NATIONAL HEALTH CARE WASTE MANAGEMENT FRAMEWORK
FOR SOUTH AFRICA ALIGNMENT OF INITIATIVES AND
POTENTIAL CONFLICTS
Zama Zincume
Acting Director, Environmental Health, National Department of Health
ABSTRACT
Health Care Waste, if it is not managed scientifically has the potential of posing a serious threat to health and
environment. It is the National Government prerogatives to set policy direction. Department of Environmental
Affairs and Tourism (DEAT) developed an Integrated Pollution and Waste Management Strategy. Further, Codes
of Practice for the complete management of infection and radioactive waste have been completed and the
Minimum Requirements for the Handling, Classification and Disposal of Hazardous Waste (1998) that provides
suitable guidelines for the management of Hazardous Waste.
DEAT and the National Department of Health (NDOH) have taken the task of addressing the inadequate
handling of Health Care Waste in the country and consulted with relevant key stakeholders in identifying key
strategies and action plans to inspire health care waste management in South Africa.
Several regional initiatives have taken place in addressing health care waste, the GDACEL (2000) study and
subsequent development which have culminated in the conference of Health Care Waste Management; Kwa-
Zulu Natal and Western Cape initiatives.
The challenge is to align these initiatives as there are specific issues in each province with the urban and rural
bias very prominent. There is a need to design our programmes that will be suitable for the provincial needs.
Replicating what will be happening in Gauteng in either Limpompo or Eastern Cape will be disastrous.
In addressing potential conflicts, DEAT and NDOH have developed a strategy identifying specific roles and
responsibilities for different departments and stakeholders to such an extent as to develop a common
understanding of concepts and definitions used in health care waste, like health care waste, health care risk
waste and others.
Key words
Health care waste, policy, stakeholders and provinces.
NATIONAL HEALTH CARE WASTE MANAGEMENT FRAMEWORK FOR
SOUTH AFRICA ALIGNMENT OF INITIATIVES AND POTENTIAL
CONFLICTS
Introduction
In meeting their constitutional responsibility to ensure that every South African lives in an environment that is not
harmful to health or well being, the Department of Environmental Affairs and Tourism and National Department
of Health initiated a process of aligning all Health Care Waste Management programs both at provincial and
national.
It is the national government prerogative to set policy direction. National Waste Management Strategy sets the
framework and principles, including that dealing with Health Care Waste.
Roles and Responsibilities
Although there are different departments involved in health care waste management, an agreement has been
reached that departments need to approach the health care waste challenge in the country collaboratively, so as
to enhance capacity at the regulatory level for effective management.
Key strategies and action plans to improve the health care waste management process in South Africa was
developed by DEAT and DOH. In health care waste management a holistic approach should be the norm with
an understanding that DEAT is essentially tasked with regulatory and coordinating the management of both
hazardous and non-hazardous waste. At the National Workshop Indaba (31 March – 1 April 2003) a resolution
was taken that NDOH should lead in the development of strategy.
This leads us to the initiatives taken by provinces.
Sustainable Management of Health Care Risk Waste in Provinces
Kwa-Zulu Natal and Western Cape have developed Health Care Waste Management Strategies (papers to be
presented in this conference).
One major project has been that of GDACEL which is supported by the Danish Cooperation for Environment and
Development (DANCED). There are major lessons that have been learnt in this project concerning the
possibilities of collaboration and the urban sustainable management of health care risk waste. Models that that
have been developed need to be redesigned by those in rural provinces. The question of adapting the current
models as they are will be disastrous.
Looking at different countries in the region like Kenya and Tanzania, it has been shown that a “rural-approach” to
health care waste management is critical.
However, it should be noted that within a health facility, the models developed are applicable throughout the
country. One can also safely say that Gauteng has been fortunate to receive generous funding from the Danish
government.
For us to align the initiatives, it is critical that funding be received for a rural study in the management of health
care waste and do a comparative analysis of models developed. The provinces of Limpompo, Eastern Cape and
Mpumalanga will be ideal for this study.
Potential conflicts
As far as DEAT and NDOH are concern, there should be few conflicts if any, unless some provinces would
dictate for the adoption of their models without the country looking at respective needs for other provinces.
Conclusion
This paper presents an ongoing process of alignment of initiatives provincially (GDACEL) other stakeholders
(SABS CODES), in fulfilling the South African requirements in the management of health care waste. Whenever,
there are selfish interest, these will be conflicts but if the health and well being of citizens of South Africa is at the
centre of our Health Care Waste Programs we could go beyond unnecessary conflict but collaboration and
integration of different efforts.
References
DACEL (2001), Health Care Waste Management Policy for Gauteng
DWAF Minimum Requirements for Landfill and for Hazardous Waste
Kwa-Zulu Natal Imbizo (October 2001)
NDOH (2003) National Workshop Indaba on Health Care Waste Management.