Background
In the midst of a limited number of health practitioners, scarce medical training, unsatisfactory logistics and basic social services together with structural and governance problem, the deadly Ebola virus disease struck with large number of mobility and mortality. This amounted to 11,400 infected and 4,800 deaths of Liberians of all ages and gender including foreigners. The Ebola Virus Disease was however defeated through collaborative efforts between Liberians from all walks of life and other international partners.
While the public health system has made substantive impact, provision of health care waste management in health care institutions is essential in protecting the environment and human health.
Health Care Waste (HCW) interventions are fundamental in disease prevention and control. Capacity building and the adequate and consistent application of health care waste management practices in health care settings and the community help to prevent human-to-human transmission of infectious diseases.
Strengthening the workforce, empowering staff and equipping them with the knowledge and tools are critical component of the efforts in managing HCW. This will effectively reduce infection risk, improve quality of care, staff moral and cost efficiency of services.
Between January and October 2015, a WASH Baseline Survey was conducted in 657 health care facilities (HCFs) in the 15 counties. Results indicated that there is a huge challenge in health care waste management especially segregation, handling, storage, treatment and final disposal of waste.
Most of the Health Care Wastes end up into the main waste stream (sanitary land fill, authorized dump site, etc); hence, there ought to be an effective approach in the management of HCW. In addition, the availability of well-trained technicians to proactively regulate Health Care Waste with a sustainable management program are needed. A well trained Staff with suitable knowledge and skills would lead to reinforcing a vibrant health care waste management in Liberia.
From this backdrop, the Youth Exploring Solutions (YES), a leading accredited non-for-profit and voluntary grassroots youth-led development organization invited a team from IDEAS For CMC (Chitwan Medical College) based in the Federal Democratic Republic of Nepal to conduct Health Care Waste Round Table Dialogue. This prompted the visitation of Professor Dr. Muni Raj Chetri and Pradish Poudel which led to the establishment of Nepal – Liberia Exchange Program and further built a stronger partnership, which include: strengthen youth initiatives, buttress public health policy, enhance community medicine, foster health care waste management, and boost the Sustainable Development Goals.
Situation Description
The management of health care waste has become an urgent need to safeguard the public health from adverse effects caused due to improper management of health care waste. Henceforth, the need to provide intensive and comprehensive training for technicians is urgent. To achieve this, an out-of-country training in Nepal was arranged to improve and strengthen the Health Care Waste Management system in Liberia. It was expected that the Nepalese experience in employing a cost-efficient and cost-effective management of health care waste would be learned by the Liberian Technicians and help Liberia to curb both environmental and public health risks associated with health care waste. This theoretical and practical training in Nepal ensured the preparation, monitoring, periodic review, and implementation of the Health Care Waste Management system in Liberia. It is also expected that the establishment of a Health Care Waste Management and Safety Committee in every health facility across Liberia to strengthen the National Guidelines on Health Care Waste.
TRAINING GOAL
To enhance the knowledge and skills in health care waste management of skilled environmental technicians. This will lead to safe and sustainable in health care waste management through the adoption of best practices from the Nepalese autoclave-based safe health care waste management system.
GENERAL OBJECTIVE
To provide a cost-efficient and effective collection, storage, transportation and final disposal of health care waste to curb environmental and public health risks associated with health care waste in Liberia.
SPECIFIC OBJECTIVE
Recognizing the urgency to develop, finalize, and approve a fully operationalized Health Care Waste Management Plan, the National Guidelines on Health Care Waste Management and the establishment of Health Care Waste Management and Safety Committee in Liberia, there is a need to quantify measurable objectives in order to meet the ultimate outcomes of this concept paper.
To successfully facilitate a week-long theoretical and practical training in the Federal Democratic Republic of Nepal for Liberian technicians including opportunity for sight-seeing to medical colleges and health care facilities to ascertain various methods employed to curb the issues of health care waste.
To identify and conduct capacity building training for Liberian technicians working on the development and operationalization of Liberia’s Health Care Waste Management Plan, the
National Guidelines on Health Care Waste and the establishment of Health Care Waste Management and Safety Committee.
To assess and provide technical supports in helping Liberia develop techniques for health care waste segregation and collection, storage and transportation/handling, treatment and disposal.
To provide resources and hands-on framework for the organization of regular awareness raising and training on health care waste management for new and existing health care workers and community members.
On the basic of the above reasons, two (2) delegates from the National Public Health Institute of Liberia traveled to Nepal on May 1, 2018 for a health care waste management training and to promote and strengthen the Asian African Networking on Public Health. This visitation was also geared towards promoting Nepal – Liberia capacity to wards safe and sustainable public health.
Program activities were expected to have commenced on May 1, 2018, but did not due to two days delayed in Ghana by the Liberian delegates because of travel documents; however, the training and other activities started on May 3, 2018 at 11 am. Activities included welcoming ceremonies and awarding token of love to delegates , training, hospitals and clinics visitations, visitation of hospitals health care waste treatment centers, visitation of Pokhara Health Care Waste and Solid Waste Management Centers , visitation of three universities promoting the Asian – African Networking on Public Health and meeting Cities Mayors promoting sustainable waste management.
The Health Care Waste Management Training
There were a total of 38 participants including facilitators. Presence at the training were high level of government officials and major hospital administrators. Amongst the officials were the Chief of District Public Health Office, Dr. Bijay K. Jha . The theoretical and practical training / workshop/ was facilitated by international and regional experts.
Session Proceedings/Methodology
Methodology included: Sessions presentations and group discussions. The training had two components (classroom lectures and field situations / practical) the class room lectures and field teaching ran for three consecutive days. It started at 11 am on May 3, 2018 to May 6, 2018. Lectures included: Power-points presentations, group work, sharing of experiences and questions and answered.
Session 1 Presentations
Each facilitator presented on the following topics:
- Health Care Waste management,
- Impact of health care waste,
- Classification of health care waste,
- Legal Institutional framework of health care waste management,
- Initiative of private hospital for health care waste management,
- Initiative for Chitwan Medical College for health care waste management,
- Health care waste management practices in Nepal,
- Health care waste management practices and SDG in Nepal and
- Mercury Free health Services and Dentistry
Presenters were: Mr. Ram Chritra shahm, Executive Director/ Environmental Scientists, Center for Public Health KTM & Environmental Developmental (CEPHED), Mr. Pratap Devkota, Chief Administrator CMC, Mr Ram Prasad Sharma , Quality Control Officer CMC and Mr. Satosh Poudel, CEO & Founder of Waste Services Pvt. Ltd , Mr. Pradish Poudel, Reg. Director –South Asia, IDEAS For Us.
Knowledge Gained
Participants learned the followings:
- The negative effects or impact of incinerating health care waste on the environment and the community.
- The significance use of modern incinerators with sophisticated control equipment if the incinerator method will be practiced in managing HCW.
- The issues of toxic gases that include: dioxins, furans and Persistent Organic Pollutants (POPs).
- The major impact of POPs on the environment and its effects on public health
Persistent Organic Pollutants (POPs) are those organic chemicals which once released into the environment, remain for longer period, travel very long distances and resist natural degradation and thus accumulate in fatty tissues of living being through the means of air, water, soil and food.
Major Impact of POPs on environment
POPs adversely affects human health including causation of cancer and disruption of reproductive, respiration, and the immune systems
The Impact of Dioxins and Furans
- Infertility-reported but disclosed
- Diabetics
- Learning disability
- Childhood cancers
- Contaminate mother body and milk
- Damage to developmental process
- Damage to reproductive system
- Accumulates in biological tissues
- Imprinted for life on the developing fetus
- Also cause genetic changes that results in cell proliferation, mutation or cancer
- Causes cancer in many different species of animals including humans
- Some health effects ( suppression of immune system, reduced estrogens level
- Carcinogen
The Liberian delegates also learned that Nepal has graduated from the use of incinerators as a means of health care waste treatment due to the Stockholm Convention on Persistent Organic Pollutants (POPs). Key among the knowledge gained were the involvement of Municipalities and Universities of Nepal is involved in managing both health care waste and Municipal wastes.
Some eye catching points during the training
- Mercury free health care facilities in Nepal
- SDGs Vs Chemicals and waste
- Impact of improper waste disposal
- Role of Journalists in HCW management
- The need for central Treatment Plant
- The involvement of municipalities in the management of Wastes
Session 2 Practical Sessions
This session lasted for three days and started with visitations of hospitals waste management treatment centers and observations of waste segregation methods at health care facilities. This was followed by site visit of Nepal’s Waste Management treatment plants (HCW and solid waste). Waste management procedures at several hospitals and clinics within Bharatpur were observed. Some of the health care facilities visited during the practical sessions were: Chitwan Medical Center (750 beds facilities), Manakamana (115 bed room hospital) Hospital, Saptagandaki Hospital, Waste Services Pvt. Ltd, Sunrise Dental Clinic and Healthy Smile Dental Health Care Center. The Waste Management Treatment Plant and Solid waste disposal Site at Pokhara was also toured during the practical sessions.
Building Collaborative Partnerships
Another essential component of the delegates travelled to Nepal was to promote and strengthen the Asian- African Networking on Public Health and to promote the Nepal – Liberia capacity towards safe and sustainable public health. In an effort to achieve the above, the delegates visited three universities and met with local government authorities (Mayors and Cities Counsels) from various Municipalities. Universities and cities visited were: The Chitwan Medical College, the Kathmandu University and the Gandaki Medical College and Kathamndu Medical College and teaching Hospital.
Municipalities visited were: Bharapur, Pokhara, Kathmandu, Dhulikhel ,and Tanahau. The Liberian Delegate did a presentation on the public health achievement and challenges in Liberia, the Mechanism use in Liberia to address the Sustainable Development Goals from the Public Health Perspective, and the Ebola experience. Universities and Municipalities authorities from Nepal also presented on the public health achievement and challenges in Nepal, the involvement of both public and private entities in the management of health care waste.
Also presenting at the various universities was Mr. Pradish Poudel. President of the Students’ Body of Chitwan Medical College and Regional Director, South Asia of IDEAS for Us who presented on the topic “The current position of Nepal in Achieving the SDG”.
Networking and promoting the Nepal – Liberia capacity towards safe and sustainable public health was paramount to this trip. The need for networking at universities and colleges between Nepal and Liberia was emphasized. This included the promotion of Students’ Exchange Programs, experience sharing and at establishing IDEAS branches in various universities in both Countries. The networking could also be strengthen or realized by also organizing seminars/workshops to accelerate the growth and development of the Asian –African Networking on Public Health.
Recommendations
- That NPHIL facilitates the improvement of the proposed Centralized Treatment Plant (CTP) at Disco Hill
- That health care institutions be encouraged to use the CTP
- That NPHIL facilitates the training of health care facility staff in healthcare waste management activities
- That the health care waste management team solicit funds to create awareness of HCW management at colleges , universities and major hospitals
- That Cities, Mayors and municipalities understand their involvement in the waste management process
- That private institutions be involved into waste management activities
- That NPHIL embarks on a campaign for a free mercury health care facility in Liberia
