Constraints to healthcare waste treatment in low-income countries - a case study from Somaliland

In low-income countries, healthcare waste is mixed with the municipal waste stream and rarely receives special attention. This paper presents the lessons learned from a pilot project targeted to improve healthcare waste management in Hargeisa (Somaliland). The interventions were carried out in three of the main hospitals in the city. Consideration was also given to improve the overall situation regarding the management of healthcare waste. Three De Montfort incinerators were built and training was provided to operators, waste workers and healthcare personnel. Although the incinerators were constructed in accordance with the required standards, major constraints were identified in the operational phase: irregular de-ashing procedures, misuse of safety equipment, and ineffective separation of healthcare waste were seen in this phase. The paper concludes that in other small hospitals in the developing world, such as those in Hargeisa, on-site incineration by use of low-cost, small-scale incinerators could be successfully applied as an interim solution, provided that an agreed and acceptable plan of operation and maintenance is in place and responsibilities for the management of the facility are clearly identified. Moreover, when replicating this experience in other settings even greater importance should be given to the technical capacity building of operators and pressure should be exercised on local administrations in order to control and supervise the whole management system.