Medical Waste Management For Small Urban Clinics In Pakistan:Efficiency Assessment And Improvement Strategies

Waste management,especially the waste generated in the healthcare facilities,is a sensitive issue all around the globe.The mishandling and ignorance create various environmental problems;in particular,densely populated countries such as India,Pakistan,and Bangladesh have been reported to have waste management issues.These countries are included in the category of“developing countries”and till date,various studies have reported on healthcare waste management of large hospitals in these countries.However,small clinics have always been neglected,and there is a scarcity of research studies in the scientific literature.In Pakistan,private practice of doctors in small personal clinics is very common.These clinics are mostly situated in densely populated areas,and the waste produced in some cases is similar to the hospital’s waste,which also contains infectious elements.If not appropriately managed,that make it even riskier.To this end,this paper takes Hyderabad,Pakistan,as an example to study the management of medical waste in small clinics.Based on the measurement of medical waste management efficiency,motivation and environmental factors are studied to explore the optimal strategies for improving management efficiency,which will provide a basis for medical waste management in other developing countries.This dissertation is divided into seven chapters;the first chapter presents the overall introduction of the study followed by the second chapter in which previous literature is presented to support this study.Chapters three introduces the methods and basic theories,chapter four measures efficiencies,practice,rules and challenges of small clinics waste management.Whereas chapters five and six are designed to explore the feasible solutions to the problems of medical waste management in small clinics from the perspective of motivation factors and environmental factors.Lastly,we have concluded the study with chapter seven.Firstly,data envelopment analysis（DEA）was used to measure the efficiency of clinics waste management.DEA results displayed that 74%of surveyed clinics showed scale or pure technical inefficiencies,and all input and output variables have slacks.Clinics location and size were detected to have some influence on clinics efficiency.Only high-income 1（HI1）,high-income 2（HI2）,high-income（HI4）,and middle-income 1（MI1）were found to be efficient,whereas none of the clinics from low-income area obtained full efficiency score.Clinics performance did not match HWM standards.The study showed that poor waste management is practiced low-level performance is found.Additionally,the motivation factors of medical waste management were analyzed with exploratory factor analysis to check if these factors can contribute to motivating clinic staff to practice sound healthcare waste management.A total of 132 staff members are selected for this survey,and two hypotheses were checked for the creditability of motivating factors.Out of 10 indicators,nine were found in support of the hypotheses,all corresponding factors loading were higher than 0.5.Hence it was discovered that active government involvement and financial support are essential factors to help in improving the condition and management efficiency.Finally,the effects on the environment of small clinics solid waste management were perceived by applying life cycle analysis approach.Samples were collected from 371private clinics;solid waste was categorically quantified on a daily basis for consecutive 30days.System limitations were defined as landfilling,incineration,composting,material recovery,and transportation of solid waste.The treatment and disposal methods were assessed according to their greenhouse gas emission rate.For the evaluation,three different scenarios were designed.The second scenario resulted in the highest emission value of1491.78kg CO₂eq/tonne of solid waste due to mixed waste incineration,whereas the first one could not offer any savings because of uncovered landfilling and 67.5%higher transport fuel consumption than the proposed network.The proposed 3rd scenario was found as a better solution for urban clinics solid waste management as it resulted in savings of 951.38kg CO₂eq/tonne of solid waste.This integrated design is practicable by the resource-constrained economy;this system consists of composting,material recovery and incineration of hazardous waste.The proposed system also includes a feasible transportation method for the urban area collection network.This study holds a multi-disciplinary approach,and the findings of the present study can play a vital role in documenting evidence.It can help healthcare management,municipal departments,environmental management,and government policymakers to identify problems related to small clinics waste management and troubleshoot issues to avoid public health risks and environmental risks,as previously no studies have been conducted on this particular case.