Role of Policymakers and Major Stakeholders in Healthcare Waste Management in Kano State, Nigeria

Abstract

Healthcare facilities save lives, but the waste they generate can endanger them. Roughly 15% of healthcare waste (HCW) is classified as hazardous including infectious sharps, pathological tissue, pharmaceuticals, and chemical residues and when it is mismanaged, it exposes health workers, waste handlers, patients, and surrounding communities to infection, injury, and environmental contamination. This study examines the roles of policymakers and major stakeholders in healthcare waste management (HCWM) in Kano State, north-western Nigeria. Eight in-depth interviews were conducted with key informants drawn from the Kano State Ministry of Health and its parastatals (the Hospitals Management Board, the Private Health Institutions Registration Unit, and the Directorate of Pharmaceutical Services), the State Primary Healthcare Development Board, the Ministry of Environment, the Refuse Management and Sanitation Board (REMASAB) and the National Environmental Standards and Regulations Enforcement Agency (NESREA), complemented by facility administrative records, a quantitative facility audit (n = 203 clinical units), and field observation.  The findings show that segregation at source is poorly practised, largely because the supply of colour-coded containers depended on a donor project (JSI-MMIS, 2004–2009) that ended a decade and a half ago. REMASAB evacuates an estimated 155.8 tonnes (443.2 m³) of HCW monthly from nine secondary facilities in Kano Metropolis about 2.0% of the municipal solid waste stream—using non-dedicated open-body trucks, and disposes of untreated HCW at ordinary municipal dumpsites. Record keeping exists in only one of the facilities surveyed. Funding is ad hoc and donor-dependent, training is rare, and responsibility for HCWM is contested between the ministries of health and environment. The National Policy on Injection Safety and HCWM was unknown even to senior policymakers in the state, although its enforcement provisions have since been strengthened by the National Environmental (Healthcare Waste Control) Regulations of NESREA. The study concludes that sustainable HCWM in Kano State requires statutory policy domestication, dedicated budget lines, trained and protected waste handlers, specialised logistics, licensed private-sector participation, and a multi-agency coordination framework.