Healthcare waste and the state-citizen relationship

If climate change has negatively impacted human health, the consequence of the improper treatment of healthcare waste has also added to the severity of climate change. It is, therefore, a two-way street. Healthcare waste thrown in open or recycled for low-cost consumer products are hazardous practices, building an infectious and toxic environment. Therefore, one of the principal duties of a healthcare institution is to ensure that it manages healthcare waste in an environmentally sound and health-protecting way. It is just not enough to dispose of waste, using practices elucidated under waste disposal management mechanisms; applying strategic thinking for the prevention of waste is equally important. Though the frontline action should come from health facilities, the programme of healthcare waste management, according to researchers, is “multisectoral and require cooperation between all levels of implementation, from national and local governments to hospital staff and private businesses”.

Sensing the sensitivity of the issue, the World Health Organization, in collaboration with its partner association, the European Centre for Environment and Health in Nancy France, arranged a working group in 1995 to produce a set of guidelines on healthcare waste management, particularly for developing countries. The effort resulted in what is commonly called a “Bluebook”, which defines healthcare waste as “all the waste generated within healthcare facilities, research centres and laboratories related to medical procedures. In addition, it includes the same types of waste originating from minor and scattered sources, including waste produced in the course of healthcare undertaken in the home (for example home dialysis, self-administration of insulin and recuperative care).”

Not all waste produced in Healthcare Establishments (HCE) is hazardous. The threat to the environment originates only from 10 to 25 per cent waste, which needs to be properly managed through a planned system of waste disposal.

The waste management catchment area of any HCE, through which the rest of the planning and development flows, is ideally based on six objectives (as delineated in the Blue Book). One, establishing a legal and legislative framework; two, rationalising waste management practices with healthcare facilities; three, dedicating resources for waste management; four, building capacity, through training, of those concerned with managing waste; five, setting up a monitoring plan; and six, reducing pollution originating from healthcare waste.

Each of these objectives is an effort to eradicate hazardous properties of waste that could affect human health through numerous interconnected and sometimes unexpected pathways.

Infections, however, is one of the leading pathways that have caused unexplained miseries in the form of hepatitis and AIDS. Any injury caused by a needle could transmit blood-borne diseases. Sharps are even more lethal. Besides inflicting injury, the pathogens attached to sharps could contaminate and make the wound worse off.

In Pakistan re-use of disposable syringes is the primary reason behind the rising number of hepatitis B and C infected people. According to WHO, 12 per cent of public-sector hospitals are supplied with re-used syringes while 75 to 94 per cent of injection equipment is re-used.

It is an open secret now that the majority of hospitals, clinics and maternity centres all across Pakistan dump toxic waste in the open, or directly into water bodies despite knowing the health hazards that such practices pose on the ecosystem.

Several studies, researches and court petitions later did the provincial governments and their healthcare sector wake up to the call of putting the horse before the cart and devised policies and other mechanisms to handle healthcare waste. Punjab Health Minister Dr Yasmeen Rashid announced a central policy for the disposal of healthcare waste in August 2019 and directed both the private and public HCE to follow the policy in letter and spirit. In addition to that, the Lahore Waste Management Company has launched the first-ever Hospital Waste Management System application to ensure safe collection and disposal of pathological waste.

Ideally, it is for the governments to build a network of disposable facilities for the treatment of waste, that could be accessed by hospitals and other healthcare facilities. Developing countries usually fall short of providing such an extensive arrangement because of parsimonious attitude towards developmental spending. However, in the absence of a government outreach, a number of other options could be followed, such as: building onsite treatment facilities in the HCE, building regional or cooperative healthcare waste treatment facilities, treating healthcare waste in existing facilities used for industrial or municipal waste management, and treating partial healthcare waste onsite while treating the rest offsite. These WHO delineated options can considerably reduce the burden of disease proliferation from healthcare waste.

For any policy to produce the result it should have legislative support and the political will to implement the legislation. In developing countries, laws usually become a handmaiden of collaborators for whom power is the manifestation of might is right.

The treatment of healthcare waste is a consideration that falls within the purview of the overall system of waste management that ultimately adds to the climatic challenges. Any delinquent act that opens the pathway to disease is an onus on the environment which, once infected, becomes the carrier of many other microbes. Therefore, the petition filed in the Lahore High Court against the failure of the provincial health authorities in managing healthcare waste, has evoked Article 14, 9 and 38 of the Constitution of Pakistan. Article 14 is about the responsibility of the state to preserve the dignity of its people. Article 9 speaks about lending security to a person’s life by not exposing it to any hazard. And Article 38 talks about the promotion of social and economic well-being of the people. If the people are falling sick because of being administered used injections, if they are losing life because of antibiotic-resistant bacteria that healthcare waste usually produce, and if the quality of life is being lost to consumer products manufactured from healthcare waste that should not have been recycled at the first place, then the state which includes all the stakeholders responsible to provide safe and quality healthcare stand accused of violating the Constitution of Pakistan.

Doing justice to climate and to human life is everybody’s business, demanding community engagement; but the buck stops with the healthcare service providers. It is their activism that will tilt the balance in favour of quality of human life.

Published in The Express Tribune, January 30^th, 2020.

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