Pharmaceutical waste management and its impact on Africa's public health sector

Africa, the second most populous continent with the fastest growth rate, is still plagued by poverty, poor sanitary conditions, and limited access to resources, such as clean drinking water, food supply, electricity, and effective waste management systems. Due to several factors, such as emergence of new diseases, old age, and lifestyle, there is a growing use of medical products. This is creating a corresponding increase in the amount of pharmaceutical waste.

There is gross improper handling, transportation, and storage of pharmaceutical waste within public and private healthcare facilities and hospitals in African countries. This has led to a rising concern about its public health implications.

Given the continuous rise in population on the continent, poor pharmaceutical waste management exposes the populace, particularly vulnerable communities, to health risks, which may include antimicrobial resistance, cancer, allergy, and other harmful effects.

It is therefore critical for Africa to develop strategies for sustainable pharmaceutical waste management, exploring eco-friendly technologies for efficient pharmaceutical waste treatment and disposal methods to ensure resilient solutions for health and environment protection in Africa.

Given the continuous rise in population on the continent, poor pharmaceutical waste management exposes the populace, particularly vulnerable communities, to health risks

Pharmaceutical waste management and its current state in Africa

Medical waste including pharmaceutical waste is defined by the World Health Organization (WHO) as ‘expired, unused, spilt and contaminated pharmaceutical products, prescribed and proprietary drugs, vaccines and serum that are no longer required and due to their chemical or biological nature, need to be disposed of carefully.’

While an effective waste management system comprises appropriate segregation and disposal, with the inclusion of transportation, storage and training facilities for workers.

Africa is estimated to have 67,740 health facilities and produce approximately 282,447 tonnes of medical waste every year. However, throughout the countries of Africa, including Algeria, Nigeria, Ethiopia, Botswana, Ghana and South Africa, state and private hospitals have not shown a significant difference in the way pharmaceutical waste is managed.

Studies suggest that some healthcare workers and waste officials are not aware of policies surrounding the handling of waste, nor of its final disposal method, and most African countries lack legislation for medical waste management.

Not all hospitals and healthcare centres have colour-coded bags for classified waste such as pharmaceutical, radioactive and clinical, thus rendering waste segregation impractical.

The lack of sanitary landfills has led to the increased use of crudely designed incinerators. Gambia, Ghana, Lesotho, Nigeria, Senegal and Tanzania have no sanitary landfills, whereas Kenya and Zambia only have crude dumpsites.

The impact of poor pharmaceutical waste management on public health in Africa

Poor pharmaceutical waste management systems pose tremendous harm to public health in Africa. Over the years, the environment has become a public health concern due to pollution-related illnesses.

Hazardous wastes, including infectious, radioactive, toxic or genotoxic items, can cause environmental and occupational health risks.

Strategies for sustainable pharmaceutical waste management in Africa

Lack of awareness about the public health impact of pharmaceutical waste, inadequate training in proper waste management, absence of waste management and disposal systems, insufficient financial and human resources and the low priority given to the topic are the most common problems connected with pharmaceutical waste management in Africa.

Strategies to address these challenges include:

• Reducing the quantity of pharmaceutical waste generated by prescribing the minimum required amount of medicines per person during a clinic visit.

• Establishing national level policies via the governments and including them in the legislation to achieve effective and successful pharmaceutical waste management programmes.

• Exploring Public-Private Partnerships to increase funding and provide expertise: Collaboration between multiple governmental and non-governmental institutions can help in achieving successful programmes for waste management. International organisations, such as WHO, should contribute their experience and increase investment in sustainable pharmaceutical waste management.

• Effective educational programmes should be presented to the stakeholders, such as doctors, pharmacists and consumers. The African Pharmaceutical Academy proposed by Bloom Public Health will play a significant role by providing pharmaceutical waste management training, covering topics such as ecotoxicology and pharmacovigilance to recent graduates, to produce local experts in the subject.

• Use of engineered sanitary landfills to minimise the risk of the landfill hazards; incinerators should be provided with emission control systems and fitted with typical air pollution control devices.

• Exploring alternative eco-friendly technologies for pharmaceutical waste, including microwave sanitation, chemical disinfection, dry heat disinfection, disinfection with super-heated steam, gasification, pyrolysis and anaerobic digestion.

Conclusion

Poor pharmaceutical waste management has been shown to have debilitating effects on the environment and public health. Although immediate action can be taken locally, long-term and sustainable improvement requires government commitment and collaboration between the healthcare systems, decision-makers, and relevant stakeholders in developing effective pharmaceutical waste management policies and programmes.

Anyakora is the CEO of Bloom Public Health and a public health expert &

Odibeli is a pharmacist and the regional communications manager at Bloom Public Health