AN EVALUATION OF EFFECTIVE MEDICAL WASTE MANAGEMENT FOR SUSTAINABLE GREEN HEALTHCARE IN CAMEROON

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

The global COVID-19 epidemic has had various repercussions on people's daily lives, society, economy, and the environment, which necessitate making trade-offs in multiple areas.  Technological advancements, including as fast testing, tracking infected individuals, and online-based remote work and education, have proven to be successful in curbing the spread of the pandemic (Singh et al., 2022). However, there are also disadvantages associated with them, including challenges in waste management caused by the growing reliance on disposable items and disparities arising from socioeconomic and digital inequities. The surge in plastic trash resulting from COVID-19-related measures has substantial implications, presenting obstacles in the pursuit of environmental sustainability (Lee & Lee, 2022). 

In their study, Penga et al. (2021) forecasted that COVID-19-related activities would lead to a 10% rise in plastic trash production, resulting in an extra 8.4 million tonnes globally across 193 nations. This increase occurred after the World Health Organisation (WHO) proclaimed COVID-19 a global pandemic in March 2020. During the pandemic, healthcare institutions were responsible for approximately 87.4% of the additional plastic waste. This waste included personal protective equipment like masks, sanitary gloves, and face shields, as well as online packaging materials due to increased online shopping. Virus test kits accounted for 0.3% of the waste. From a geographical perspective, Asia had the largest waste generation rate at 46.3%, followed by Europe at 23.8%, South America at 16.4%, Africa at 7.9%, and North America at 5.6% (Penga et al., 2021).  Penga et al. (2021) conducted a modelling research on the dynamics of plastic garbage associated to COVID-19. They estimated that a range of 3800 to 25,900 tonnes of debris has been discharged into the sea. By the end of 2021, there were an estimated 280 million confirmed cases of COVID-19, resulting in around 11 million tonnes of medical waste. Out of this, around 34,000 tonnes were disposed of in the sea (IHME, 2021).

Healthcare services enhance and extend individuals' lives by promoting health and preventing and treating diseases. Nevertheless, healthcare services produce a significant quantity of medical waste, with 20% of this trash carrying potential health hazards, including the risk of infection and exposure to dangerous chemicals or radiation (Ngo, 2022).  The World Health Organisation (2021) issued guidelines for the handling of medical waste in its study titled "Safe management of waste from healthcare activities". The World Health Organisation (WHO) has provided a definition for healthcare waste, stating that it encompasses all trash produced by healthcare facilities, medical laboratories, and biomedical research facilities, as well as garbage originating from smaller or dispersed sources. The ICRC (2018) stated that "medical waste encompasses all waste generated from healthcare or diagnostic activities." According to the United States Environmental Protection Agency (US EPA) in 2022, medical waste is a specific type of waste that is produced in healthcare facilities, including hospitals, doctors' offices, dental practices, blood banks, veterinary hospitals/clinics, as well as medical research facilities and laboratories. According to Article 2, No. 5 of the "Wastes Control Act" in South Korea, medical wastes are described as the wastes that are released from public health and medical institutions, veterinary clinics, testing and inspection institutions, and other similar establishments. These wastes include parts and extracts of human bodies and carcasses of laboratory animals. They have the potential to cause harm to human bodies through infection or other means and require special control measures for the protection of public health and environmental conservation. Various international authorities offer different definitions of medical waste, although they generally agree that it refers to trash produced by healthcare facilities (EPA, 2022). For the purposes of this study, medical waste is defined as the trash that is produced during the various procedures involved in patient treatment.

Medical waste can be categorised as either hazardous or non-hazardous, falling under the broader classification of general garbage. Although non-hazardous medical waste does not present a distinct danger, hazardous medical waste has the potential to induce diseases and environmental concerns (EPA, 2022). According to the World Health Organisation (WHO) in 2022, medical waste is divided into eight distinct categories: infectious waste, pathological waste, sharps waste, chemical waste, pharmaceutical waste, cytotoxic waste, radioactive waste, and non-hazardous or general trash. While there may be some variations in the definition of medical waste among different institutions and nations, its categories and contents remain mostly consistent. 

As per the World Health Organisation (WHO) in 2022, 15% of the total medical waste produced is classified as hazardous. High-income countries produce 0.5 kg of dangerous medical waste per hospital bed day, while low-income countries produce 0.2 kg. Amidst the COVID-19 outbreak, there has been a notable increase in the production of medical waste. The United Nations Environment Program (2020) reports that the global average volume of medical waste produced by medical facilities associated with COVID-19 is 3.4 kg per person and roughly 2.5 kg per hospital bed per day. China produced an estimated 469 tonnes of medical waste per day during the pandemic (Penga et al., 2021). Japan, India, and Indonesia produced 876, 608, and 290 tonnes per day, respectively [26], whereas South Korea produced 476 tonnes per day (Shin et al., 2020).

Hassan et al. (2018) contended that the issue of medical waste arises due to a combination of factors, including a lack of understanding and motivation among healthcare workers, as well as unclear policies and legislation regarding the appropriate handling of medical waste. Hossain et al. (2019) highlighted that the misconduct of personnel and inadequate means of disposing medical waste in hospitals can escalate significant health hazards and environmental contamination, given the infectious nature of the waste. Consequently, healthcare facilities necessitate an effective plan to educate those involved in the production of medical waste in order to address this significant issue.

Prior studies on medical waste management generally concentrated on the handling of dangerous waste, but there has been a recent change in attention towards operational solutions for managing the disposal of all categories of medical waste. The primary cause of this pattern is the imperative need to ensure the proper management and elimination of medical waste, which is crucial in mitigating potential risks such as diseases, injuries, and environmental pollution (Blenkharn, 2017). The thorough exploration of the transmission of blood-borne viruses and respiratory and other illnesses through inappropriate medical waste disposal has not been conducted yet. However, it is evident that there are significant concerns to human health and the environment (Kumar et al., 2017).  Medical waste management is currently considered an essential element of top-notch medical services (Borowy, 2020). This change is a consequence of reports that have shown how environmental toxins produced during garbage treatment are endangering the ecosystem in which we live and human health. In their study, Penga et al. (2021) asserted that a total of eight million tonnes of plastic garbage, specifically related to the COVID-19 pandemic, was produced worldwide. Out of this amount, more than 25,000 tonnes were released into the ocean. This has the potential to result in detrimental long-term consequences for the marine ecosystem.

Windfeld and Brooks (2018) proposed the necessity of implementing a uniform classification system to train healthcare professionals in the effective handling of medical waste.  Thakur et al. (2021) identified six key aspects of medical waste management practices: experience, relationship, environmental variables, technology and certification, economic factors, and firm's capabilities. Healthcare institutions had to formulate comprehensive medical waste management strategies encompassing the daily retrieval, treatment, segregation, and packing of medical waste, alongside the establishment of routine surveillance and educational initiatives (Seifert et al., 2021). Ensuring the efficient functioning and upkeep of medical equipment and facilities can help reduce the frequent production of medical waste. One way to prolong the lifespan of medical equipment is by implementing appropriate maintenance practices. Hence, the effective operation and maintenance necessitate ongoing management tasks, including staff training and provision of suitable materials and spare parts.

In order to establish a sustainable medical setting by minimising and effectively handling medical waste, it is crucial to cultivate a suitable organisational culture that promotes the active involvement of all individuals involved in the formation of medical waste (Lee & Lee, 2022). This necessitates the participation and collaboration of all parties involved, including the many professions/sections within the healthcare establishment, as well as the cooperation of patients, guardians, subcontractors, and communities (Mcgain, 2017). Healthcare institutions ought to establish a comprehensive strategy for the management of medical waste (Thakur et al., 2021). Hence, it is not advisable for a single department to shoulder the entire burden of medical waste reduction. Instead, all members of the hospital should engage in these practices throughout their job. For example, the department responsible for medical waste disposal shall implement appropriate segregation measures to avoid the inclusion of general waste with medical waste.  Healthcare departments should strive to decrease emissions resulting from infectious waste and disposable products. By engaging in these common activities, healthcare facilities can effectively decrease the production of medical waste and lower associated expenses, so establishing a sustainable healthcare service environment (Singh et al., 2022).

Healthcare facilities in Cameroon produce a range of medical waste, which includes infectious, hazardous, and non-hazardous waste. The mishandling and improper disposal of this waste can result in substantial public health threats, such as the transmission of infectious diseases, contamination of the environment, and occupational dangers for healthcare personnel (Ndiye, 2023). In addition, the absence of uniform waste management procedures contributes to environmental deterioration, which undermines endeavours to establish sustainable and eco-friendly healthcare systems (Marin, 2023). The endeavour to enhance medical waste management in Cameroon has encountered numerous obstacles, such as a lack of awareness among healthcare personnel, insufficient training, and restricted availability of suitable waste disposal technology (Gossi et al., 2023). Comprehensive initiatives are required to tackle these difficulties and encourage sustainable practices in the management of healthcare waste. These policies should prioritise the development of skills and resources, the allocation of funds for waste management infrastructure, and the strict implementation of applicable rules.

The significance of efficient medical waste management cannot be exaggerated, particularly in the realm of sustainable development and safeguarding the environment. In order to achieve the United Nations Sustainable Development Goals (SDGs), specifically SDG 3 (Good Health and Well-being) and SDG 6 (Clean Water and Sanitation), it is crucial for countries like Cameroon to give priority to sustainable waste management practices in their healthcare systems (Marin, 2023). This study aims to assess the present condition of medical waste management in Cameroon, identify significant obstacles, and provide approaches to achieve sustainable green healthcare.

1.2 Statement of the problem

Efficiently managing medical waste is essential to maintain environmental sustainability and ensure public health safety, especially in developing nations such as Cameroon. Improper management of medical waste, which consists of dangerous substances like infectious waste, sharp objects, and leftover pharmaceuticals, can lead to substantial problems. The issues related to waste management in Cameroon have been worsened by the growing healthcare services and population, resulting in a larger amount of medical waste being produced (Sambo et al., 2017).

Presently, the administration of medical waste in Cameroon encounters numerous pressing concerns. Medical waste management at numerous healthcare facilities around Cameroon suffers from a deficiency in standardised processes for the segregation, collection, and disposal of medical waste. The situation is worsened by the lack of proper infrastructure, limited financial resources, and inadequate training for healthcare workers. Consequently, medical waste is frequently disposed of in an unsuitable manner, resulting in environmental deterioration and presenting significant health hazards to the community (Ndiaye et al., 2018). Inadequate waste management techniques not only have a negative impact on environmental sustainability but also pose a threat to public health by increasing the risk of exposure to harmful substances (Fongang & Achu, 2021). In addition, healthcare staff have a limited understanding and training in the most effective methods of waste management (Nguetnkam & Tsafack, 2019).

Moreover, the legislative system that oversees the treatment of medical waste in Cameroon is sometimes inadequately enforced, resulting in numerous healthcare facilities not adhering to the established rules. The lack of enforcement can be attributed to several causes, such as insufficient governmental supervision, a scarcity of skilled staff, and the absence of sufficient monitoring systems (Toure et al., 2018). The issue is exacerbated by the increasing amount of medical waste produced as the healthcare industry in Cameroon increases. Due to the growing need for healthcare services, especially in urban regions, there is anticipated to be a substantial increase in the quantity of medical waste generated. The lack of efficient management solutions is expected to worsen the current environmental and health issues due to the rise in trash (Diop & Adebayo, 2022).

In order to tackle these difficulties and progress towards an environmentally sustainable healthcare system, it is crucial to assess the existing methods of managing medical waste and pinpoint areas that can be enhanced. Efficient management strategies should integrate concepts of waste reduction, appropriate categorisation, secure processing and disposal techniques, and the implementation of eco-friendly technologies. Cameroon can progress towards a more environmentally friendly healthcare system by enhancing its medical waste management methods. This will not only safeguard public health but also accord with global sustainability objectives (World Health Organisation, 2020).

Objectives of the study

The primary objective of this study is to critically evaluate effective medical waste management for sustainable green healthcare in Cameroon. Specific objectives of this study are to:

To assess the current practices of medical waste segregation, collection, and disposal in healthcare facilities across Cameroon

To identify the barriers to effective medical waste management in Cameroon

To analyze the impact of improper medical waste management on public health and the environment in Cameroon

To evaluate the role of governmental policies and regulations in shaping medical waste management practices in Cameroon.

To propose a framework for sustainable medical waste management that aligns with green healthcare principles

1.4 Research Questions

The following research questions which are in line with the objectives of this study will be answered in this study:

What are the current practices of medical waste management in healthcare facilities across Cameroon?

What are the barriers to effective medical waste management in Cameroon?

What is the impact of improper medical waste management on public health and the environment in Cameroon?

What is the role of governmental policies and regulations in influencing medical waste management practices in Cameroon?

What strategies can be implemented to promote sustainable green healthcare through improved medical waste management in Cameroon?

1.5 Research Hypotheses

To determine the effectiveness of this study, the following research null hypotheses will be formulated to guide the study and it will be tested at 0.05% levels of significance.:

Ho: Improper medical waste management practices have no significant impact on public health and the environment in Cameroon.

Ha: Improper medical waste management practices have a significant impact on public health and the environment in Cameroon.

1.6 Significance of the study

Efficiently managing medical waste is essential to ensure public health, protect the environment, and maintain the long-term viability of healthcare institutions. In Cameroon, where healthcare infrastructure is frequently inadequate and regulatory enforcement is unreliable, the importance of this study cannot be emphasised enough. This study aims to provide significant findings and actionable suggestions for enhancing the management of medical waste in Cameroon. The outcomes of this research will have far-reaching effects on public health, environmental sustainability, and healthcare policy.

Efficient treatment of medical waste is essential for protecting public health. Improper disposal of medical waste can result in the transmission of infectious diseases, pollution of water sources, and contact with hazardous substances. This study seeks to mitigate health hazards related to medical waste and promote the overall safety of healthcare settings by assessing and enhancing waste management methods.

Moreover, Medical waste frequently contains perilous substances that can cause significant environmental consequences if not appropriately handled. Improper disposal can result in the contamination of soil and water, which contributes to the long-term damage of the environment. The study's emphasis on sustainable waste management procedures is in line with global environmental sustainability objectives and aids in decreasing the ecological impact of the healthcare industry in Cameroon.

Moreover, a comprehensive assessment of existing methodologies offers significant perspectives for policymakers and regulatory authorities. An in-depth comprehension of the deficiencies and obstacles in current medical waste management systems would facilitate the formulation of more efficient legislation and policies. This can result in the creation of complete frameworks that guarantee appropriate waste management and adherence to international standards.

Moreover, numerous healthcare facilities in Cameroon encounter logistical and infrastructural obstacles when it comes to handling medical waste. This study aims to discover best practices and effective tactics that may be used by healthcare facilities to develop sustainable waste management solutions. Consequently, this enhances operational efficiency and leads to a more secure and healthier working environment for healthcare personnel. Efficient waste management can result in financial savings by minimising the necessity for emergency actions associated with garbage mishandling and by optimising the utilisation of resources. Efficient waste management techniques can create chances for the advancement of green technologies and new solutions, which may contribute to economic growth in the healthcare industry.

Additionally, the project will contribute valuable data to the existing body of research on the handling of medical waste, particularly at healthcare facilities in Cameroon and similar settings. The findings may highlight specific areas that require more investigation, offering guidance for future research efforts in the field of biomedical waste management and healthcare waste practices.

1.7 Scope of the study

Broadly, this study focus is to critically evaluate effective medical waste management for sustainable green healthcare in Cameroon. Specifically, this study seeks to assess the current practices of medical waste segregation, collection, and disposal in healthcare facilities across Cameroon, identify the barriers to effective medical waste management in Cameroon and analyze the impact of improper medical waste management on public health and the environment in Cameroon. 

Further, this study will focus on evaluating the role of governmental policies and regulations in shaping medical waste management practices in Cameroon and it also seeks to propose a framework for sustainable medical waste management that aligns with green healthcare principles.

 The study is carried out in Cameroon. 

1.8 Limitations of the study

During the assessment, the researchers noted certain minor constraints, which are customary in any human endeavour. The main limitation was the lack of extensive literature on the subject, resulting from the scarcity of data on evaluating efficient medical waste management for sustainable environmentally-friendly healthcare in Cameroon. Therefore, a significant allocation of time and exertion was necessary to determine the appropriate materials, books, or information and gather data. 

Furthermore, this study is constrained by its small sample size and narrow geographic scope, focusing just on Cameroon. Therefore, the capacity to extrapolate the findings of this study to a broader context is restricted, underscoring the need for more investigation. 

Moreover, the researcher's limitations were primarily ascribed to financial constraints, as they are a student who lacks the requisite financial means to sustain themselves. The exorbitant transportation rates at the research site posed a challenge in meeting the financial obligations related to transportation expenses.

Furthermore, the researcher faced a time constraint due to the need to do this research while simultaneously fulfilling the obligations of attending lectures and participating in other educational pursuits.

1.9 Definition of terms

Medical waste: Medical waste is any waste containing infectious or potentially infectious materials. These wastes are generated during the diagnosis, treatment, and immunization of humans and animals. Biomedical wastes can be in both solid and liquid forms.

Medical waste management: Medical waste management plays a crucial role in safeguarding the safety and well-being of individuals and the environment. It encompasses the proper handling, treatment, and disposal of waste generated by healthcare facilities.

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