Geneva Health Forum Archive

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Enhancing Access and Quality of Care in Developing Countries through Integrated Provider Empowerment and Environmental Safety

Author(s): E. I. Okechukwu*1, A. C. Onyenwenyi2, G. F. Upham3, B. M. Kady4
Affiliation(s): 1Action Family Foundation, 2Institute of Child Health & Primary Care, Lagos, Nigeria, 3Safe Observer Int’l, France, 4Society for Women and AIDS in Africa, Kinshasa, Democratic Republic of the Congo
Keywords: Healthcare, safety, stigma, waste management, provider confidence

The weak healthcare in developing countries engenders chaotic management of medical wastes, thereby exposing care providers and patients to risk of injuries and infections by deadly blood-borne pathogens aside environmental degradation. Millions of women as healthcare personnel, domestic care providers or pregnant mothers and babies on immunization or children at play are primary casualties of unsafe healthcare practices especially improper handling of medicare wastes. In the absence of safety nets among health providers, the fear of contracting infections at the workplace compromises the quality of services rendered to patients especially those infected or affected by HIV/AIDS. WHO estimates that in developing countries, over 60% of injections are unsafe, and 10% of the global workforce are at risk of needle stick injuries capable of transmitting blood-borne pathogens. A survey of five West African countries (including Nigeria) revealed that public containers meant for household refuse receive more than 50% of medical wastes. There are anarchical practices at the collection, sorting and stocking, transport and elimination phases.


In 2005, Action Family Foundation, civil society groups, Safe Observer International and academics from the Institute of Child Health and Primary Care of the Lagos University Teaching Hospital initiated interventions to mainstream proper healthcare waste management in Nigeria through capacity building, community mobilization and practical medical waste handling services. We developed survey instruments and obtained baseline data on the knowledge, attitude and practices of stakeholders; co-hosted with the state agency two annual medical waste management summits and raised community awareness to the hazards of unsafe medicare waste practices as well as organized sensitization sessions for different professional groups. We are engaging in the project as an intervention research work to build the local capacity, conduct research and generate data to inform scaling up and replication to other regions.


Presently, about 15% of the over 3000 healthcare facilities are being covered. Generators are sorting waste at source, and are expected to budget for waste disposal while the government Waste Management Authority supplies consumables and carts waste regularly. The public is more aware and empowered, including holding their care providers accountable for medicare waste.

Lessons learned:

The advocacy and community mobilization expertise of civil society groups when matched with political will of public service organs can reconstruct people’s attitudes and enforce desired practices with modest investments. Our initiative brought together patients, practitioners, consumer groups along with persons living with, or affected by nasocomial pathogens. The presentation will draw on work in process in Nigeria, Uganda, India and globally. We shall share the locally applied strategies, challenges and success stories of Action Family Foundation’s pioneering work in mainstreaming integrated medical waste management.

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