PHARMACEUTICAL WASTE MANAGEMENT IN GHANA-CONSEQUENCES AND INTERVENTIONS. Samuel Sasu Chair of Waste Management and Emissions University of Stuttgart

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1 PHARMACEUTICAL WASTE MANAGEMENT IN GHANA-CONSEQUENCES AND INTERVENTIONS Samuel Sasu Chair of Waste Management and Emissions University of Stuttgart

2 OUTLINE Introduction and Motivation Case Study on Phamaceutical Waste Management at Selected Hospitals Health Risk and Environmental Impacts Interventions, Challenges and Opportunities

3 INTRODUCTION Drugs constitute 60 80% of costs of health care delivery in Ghana Introduction of NHIS in 2007 has significantly improved access to medicines Total market at retail value Prescription drugs total (70% of total) Growth rate in % 6-8% Retail sales of domestic manufacturers (30%) 300 million USD 210 million USD 90 million USD Estimates place the share of illegally/fake circulating drugs at 10-20% Market overview for 2008 based on estimates of market participants, no solid data (Seiter and Gyansa Lutterodt 2009)

sales of domestic manufacturers (30%) 300 million USD 210 million USD 90 million USD Estimates place the share of illegally/fake

4 MOTIVATION Improper handling and disposal of healthcare waste Inappropriate wastewater technology system Less done 5% of household in Ghana are connected to WWTP More than 95% of the hospitals selected for the study are not connected to WWTP Lack of data and published study on pharmaceuticals in the environment in Ghana Less information on the risk assessment of drugs consume in developing countries

selected for the study are not connected to WWTP Lack of data and published study on pharmaceuticals

5 Definition of Pharmaceutical Wastes (Type D1) Made up of expired, unused, partially used, drug residue, contaminated and fake drugs /pharmaceutical products for Human & Veterinary use Includes: Tablets, syrups, injectables Anaesthetics : liquids / gases drug vials, gloves & masks, containers vaccines no longer required MOH 2005, Policy and Guideliness Document for Health Institutions on Health Care Waste Management in Ghana.

injectables Anaesthetics : liquids / gases drug vials, gloves & masks, containers vaccines no longer

6 ENVIRONMENTAL PATHWAY OF DRUGS USE IN GHANA

7 Case Study of Pharmaceutical Waste at Selected Hospitals in Ghana GHS 2003 : 28 Facilities (All levels) Samuel Sasu (2008, 2010) : 5 facilities Quantities of waste generated: Both studies report absence of data on Expired / Left over drugs

(2008, 2010) : 5 facilities Quantities of waste generated:

8 WASTE SEGREGATION (GHS2003) 100% 80% 60% 40% Yes No 20% 0% sharps Path Inf Pha

9 FACILITIES GENERATING HEALTHCARE WASTE (GHS 2003) Type of waste No. that generate Yes No. that do not generate No Total Sharps Pathological Infectious Radioactive Pharmaceuticals 16 (57%) 12 (43%) 28 Chemical

that do not generate No Total Sharps 28-28 Pathological 21 7

10 Waste Class Universität Stuttgart WASTE CLASSIFICATION AND COLOUR CODING CONTAINER (Sasu 2008,2010) MOH Recommended Container Colour Korle-Bu Teaching Hospital Komfo Anokye Teaching Hospital Eastern Regional Hospital General Black bin Black Bin Black Bin Green/ Blue Sharp Yellow Plastic Container Bin Yellow Box Yellow Box Yellow Box Infectious Yellow Bin Yellow sack in box Yellow Bin Red/ Black bin Pharmaceuticals Brown Bin Black bin Black Bin Green/ Blue Bin

bin Black Bin Black Bin Green/ Blue Sharp Yellow Plastic Container Bin Yellow Box Yellow Box Yellow Box Infectious

11 DISPOSAL AND TREATMENT (SASU 2008,2010) Hospital Location No. of Segregation Disposal of Disposal of Beds Solid Waste Liquid Waste Korle-Bu Teaching Hospital Komfo Anokye Teaching Hospital Eastern Regional Hospital Accra 1600 No Brick Incineration, Burial and Land filling Kumasi 1000 No Brick Incineration and land filling Koforidua 323 No Brick Incineration, Biogas and Land filling Direct Discharge to Korle-Lagoon Septic Tank and WWTP Septic Tank Manhyia District Hospital Kumasi 37 No Land filling and Brick Incineration Septic Tank Cocoa Clinic Accra Yes Land filling Septic Tank

Hospital Accra 1600 No Brick Incineration, Burial and Land filling Kumasi 1000 No Brick Incineration and land filling Koforidua 323 No Brick

12 Left: Pharmaceutical waste ready for crushing and burying (Source FDB) Up: Brick Incinerator with no gas cleaning technology Left: Liquid waste directly discharge to Korle lagoon

13 HEALTH AND ENVIRONMENTAL IMPACTS 1. Drugs from sewage & landfill leachates may affect non-target organisms. 2. Disease causing bacteria not harmed may develop into resistance strains e.g. Antibiotic resistance 3. Drugs & personal care products may contain Persistent Bioacummulative Substances (PBTS) which can pollute air, land, surface & ground water

Disease causing bacteria not harmed may develop into resistance strains e.g. Antibiotic resistance 3.

14 HEALTH AND ENVIRONMENTAL IMPACTS II 4. Some act as endocrine disruptors: resulting in changes in reproduction and sex ratios of aquatic organisms 5. Incomplete burning (drugs & containers) may lead to release of dioxins and other dangerous air bioaccummulative pollutants 6. Due to increased demands on world s water resources, likelihood of increase in reuse of municipal wastewater which may be contaminated by pharmaceuticals

5. Incomplete burning (drugs & containers) may lead to release of dioxins and other dangerous air

15 INTERVENTIONS IN GHANA I Regulations No specific legislation on management of pharmaceutical waste Food & Dugs Law authorizes FDB to supervise destruction of large quantities of drugs Assessment of HCWM by GHS in 2003 led to Development of MOH Health Care Waste Management Policy (HCWM 2006) Based on polluter pays principle Applied WHO guidelines on management of healthcare waste Offenders cannot be prosecuted!!!!!!!!!!!!!!!!!!!

2003 led to Development of MOH Health Care Waste Management Policy (HCWM 2006) Based on polluter pays

16 INTERVENTIONS IN GHANA-HCWM POLICY Objective : Health facilities to ensure effective collection, treatment and disposal while minimizing adverse health and environmental effects Standard Procedures: Waste Minimization Segregation at source Colour coded storage containers (WHO): Brown for pharmaceuticals Appropriate treatment & final disposal

effects Standard Procedures: Waste Minimization Segregation at source Colour coded

17 INTERVENTIONS IN GHANA III Policy Operational since 2008 with ff activities i. Policy dissemination forum ii. Trainer of Trainers : National level ( ) iii. District trainings (2 regions) iv. Encourage formation of HCWM committees at regional & district hospitals Two hospitals have pharmaceutical waste segregation program: Swedru District Hospital (Internal) Cocoa Clinic (Internal and External)

18 IMPROVED HOSPITAL WASTE SEGREGATION SYSTEM

19 DISPOSAL OF UNWANTED MEDICINES PROGRAM (DUMP)

20 CHALLENGES 1. Lack of resources for scaling up training for health staff in districts 2. Inadequate treatment facilities eg High temperature incinerators, WWTP 3. Landfill sites not engineered : increasing risk of water contamination from leachates 4. Lack of support from both the Government and the Private Sector 5. Lack of well trained personnel to properly manage HCWM.

Landfill sites not engineered : increasing risk of water contamination from leachates 4.

21 OPPORTUNITIES Increase awareness of health risks from inappropriate management of health care waste Maximise use of resources through efforts to integrate healthcare waste activities with well funded programme activities Operationalize management of Healthcare waste through existing committees in the hospitals Grow interest between both government & private sector in building partnerships

22 Thank you very much for your attention

BIO MEDICAL WASTE MANAGEMENT

Bio Medical Waste Management MODULE 5 BIO MEDICAL WASTE MANAGEMENT 5.1 INTRODUCTION Bio medical waste (BMW) may be defined as any solid, fluid or liquid waste material including its container and any other