Critical Evaluation of Medical Waste Management Policies, Processes and Practices in Selected Rural Hospitals in the Eastern Cape
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Critical Evaluation of Medical Waste Management Policies, Processes and Practices in Selected Rural Hospitals in the Eastern Cape A thesis submitted in fulfilment of the requirements for the degree of MASTER OF SOCIAL SCIENCE IN ENVIRONMENTAL AND DEVELOPMENTAL SOCIOLOGY RHODES UNIVERSITY by Qondile Maseko Student Number: 607m2042 Pa g e | ii ABSTRACT This thesis critically evaluates the policies, processes and practices of medical waste management in selected rural hospitals in the Eastern Cape. Medical Waste Management is a growing public health and environmental issue worldwide. Research shows large scale incapacity in dealing with medical waste in an efficient and sustainable fashion globally, which demonstrates that it is not merely a developing world problem alone. This study is conducted against the backdrop of an increasing medical waste crisis in South Africa. Although there are an abundance of studies on solid waste management, there is a lack of data and research particularly on medical waste management in rural hospitals. The crisis of medical waste management in South Africa is closely intertwined with the collapsing health care system and an overburdened natural environment. It is an undisputable fact that South Africa’s generation of medical waste far exceeds its capacity to handle it effectively. This thesis argues that the neglect of medical waste as an environmental-health issue and the absence of an integrated national medical waste management plan aggravate the medical waste problem in the country. In explaining the medical waste crisis, this thesis adopts a Marxist perspective which is based on the premise that industrial capitalist societies place economic growth and production at high priority at the expense of the natural environment; creating a society that is engulfed by high health risk due to the generation of hazardous and toxic waste. Industrial societies view themselves as superior and separate from the natural environment, whereas one cannot separate nature from society as they are interlinked. As society attempts to adopt a sustainable environmental approach towards environmental management, science and technology are enforced as a solution to environmental problems in order to continue developing countries’ economies whilst sustainably managing and protecting the environment, which is contradictory. This thesis emphasises that medical waste management is a socio-political problem as much as it is an environmental problem, hence the need to focus on power relations and issues of environmental and social justice. The results of the study identified gaps in policy framework nationally and institutionally on medical waste management. In addition, there were poor waste management practices due to poor training, inadequate infrastructure and resources as well as poor budget support. Pa g e ....................................................................................................................... |iii TABLE OF CONTENTS Abstract ............................................................................................................................. ii List of Figures ................................................................................................................. vii List of Acronyms and Abbreviations ......................................................................... viii Acknowledgments ........................................................................................................... xi Chapter 1: An Introduction .............................................................................................1 1.1 Conceptual Framework ...............................................................................................1 1.2 Context of the Study ...................................................................................................4 1.2.1 Context of Healthcare Problem in South Africa ........................................................4 1.2.2 Private/Public Healthcare Sector Divide ...................................................................9 1.2.3 Historical Background of the Study Area ...................................................................9 1.3 Goals of the Study ....................................................................................................11 1.4 Structure of the Thesis .............................................................................................12 Chapter 2: A Global Comparative of Medical Waste Management Practices .........14 2.1 Structural Framework of National Policies on Medical Waste Management ........ 15 2.2 Compliance, Enforcement and Implementation ......................................................18 2.3 Practices and Processes of Medical Waste Management .........................................19 2.4 Training and Knowledge of Staff ............................................................................21 2.5 Disposal Methods ....................................................................................................23 2.6 Infrastructure and Resources ...................................................................................27 2.7 Transboundary Movement of Waste ........................................................................29 2.8 Lessons Learned And Recommended Priority Policy Measures And Actions .......30 2.8.1 Institutional Fragmentation .....................................................................................30 2.8.2 Lack of National Policies and Guidelines ...............................................................31 2.8.3 Scarcity of Research ...............................................................................................32 2.8.4 Lack of Institutional Capabilities ............................................................................32 2.8.5 Piecemeal Intervention ............................................................................................33 |iv 2.8.6 Weak Governance ...................................................................................................34 2.8.7 Outdated Strategies and Laws Unresponsive to Current Challenges ......................35 2.9 Conclusion ..............................................................................................................35 Chapter 3: Medical Waste Management in South Africa ...........................................37 3.1 Medical Waste Management Policies and Power Relations .....................................41 3.1.1 Policies at National Level ........................................................................................43 3.1.2 Policies at Provincial Level .....................................................................................46 3.1.3 Policies at Local Level .............................................................................................51 3.2 Neglect and Dearth of Attention on Medical Waste Management ......................... 52 3.3 Medical Waste Status and Practices ........................................................................52 3.4 Medical Waste as a Field of Social Inquiry .............................................................58 3.4.1 Urban Bias in Medical Waste Studies .....................................................................58 3.4.2 Environmental Justice and Waste Reclaimers .........................................................60 3.5 Conclusion ...............................................................................................................63 Chapter 4: Theoretical Framework ..............................................................................66 4.1 Environmental Sociology ..........................................................................................70 4.2 A Marxist Political Economy Perspective: Capitalist Society and the Environment ................................................................................................71 4.3 Marx and the Metabolic Rift .....................................................................................76 4.4 The Treadmill of Production and Waste Management .............................................78 4.5 Politics of Waste Management .................................................................................80 4.6 The “Greenwashing” of Waste Management ...........................................................81 4.7 Conclusion ................................................................................................................85 Chapter 5: Research Design and Methodology ............................................................86 5.1 Qualitative Methodology ..........................................................................................86 5.2 Population and Sampling ..........................................................................................88 5.3 Data Collection .........................................................................................................89 Pa g e | v 5.3.1 Settlers Hospital, Grahamstown ...............................................................................89 5.3.2 Nompumelelo Hospital, Peddie ..............................................................................92 5.3.3 Waste Generation and Handling ..............................................................................94 5.3.4 Waste Segregation ...................................................................................................95 5.3.5 Waste Storage ..........................................................................................................95