Developing an integrated framework for sustainable solid waste management at rural hospitals in Chirumanzu District, Zimbabwe

Abstract

Hospital solid waste management is a significant global challenge, particularly in developing countries where waste from hospitals often exceeds available resources. Zimbabwe, like many developing nations, struggles to manage solid waste effectively, especially in rural hospitals. Management of solid waste in financially and technically struggling rural hospitals is far from acceptable standards, presenting environmental and health problems. Despite presenting critical problems, management of solid waste from rural hospitals is an under-researched area in Zimbabwe. However, Sustainable Development Goals, Agenda 21 Chapter 21 complemented by Zimbabwe’s Vision 2030 aspirations calls for appropriate management of solid waste from various sources encompassing rural hospiatls. Sustainable management of solid waste from rural hospitals requires evidence based decisions supported by frameworks that guide approaches and systems towards sustainability. Consequently, this study focused on developing an integrated framework for sustainable solid waste management at rural hospitals in Chirumanzu district, Zimbabwe. It focuses on characteristics of solid waste, management strategies and associated environmental health risks, aspects essential to develop framework. Descriptive cross sectional research design which triangulates quantitative and qualitative paradigms was adopted. Data was collected using questionnaires, interviews, observations and from secondary sources. To complement these data collection methods and fully address all the study objectives, soil and water samples were collected and analysed. Quantitative data was analysed using Statistical Package for Social Sciences and Microsoft Excel while content analysis was used to analyse qualitative data. Results illustrated that major components of solid waste from rural hospitals encompass pharmaceutical, sharps, infectious, pathological, cytotoxic, radioactive, chemical and general waste. Generated solid waste illustrated both hazardous and non-hazardous materisls, presenting the significance of solid waste segregation during waste management. Solid waste generation rate was 0.83kg per patient per day on average and quantity of solid waste was also proportional to number of patients. This implies that since population in the district is increasing at 1.2%, people who require health serves is going to escalate, causing growth of generated solid waste. On average ST Theresa hospital generated 77.35% general waste, 22.65% hazardous waste whereas Holy Cross generated 79% general waste and 21% hazardous waste. Although quantity of hazardous waste is low, but it needs more attention since it causes more harm to human and the environment compared to non-hazrdous waste. Mostly used solid waste storage receptacles included sharp waste containers made with rigid materials, pedal operated bins, metal and plastic buckets, plastic bags and cardboard boxes. Indiscriminate storage of solid waste which translates to co-disposal of waste was common at these hospitals. Solid waste receptacles were mostly emptied on a daily basis at Holy Cross (78.2%) and ST Theresa (86.7%) though disposal of sharp containers was determined by quantity of sharps rather than number of days. Surveyed rural hospitals employ various solid waste disposal approaches namely open pits, burning, incineration, designated dumpsites and auto-way pits. Incineration was highly used at ST Theresa (44.8%) and Holy Cross (41.8%). Most disposal approaches employed at these hospitals are least prioritised by the waste management hierarchy, therefore, have potential to cause adverse environmental health effects. Solid waste management strategies at these rural hospitals are associated with air, water and soil contamination while potentially exposing people to various ailments and occupational hazards. Inappropriate management of hospital solid waste is attributed to low compliance to legal framework, lack of awareness among health workers, improper waste segregation and shortage of resources as well as lack of an appropriate guiding waste management framework. The scenario is exacerbated by application of unclearly defined waste management approaches where there is lack of clear definition of roles, deficiency of coordination coupled by giving less attention to strategies that promote sustainability. Major options to attain proper solid waste management at these rural hospitals encompass collaboration of all accountable stakeholders, raising awareness of health workers and investing in approaches which consider hospital solid waste as a resource. There is a need for the government to implement policies tailored for rural hospitals with insufficient resources. Most importantly, the proposed framework demonstrated possible alternatives to integrate and narrow the gap to reach sustainable solid waste management at rural hospitals. The research presents various relevance to real world scenarios since it has potential assists policy makers and pave route to attain global and local sustainable development goals. In the academic domain, the research can be used as a reference point by other researchers and learners. Characteristics of the framework enables accountable stakeholders to implement strategies which create safe and healthy rural environment through suppression of environmental health problems caused by solid waste from hospitals. Although the study’s strengths outweigh its limiations but applicability of the framework to other rural and urban hospitals is limited since the framework was developed considering characteristics and needs of ST Theresa and Holy Cross hospitals.