Influencing factors behind inappropriate solid waste management of small clinics in a resource-constrained country.

Appropriate clinical waste management is a critical concern in today's era. Resource-constrained countries agonize greatly over this issue in order to mitigate inappropriate clinical waste management practices. The goal of this study is to assess factors behind inappropriate waste management of small clinics in resource-constrained countries. We tested the hypothesis that negligence of government, knowledge and awareness, and financial burden are three key factors behind inappropriate solid waste management of small clinics. A two-phase survey including a pilot study and a main study was conducted for exploratory factor analysis and confirmatory factor analysis, respectively, in the fourth largest city of Pakistan, i.e., Hyderabad. One sample t test was used to validate the hypothesis, the correlation between the three key factors, and the location of the clinics were established. These factors were found to have a contribution to inappropriate waste management of small clinics. The hypothesis was then validated, and all three factors were found to have no significant variation in responses with the contrast of three types of clinic locations, namely, low-, medium-, and high-income areas. Responses were almost identical and bear equal significance from all locations, the financial burden factor is at the highest, the second factor is the negligence of government, and the third factor is that of knowledge and awareness. This study highlights the factors that are usually neglected and can help to improve solid waste management of small clinics in resource-constrained countries.

A Study on Small Clinics Waste Management Practice, Rules, Staff Knowledge, and Motivating Factor in a Rapidly Urbanizing Area.

Thousands of small clinics in Pakistan are generating dispersed medical waste, unlike large hospitals, small clinic waste management is often ignored. This study was conducted on 135 small clinics in Hyderabad, Pakistan, with the aim to determine small clinics' waste management practices in contrast to rules, level of knowledge, the environmental impact of disposal methods, and motivating factor analysis to understand the current situation from multiple perspectives. Overall, the waste generation rate was calculated to be 2.01 kg/clinic/day and the hazardous waste generation rate was 0.89 kg/clinic/day, whereas the general waste generation rate was 1.12 kg/clinic/day. The hazardous waste generation rate percentage is found to be higher than those found in large hospitals by 20%. The waste management practice among surveyed clinics was deplorable; none of the clinics were completely following hospital waste management rules of 2005 and thus the absence of proper segregation, storage, transportation, and disposal was commonly encountered during the study. Clinic staff possessed low level of knowledge and awareness, and acquired no training about waste management practice and rules, moreover, frequent employee turnover was noticed too. Additionally, two hypotheses were checked for creditability of motivating factors with an exploratory factor analysis to check their contribution to motivating clinic staff to practice sound healthcare waste management. Out of 10 indicators, nine were found in support of the hypotheses. Hence, it was discovered that active government involvement and financial support in providing training and inspecting small clinics could help in improving the condition. The findings of the present study can play a vital role in documenting evidence, and for policymakers and governments to plan solid waste management of small clinics and other healthcare facilities.

Greenhouse gas emission from small clinics solid waste management scenarios in an urban area of an underdeveloping country: A life cycle perspective.

This study aimed to investigate the effects on the environment of small clinics solid waste management by applying a life cycle analysis approach. Samples were collected from 371 private clinics situated in densely populated areas of Hyderabad, Pakistan. The solid waste from surveyed clinics was categorically quantified on daily basis for 30 consecutive days. The functional unit for waste was defined as 1 tonne. 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 of 1491.78 kg CO2 eq/tonne of solid waste due to mixed waste incineration, whereas the first scenario could not offer any saving because of uncovered landfilling and 67.5% higher transport fuel consumption than the proposed network. The proposed third scenario was found to be a better solution for urban clinics solid waste management, as it resulted in savings of 951.38 kg CO2 eq/tonne of solid waste. This integrated design is practicable by 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 urban area collection networks. The findings of the present study can play a vital role in documenting evidence and for policymakers to plan the solid waste management of clinics, as previously no studies have been conducted on this particular case. Implications: This study aims to highlight the impact of small clinics solid waste management scenarios on the environment in a developing country's urban area. Life cycle analysis is used for comparison of greenhouse gase emission from different scenarios, including the purposed integrated method. Small clinics play a very important role in health care, and their waste management is a very serious issue; however, there are no previous studies on this particular case to the best knowledge of the authors. This study can be considered as forerunner effort to quantify the environmental footprint of small clinics solid waste in urban areas of a developing country.