Mentore Vaccari

International governance structures for health-care waste management: a systematic review of scientific literature

Significant differences exist in the management of health-care waste management, globally. This is particularly so between low, middle and high-income countries. A systematic review of scientific literature on global healthcare waste management spanning the period 2000 - current was undertaken, in order to identify key policies, practices, challenges and best practice. The findings were analysed considering the Gross National Income and the Human Development Index of each country. Effective regulation and operative definitions of waste categories are key-factors requiring improvement at the national level. The economic conditions in the country are an important factor, especially regarding treatment and disposal. Areas for improvement (e.g. the need for improved governance structures, the development of regional clusters, as well as sharps waste segregation) are suggested.

Agricultural waste as household fuel: Techno-economic assessment of a new rice-husk cookstove for developing countries

In many rural contexts of the developing world, agricultural residues and the organic fraction of waste are often burned in open-air to clear the lands or just to dispose them. This is a common practice which generates uncontrolled emissions, while wasting a potential energy resource. This is the case of rice husk in the Logone Valley (Chad/Cameroon). In such a context household energy supply is a further critical issue. Modern liquid fuel use is limited and traditional solid fuels (mainly wood) are used for daily cooking in rudimentary devices like 3-stone fires, resulting in low efficiency fuel use, huge health impacts, increasing exploitation stress for the local natural resources. Rice husk may be an alternative fuel to wood for household energy supply. In order to recover such a biomass, the authors are testing a proper stove with an original design. Its lay-out (featuring a metal-net basket to contain the fuel and a chimney to force a natural air draft) allows a mix of combustion/gasification of the biomass occurring in a completely burning fire, appropriate for cooking tasks. According to results obtained with rigorous test protocols (Water Boiling Test), different lay-outs have been designed to improve the performance of the stove. Technical and economic issues have been addressed in the development of such a model; building materials have been chosen in order to guarantee a cost as low as possible, using locally available items. The feasibility of the introduction of the stove in the studied context was assessed through an economic model that keeps into account not only the technology and fuel costs, but also the energy performance. According to the model, the threshold for the trade-off of the stove is the use of rice husk to cover 10-15% of the household energy needs both with traditional fireplaces or with improved efficiency cookstoves. The use of the technology proposed in combination with improved woodstove would provide householders with an appropriate and convenient cooking technology portfolio, increasing the opportunities of choice of the preferred energy system for the user and allowing significant savings for the family budget (up to 50% of the total annual cooking energy expenditure). The proposed model may be used also as a tool for the evaluation of the affordability or for the comparison of different cooking technologies also in other similar contexts, given their specific techno-economic parameter values.

Understanding the perceptions, roles and interactions of stakeholder networks managing health-care waste: A case study of the Gaza Strip

The sustainable management of waste requires a holistic approach involving a range of stakeholders. What can often be difficult is to understand the manner in which different types of stakeholder networks are composed and work, and how best to enhance their effectiveness. Using social network analysis and stakeholder analysis of healthcare waste management stakeholders in the case study region of the Gaza Strip, this study aimed to understand and examine the manner in which the networks functioned. The Ministry of Health was found to be the most important stakeholder, followed by municipalities and solid waste management councils. Some international agencies were also mentioned, with specific roles, while other local institutions had a limited influence. Finally while health-care facilities had a strong interest in waste management, they were generally poorly informed and had limited links to each other. The manner in which the networks operated was complicated and influenced by differences in perception, sharing of information, access to finance and levels of awareness. The lack of a clear legal framework generated various mistakes about roles and responsibilities in the system, and evidently regulation was not an effective driver for improvement. Finally stakeholders had different priorities according to the waste management issues they were involved with, however segregation at the source was identified as a key requirement by most. Areas for improving the effectiveness of the networks are suggested. The analysis utilized an innovative methodology, which involved a large number of stakeholders. Such an approach served to raise interest and awareness at different levels (public authorities, health providers, supporting actors, others), stimulate the discussion about the adoption of specific policies, and identify the effective way forward.

From mixed to separate collection of solid waste: Benefits for the town of Zavidovići (Bosnia and Herzegovina)

In Bosnia and Herzegovina only 50% of the municipalities have a well-organized service for (mixed) waste collection and disposal. Illegal dumping is very common, in particular in rural areas, which are not regularly served by any service of collection. This situation leads to serious risks for public health and has dangerous environmental impacts. In Zavidovići the municipality is trying to meet high standards in the delivery of services of waste collection, but is constrained by scarce financial and technical resources. Different scenarios for the implementation of a system of separate collection in Zavidovići were elaborated in order to provide a useful tool for decision making by comparing costs and environmental & economic benefits of each scenario. Six scenarios were considered, based on different recovery rates for plastic, paper & cardboard, and metals. Benefits resulting from the implementation of each of the proposed scenarios are compared in terms of savings of landfill volume and costs. The study concludes that the adoption of a system of separate collection could generate positive impacts on all the stakeholders involved in the solid waste management sector in Zavidovići and could contribute to the compliance of European standards in many Central and Eastern European countries as established by a number of national environmental protection strategies.

Techno-economic evaluation for the improvement of MSW collection in Somaliland and Puntland

This paper is based on a study, which aim is to provide an overview of the current MSW management in the main cities in Somaliland and Puntland and to identify strategies to improve the present situation. In particular, this article illustrates assessments concerning waste collection and technical solutions identified for its improvement, whereas waste treatment and disposal phases will be discussed in a further paper. The survey, which has been carried out in close collaboration with local administrators and technicians, has shown that MSW management is very lacking and needs both structural and operational actions. Waste collection in the surveyed cities covers 65% of population at its best, whereas it is substantially absent in Gardo and Sheik. The extension of waste collection service to the entire population of each city would need investment costs varying between 17,500 USD for Sheik and 200,000 USD for Galkayo, whereas total operational costs would vary between 1.17 USD/ inh/y in Boroma and 5.73 USD/inh/y in Garowe. Anyway, technical interventions are necessary to provide a larger number of citizens with a regular waste collection service and they should be preceded and accompanied by public awareness campaigns on environmental protection and capacity building services addressed to local administrators and technicians.

How to assess solid waste management in armed conflicts? A new methodology applied to the Gaza Strip, Palestine

We have developed a new methodology for assessing solid waste management in a situation of armed conflict. This methodology is composed of six phases with specific activities, and suggested methods and tools. The collection, haulage, and disposal of waste in low- and middle-income countries is so complicated and expensive task for municipalities, owing to several challenges involved, that some waste is left in illegal dumps. Armed conflicts bring further constraints, such as instability, the sudden increase in violence, and difficulty in supplying equipment and spare parts: planning is very difficult and several projects aimed at improving the situation have failed. The methodology was validated in the Gaza Strip, where the geopolitical situation heavily affects natural resources. We collected information in a holistic way, crosschecked, and discussed it with local experts, practitioners, and authorities. We estimated that in 2011 only 1300 tonne day−1 were transported to the three disposal sites, out of a production exceeding 1700. Recycling was very limited, while the composting capacity was 3.5 tonnes day−1, but increasing. We carefully assessed system elements and their interaction. We identified the challenges, and developed possible solutions to increase system effectiveness and robustness. The case study demonstrated that our methodology is flexible and adaptable to the context, thus it could be applied in other areas to improve the humanitarian response in similar situations.

Constraints to healthcare waste treatment in low-income countries – a case study from Somaliland

In low-income countries, healthcare waste is mixed with the municipal waste stream and rarely receives special attention. This paper presents the lessons learned from a pilot project targeted to improve healthcare waste management in Hargeisa (Somaliland). The interventions were carried out in three of the main hospitals in the city. Consideration was also given to improve the overall situation regarding the management of healthcare waste. Three De Montfort incinerators were built and training was provided to operators, waste workers and healthcare personnel. Although the incinerators were constructed in accordance with the required standards, major constraints were identified in the operational phase: irregular de-ashing procedures, misuse of safety equipment, and ineffective separation of healthcare waste were seen in this phase. The paper concludes that in other small hospitals in the developing world, such as those in Hargeisa, on-site incineration by use of low-cost, small-scale incinerators could be successfully applied as an interim solution, provided that an agreed and acceptable plan of operation and maintenance is in place and responsibilities for the management of the facility are clearly identified. Moreover, when replicating this experience in other settings even greater importance should be given to the technical capacity building of operators and pressure should be exercised on local administrations in order to control and supervise the whole management system.

Costs associated with the management of waste from healthcare facilities: An analysis at national and site level

Given rising spend on the provision of healthcare services, the sustainable management of waste from healthcare facilities is increasingly becoming a focus as a means of reducing public health risks and financial costs. Using data on per capita healthcare spend at the national level, as well as a case study of a hospital in Italy, this study examined the relationship between trends in waste generation and the associated costs of managing the waste. At the national level, healthcare spend as a percentage of gross domestic product positively correlated with waste arisings. At the site level, waste generation and type were linked to department type and clinical performance, with the top three highest generating departments of hazardous healthcare waste being anaesthetics (5.96 kg day-1 bed-1), paediatric and intensive care (3.37 kg day-1 bed-1) and gastroenterology-digestive endoscopy (3.09 kg day-1 bed-1). Annual overall waste management costs were

Appropriate Technology for Household Energy Access: The Case of the Centrafricain Stove in the Logone Valley (Chad, Cameroon)

US5,079,191, or approximately

Wells sanitary inspection and water quality monitoring in ban Nam Khem (Thailand) 30 months after 2004 Indian Ocean tsunami.

US2.36 kg-1, with the management of the hazardous fraction of the waste being highest at