Clinical laboratories play key role in waste management

Uganda’s population growth is certainly outpacing available medical services. However, the medical sector is also constantly repositioning itself to match the population’s health needs while improving quality of services. In doing so, there is expanding emphasis on evidence-based decision making for patients by clinicians. This need for judicious use of best evidence in patient care has put clinical laboratories at the centre of medical practice.
This is one of the reasons why the global clinical laboratory tests market size is projected to rise from the current $208b to $344.5b in 2025. In short, the room for fishing expeditions in diagnosis has shrunk and the major thrust of diagnosis is the clinical laboratory. Conversely, this has not come without problems. One of them is that of increased generation of medical waste, which burdens both the healthcare system and communities. Notably, medical waste management is one of the worst performing areas in the health sector in Uganda.
Reports about improper disposal of medical waste, especially in highly populated urban and semi-urban centres, are common in Uganda. Recently, the media was awash with stories of how some people even ferry medical waste out of health facilities to their homes! Medical waste such as syringes, fluid bags, blood, sharps, microbiological cultures and human tissues, among others, are increasingly becoming a common sighting on roadsides and municipal dumpsites. Because much of this waste is not treated before being dumped in such places, it poses life-threatening risks to people, animals and plants in form of infections and physical harm. Sometimes, the waste also damages the soil where it is dumped. Worse still, scavenging animals like dogs and birds like marabou storks can easily move this waste from one place to another, including our homes, offices, schools, eateries, etc.
However, there is more to what we see and this is the laboratory liquid waste (for example liquid samples and reagents – chemicals used in laboratories during testing). These are often discarded into the water sinks to join sewage systems. This not only endangers sewage handlers, but also exposes communities to health risks that may present through possible contamination of ground water.
The Ministry of Health and sister agencies have made some efforts to respond to the challenge. Under the Intergovernmental Fiscal Transfer Program for Results (IFTPR) programme, the ministry is overhauling the medical waste management infrastructure in Uganda. In addition, benchmarks have been taken from best performing local healthcare facilities and countries such as Ghana. There are also occasional skilling programmes being implemented in some health facilities. In terms of policy, there is the National Policy on Injection Safety and Healthcare Waste Management as well as Nema guidelines for Hazardous Waste Management.
However, we need to remember that the best way to manage medical waste is to reduce its generation. Much as there have been technological advances in other areas of the treatment chain such as oral medicines as alternatives to injectables (reduces use of sharp instruments), the pace has been slow for laboratories. The sluggishness is in both development of alternatives and their uptake in laboratories. It is one area where use of sharps and chemicals has either not changed or is even increasing. In the private sector, generation and management of clinical laboratory waste is even worse.
Given the unique nature and contribution of clinical laboratories as regards medical waste generation and management, we need to rethink our approaches. It is a segment of the treatment process that needs more emphasis.
Ms Bahizi is a biomedical scientist and public health specialist at School of Public Health, Makerere University.