes in communities. Lack of segregation of waste and illegal dumping of waste were the main barriers to proper management practices of HCW at household level while at the municipal level, corrupt tender processes and inadequate funding for waste management programmes were identified as the main barriers. In order to address these issues, all the policy-makers and stakeholders have taken steps to collaborate and develop education awareness programmes. They also liaise with various government offices to provide resources aimed at waste management programmes. Conclusions HCW is generated in CBC and it is poorly managed and treated as domestic waste. With the rollout of the new primary health care model, there is a greater need to consider HCWM in CBC. There is need for the Department of Health to work together with the municipality to ensure that they devise measures that will help to deal with improper HCWM in the communities

Additional file 1: of Perspectives of policy-makers and stakeholders about health care waste management in community-based care in South Africa: a qualitative study

Interview guides 1 to 3. The attached file contains 3 interview guides that consists of series of open-ended questions which were asked to all the participants that participated in this study. (DOCX 13 kb