SWAZILAND ENVIRONMENTAL AUTHORITY (SEA) WITH THE SUPPORT OF THE DANISH GOVERNMENT THROGH THE DANISH CO-OPERATION FOR ENVIRONMENT AND DEVELOPMENT (DANCED) DEVELOPED A NATIONAL SOLID WASTE MANAGEMENT STRATEGY (NSWMS)

1
SWAZILAND ENVIRONMENTAL AUTHORITY (SEA) WITH THE
SUPPORT OF THE DANISH GOVERNMENT THROGH THE
DANISH CO-OPERATION FOR ENVIRONMENT AND
DEVELOPMENT (DANCED) DEVELOPED A NATIONAL SOLID
WASTE MANAGEMENT STRATEGY (NSWMS)

• NSWMS serves as an enabling mechanism for the
  implementation of the Waste Regulation 2000.
• The National Solid Waste Management Strategy
  vision
• for Swaziland
• To develop, implement and maintain an integrated
  Waste Management System that will reduce the
  adverse impact of all forms of solid waste so
  that social and economic development in
  Swaziland, the health of its people and the
  quality of the environment and its resources
  benefit (refer NSWMS draft I II).

2

• The strategy applies to all government society at
  large
• and to all activities that impact on waste
  management.
• Health Care Waste Management was initiated by SEA
  in collaboration with the Ministry of Health
  Social Welfare.
• To test the relevance of the NSWMS in urban
  hospital.
• To assist the SEA in developing approaches for
  the installation of Waste Management System in
  areas not currently serviced.

3
Health Care Waste Management Pilot Project
Mbabane Government Hospital

• National Referral Hospital
• Has total of 500 beds
• Occupancy rate of 110
• Has 18 operational units
• Has one local incinerator.

4
Situational AnalysisMbabane Government Hospital
(November 2001) Findings

• No system in place to manage waste.
• Shortage of equipment, lack of understanding and
  weak supervision resulted in poor segregation of
  waste.
• No secure storage areas for HCW awaiting
  collection.
• General public were exposed to potentially
  harmful properties of HCRW.
• Local incinerator was in poor condition with
  incomplete combustion.

5
Operational Objectives

• To develop a Waste Management Plan for the
  Mbabane Government Hospital.
• Implement Waste Management System at the Mbabane
  Government Hospital covering all aspects of HCWM.
• Capacitate and train hospital personnel to
  implement the system.
• An awareness campaign on health care risk waste.

6
System DevelopmentThree (3) Principles applied
in Development of the System

• Legal framework presently existing in Swaziland
• Environmental Management Act. The
  precautionary principles, polluter pays principle
  and duty to care principles are applicable.
• Waste Regulation 2000
• Under these regulation Mbabane Government
  Hospital as a waste generator and with a
  treatment/disposal facility is required to apply
  for
• Environmental compliance certificate.
• A waste Management license.
• A facility operating plan.

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• Multi Disciplinary Approach
• Interaction at all levels with the hospital.
• Collaboration with external relevant
  organisation/institutions.
• Segregation at Source
• Provision of sufficient colour coded and
  labeled equipment.
• Minimum handling of waste.
• Decision Making Processes
• To facilitate the decision-making in the
  development of the system, the following
  structures are in place

8

• HCWM Steering Committee
• Comprised of representatives from Swaziland
• Environmental Authority, Ministry of Health,
  Mbabane
• City Council, Hospital Management, Regional
• Environmental Health office, Stores, Biomedical
• Engineering Department, Regional Health Educator.
• Outputs
• Waste Management System.
• Implementation Plan for the hospital.
• Sustainability of the system in the hospital etc.

9

• HCWM Operational Committee
• Consisted of Unit Managers, Matrons, Stores,
  Senior
• Orderly, Biomedical Engineering Department, Waste
• Management Officer, and Hospital Administrator.
• Outputs
• Implementation of the HCWM system at unit level.
• Decide on positioning of equipment in units.
• Decide on equipment specification and quantities.

10

• HCWM Training Task Team
• Comprised of staff from the in-service training
  office, Health Education Officer, WMO,
  Representative from Nursing Cadre.
• Responsible for the development of a plan to
  address performance gaps, identified under
  three (3) main categories knowledge skills,
  changing attitudes and behaviour.
• Develop HCWM training and awareness material.

11

• Classification of Waste
• Health Care Waste classified into two categories.
• Health Care General Waste (HCGW).
• Health Care Risk Waste (HCRW).
• The waste regulation and World Health
  Organisation
• requirements were considered.
• Colour Coding and Labeling
• Two colour and internationally recognised
  labeling/symbols
• are used-
• Red HCRW
• Black HCGW
• These two colours are observed on the plastic
  liners fitted on
• the re-usable containers.

12

• Equipment, Design and Specification
• When designing the system the following aspects
  were of key importance-
• For the system to be sustainable the consumable
  items must be readily available to the
  facilities.
• Specification for the equipment must be in line
  with international standards and guidelines.
• Affordability without compromising the minimum
  specification.
• Equipment must be robust to withstand rough
  handling.

13

• Monitoring and Evaluation
• The main reason for the project was to inform the
  National Solid Waste Management Strategy and from
  the lessons learnt make recommendation for
  implementation.
• Specific Objectives for Monitoring the Project at
  Institutional
• levels-
• To assess whether the health care waste is
  disposed of safely and in an environmentally
  friendly manner.
• To assess the variability of the new system for
  the whole hospital in terms of human resources
  and equipment.
• To assess the cost effectiveness and benefit to
  the hospital.
• To assess the level of commitment and awareness.

14

• Monitoring tools used
• Performance check list forms.
• Inspection report forms
• Questionnaires.
• Constraints
• No separate budget allocation for HCWM.
• System require specific equipment which is not
  locally available sharp containers and
  speci-cans.
• Resistance in behaviour change among the
  personnel.
• Health Care Risk Waste Treatment remains an
  environmental challenge incineration.

15
Way forward

• For the Ministry of Health to expand the project
  to other health care facilities in the country
  there is a need to
• Conduct a National HCWM Rapid Situational
  Assessment.
• Develop a national HCWM Policy and Legislation.
• Allocate Separate National Budget for HCWM
  Initiative.
• Invest more on HCWM treatment technology and
  human resource development.
• THANK YOU.