The reality of waste management in primary health care units in Brazil

Abstract

A large number of users are serviced in primary health care units in Brazil, both in health facilities and in households. These services generate waste that must be managed safely, but there is no legislation that regulates this type of waste management in Brazil. The objective of this study was to analyse the production and management of waste in primary health care. A direct observation was performed of the stages in the handling and weighing of waste generated in primary health care units in the municipality of Goiânia (Brazil). The units generated infectious, chemical, and common waste, as well as sharp objects. The generation of waste ranged between 0.027 and 0.075 kg user-day. The generated waste was classified mostly as common and recyclable. Flaws were observed in the management of all types of waste. The critical point is segregation. Only 34.1% of the waste disposed of as infectious actually belonged to this group, the rest was ordinary waste. Flaws at this stage increase the volume of infectious waste, the occupational and environmental risks, and associated costs. Intervention to change this reality is needed and it requires the careful preparation of a waste management plan, corroborating structural changes to the implementation of this plan, and professional training and public policies to guide waste management in primary care, especially those generated in households.

Solid waste management in primary healthcare centers: application of a facilitation tool

“…Although the management of HW is routinely practiced by healthcare facilities, studies in developing countries 3 - 11 indicate frequent inadequacies, such as inefficient management; failures in segregation and handling; lack of training and awareness of risks, insufficient human and economic resources for the right management; adoption of inadequate treatment techniques; lack of control over the endpoint and even shortcomings or absence of specific regulations.…”

“…HWMP is the document that describes all internal and external steps for the management of waste in healthcare services, in order to prevent occupational accidents, to avoid environmental impacts and to protect the public health 3 , 12 . It could therefore go beyond a simple mandatory document and become an important supporting tool management.…”

“…It could therefore go beyond a simple mandatory document and become an important supporting tool management. However, it has been widely assumed that, in spite of it being a legal requirement, the implementation of HWMP has not been a reality in the country 3 - 5 .…”

“…Five years later, a new assessment carried out in nine Primary Healthcare Centers (PHC), in the Brazilian state of Goiás 3 showed that none had HWMP or even a technician responsible for the management of waste. Therefore, another important obstacle for the HWMP is the lack of trained professionals to implement and monitor the plan, a task that is informally delegated to managers of units or nursing professionals, who do not have any systematic method to help them to carry out this demand.…”

“…Primary Healthcare Centers (PHC), which provide basic healthcare services that do not require hospitalization (medical consultations, guidelines, inhalation therapy, bandages, immunizations, application of injectable drugs, collection of samples for laboratory tests, dental treatment and basic medication provision) are also called upon to properly manage their waste, according to the rules in force in the country ( 3 , 12 .…”