Date of Award

11-4-2024

Degree Type

Thesis

Degree Name

Master of Health Policy and Management

First Advisor

Dr Syed Zafar Ahmed Fatmi

Second Advisor

Dr Asaad Nafees

Third Advisor

Dr Imran Naeem

Department

Community Health Sciences

Abstract

Introduction: Healthcare waste (HCW) poses significant challenges in healthcare settings, affecting the quality of patient-centered care, safety protocols, and environmental sustainability. The waste is categorised into hazardous (15%) and non hazardous (85%) of total waste. Poor healthcare waste management can result in the spread of diseases, impacting healthcare professionals, patients, communities, and the surrounding environment. WHO highlights the need for improved safe drinking water, sanitation facilities, healthcare waste management, and hygiene practices to attain universal access. In Pakistan, the provincial environment agency sets a regulatory framework for the segregation, collection, storage, treatment, & disposal of hazardous waste. The provincial healthcare commission enforces Service Delivery Standards that outline the minimum criteria for waste management in healthcare establishments. WHO/UNICEF under JMP monitor progress in WASH services at healthcare facilities to mitigate disease transmission and enhance the quality of care. This study seeks to investigate the managerial barriers, technical challenges, and obstacles encountered in the implementation of effective and sustainable HCWM practices within public hospitals in the Sindh province.
Methodology: This study employed an interpretivist paradigm with a qualitative descriptive exploratory research design to collect data from public tertiary hospitals in Sindh. Interviews; IDIs were conducted with service providers from hospitals and KIIs with stakeholders and policymakers from provincial Health Departments and various regulatory organisations. A purposive sample strategy was used to recruit participants. The sample included 15 participants from both groups. Data was evaluated deductively, with themes being identified, analysed, and interpreted through thematic analysis. Reporting and interpretation utilised rigour, while data triangulation offered multiple perspectives on health waste management. All ethical principles were adhered to in this study.
Findings: The study identifies multiple barriers to effective healthcare waste management in public hospitals that include managerial roles, technical challenges, waste handling infrastructure, sustainability issues, capacity development and training requirements, interaction with external organisations, and oversight and compliance systems with regulations. Technological challenges represent outdated systems, inconsistent waste segregation and collection practices, inadequate transportation, insufficient storage, and improper disposal methods. Insufficient training and resources present considerable challenges. Transport and storage infrastructure pose logistical challenges, lack sufficient storage facilities, and exhibit inadequate disposal methods. Budgetary constraints, resource availability, and equipment shortages present major obstacles. Lack of capacity building, training programs and compliance oversight threaten HCWM sustainability.
Conclusion: The study highlights challenges in implementing effective healthcare waste management practices in public hospitals in Sindh, Pakistan, such as unclear roles, insufficient planning, outdated systems, and limited resources. It suggests an integrated approach with explicit policies, accountability measures, collaboration with technical or international agencies, and dedicated resources. A provincial task force could improve oversight and ensure compliance with regulations and international best practices. Mitigating these challenges can improve care quality, environmental health, and safety outcomes, necessitating strategic policies for improved waste management in public hospitals

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1

Last Page

41

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