1. 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. 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). “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. 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. 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 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. To assist the SEA in developing approaches for the installation of Waste Management System in areas not currently serviced.

3. 3 Health Care Waste Management Pilot Project – Mbabane Government Hospital National Referral Hospital National Referral Hospital Has total of 500 beds Has total of 500 beds Occupancy rate of 110% Occupancy rate of 110% Has 18 operational units Has 18 operational units Has one local incinerator. Has one local incinerator.

4. 4 Situational Analysis: Mbabane Government Hospital (November 2001) Findings: No system in place to manage waste. No system in place to manage waste. Shortage of equipment, lack of understanding and weak supervision resulted in poor segregation of waste. Shortage of equipment, lack of understanding and weak supervision resulted in poor segregation of waste. No secure storage areas for HCW awaiting collection. No secure storage areas for HCW awaiting collection. General public were exposed to potentially harmful properties of HCRW. General public were exposed to potentially harmful properties of HCRW. Local incinerator was in poor condition with incomplete combustion. Local incinerator was in poor condition with incomplete combustion.

5. 5 Operational Objectives To develop a Waste Management Plan for the Mbabane Government Hospital. 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. Implement Waste Management System at the Mbabane Government Hospital covering all aspects of HCWM. Capacitate and train hospital personnel to implement the system. Capacitate and train hospital personnel to implement the system. An awareness campaign on health care risk waste. An awareness campaign on health care risk waste.

6. 6 System Development: Three (3) Principles applied in Development of the System: A. 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.

7. 7 B. Multi Disciplinary Approach: * Interaction at all levels with the hospital. * Collaboration with external relevant organisation/institutions. C. 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. 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. Waste Management System. Implementation Plan for the hospital. Implementation Plan for the hospital. Sustainability of the system in the hospital etc. Sustainability of the system in the hospital etc.

9. 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. Implementation of the HCWM system at unit level. Decide on positioning of equipment in units. Decide on positioning of equipment in units. Decide on equipment specification and quantities. Decide on equipment specification and quantities.

10. 10 HCWM Training Task Team: 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. 11 Classification of Waste: Health Care Waste classified into two categories. Health Care Waste classified into two categories. Health Care General Waste (HCGW). Health Care General Waste (HCGW). Health Care Risk Waste (HCRW). 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 Red – HCRW Black – HCGW Black – HCGW These two colours are observed on the plastic liners fitted on the re-usable containers.

12. 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. 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. Specification for the equipment must be in line with international standards and guidelines. Affordability without compromising the minimum specification. Affordability without compromising the minimum specification. Equipment must be robust to withstand rough handling. Equipment must be robust to withstand rough handling.

13. 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. 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 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 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 cost effectiveness and benefit to the hospital. To assess the level of commitment and awareness. To assess the level of commitment and awareness.

14. 14 Monitoring tools used: Performance check list forms. Performance check list forms. Inspection report forms Inspection report forms Questionnaires. Questionnaires.Constraints: No separate budget allocation for HCWM. No separate budget allocation for HCWM. System require specific equipment which is not locally available – sharp containers and speci-cans. System require specific equipment which is not locally available – sharp containers and speci-cans. Resistance in behaviour change among the personnel. Resistance in behaviour change among the personnel. Health Care Risk Waste Treatment remains an environmental challenge – incineration. Health Care Risk Waste Treatment remains an environmental challenge – incineration.

15. 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: 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.