Success Story: Training Health Workers in Successful Waste Management in Mbale, Uganda

Training Health Workers in Successful Waste Management in Mbale, Uganda

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Background

Jane Saakwa is in charge of the Namawanga Health Center, a Level III health facility in the Mbale District of eastern Uganda. Originally a nurse and later a clinical officer, Saakwa likes working in a clean environment. Like many health centers of its type, however, Namawanga Health Center was not especially clean. Waste management was an area that had been neglected for a long time, to the point where staff were at serious risk of injury and infection. Workers were disposing used needles and syringes in waste bins not meant for sharps and leaving used sharps on tabletops, putting health workers and waste handlers at risk. Community members were also at risk because the waste was openly dumped.

When given the opportunity, health assistants and other field staff can be especially instrumental in providing supportive supervision and ensuring that health care waste is disposed of properly.

 

Intervention

After a visiting health official deemed the facility to be unsafe, AIDSTAR-One (funded by the U.S. President's Emergency Plan for AIDS Relief [PEPFAR] through the U.S. Agency for International Development [USAID]) stepped in to provide technical assistance to health centers in Mbale—including the Namawanga Health Center—by designing interventions that would improve waste management practices at the facility level. This was at the request of the Strengthening TB and HIV/AIDS District Responses–Eastern Region project (STAR-E; funded by USAID) which was concerned that scaling up HIV services in the working environment of Namawanga and other health centers would cause further problems, as the provision of HIV services generates more infectious wastes.

Segregation bins

Segregation bins in a service delivery center.

One of the interventions organized by AIDSTAR-One was training for technical resource persons within Mbale. Beatrice Kudhongania, the Health Assistant supporting Bukhongo South, the health sub-district (HSD) that includes Namawanga Health Center, was one of the trainees. After the training, AIDSTAR-One made arrangements between STAR-E and district health offices so that health assistants like Kudhongania could visit and train those in charge of facilities in health care waste management (HCWM).

Saakwa, from Namawanga, was eager to receive this training, saying: "My personal interest in cleanliness motivated me to take up the HCWM training offered by the health assistant with a lot of interest." Since the training, she has mentored all of her staff about segregating waste at the source. Her mentoring is accomplished through periodic meetings and daily on-the-job supportive supervision. Her efforts are regularly supplemented by external technical supervision visits conducted by Kudhongania, with whom she lobbies for additional resources to sustain the good practices achieved at the facility.

In addition, using part of the primary health care funds allocated to the facility, Saakwa, with technical support from Kudhongania, had a shallow pit for burning sharps waste dug at the facility. Although a pit is not the ideal standard, it is a vast improvement over open dumping.

Outcome

Jane Saakwa and Beatrice Kudhongania

Jane Saakwa and Beatrice Kudhongania next to the Namawanga Health Center expansion.

Since the interventions organized by AIDSTAR-One, HCWM has been high on the agenda in Bukhongo South HSD. The HSD manager allocates a little money from the primary health care funds every month to provide HCWM supportive supervision to all of the health facilities in the HSD. Namawanga Health Center in particular has benefitted, achieving high waste segregation standards. Waste is regularly burned in a shallow pit, and then the ash is poured into a deeper medical waste pit for final disposal, which has made the facility substantially cleaner. Staff at the facility are also safer, with no health workers or waste handlers reporting needle stick injuries in the last six-month reporting period.

Lessons Learned

Owing to Saakwa's enthusiasm and leadership, which resulted in Namawanga Health Center becoming cleaner and safer, the district decided to expand the health center to provide more space for the facility's operations. The new expansion plan also provides for the construction of an environmentally-friendly incinerator, furthering the capacity of Namawanga Health Center to properly manage health care waste.

AIDSTAR-One's assistance in continuous and consistent advocacy, proper training, and supportive supervision can go a long way in helping planners and health service providers to prioritize HCWM. When given the opportunity, health assistants and other field staff can be especially instrumental in providing supportive supervision and ensuring that health care waste is disposed of properly. Positive attitudes and interest among health facility leaders like Saakwa is another key to enhancing proper waste segregation and disposal. Now when Saakwa goes to the facility, she feels pride in the environment where she works.

Disclaimer: The authors' views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development or the United States Government.