Environmental and Human Health Problems Associated with Hospital Wastewater Management in Zimbabwe.

PURPOSE OF THE REVIEW: Wastewater is a term used to describe water that has undergone degradation in quality owing to anthropogenic activities or natural processes. Wastewater encompasses liquid waste originating from academic institutions, households, agricultural sector, industries, mines and hospitals. Hospital wastewater contains potentially hazardous substances including residues of pharmaceuticals, radioisotopes, detergents and pathogens, with detrimental impacts to the environment and human health. Nevertheless, studies related to hospital waste management are limited in Africa, particularly in Southern Africa. This research offers an overview of aspects surrounding hospital wastewater in Southern Africa, focusing on Zimbabwe. Already published and grey literature was reviewed to compile the paper. RECENT FINDINGS: Number of patients, nature of medical services offered and hospital size influences generation of hospital wastewater. Partially and non-treated hospital wastewater is managed together with municipal wastewater. Management of hospital wastewater is impeded by shortage of resources, lack of co-ordination among responsible authorities and ineffective legal framework enforcement, among other challenges. Inappropriate hospital wastewater management results in environmental contamination, causing human ailments. Attainment of sustainable hospital wastewater management requires clearly defined and enforced legislation, collaboration of accountable stakeholders, sufficient resources and enhanced awareness of involved stakeholders. Application of technologies that uphold recycling and reuse of wastewater is essential to reach Sustainable Development Goals, Zimbabwe Vision 2030 and National Development Strategy 1 targets, particularly those dealing with environmental protection while upholding human health.

A review towards developing a hierarchical model for sustainable hospital solid waste management in rural areas of Zimbabwe.

Management of solid waste from rural hospitals is amongst problems affecting Zimbabwe due to diseases, population, and hospital increase. Solid waste from rural hospitals is receiving little attention translating to environmental health problems. Therefore, 101 secondary sources were used to write a paper aiming to proffer a hierarchical model to achieve sustainable solid waste management at rural hospitals. Rural hospitals' solid waste encompasses electronic waste, sharps, pharmaceutical, pathological, radioactive, chemical, infectious, and general waste. General solid waste from rural hospitals is between 77.35 and 79% whilst hazardous waste is between 21 and 22.65%. Solid waste increase add burden to nearly incapacitated rural hospitals. Rural hospital solid waste management processes include storage, transportation, treatment methods like autoclaving and chlorination, waste reduction alternatives, and disposal. Disposal strategies involve open pits, open burning, dumping, and incineration. Rural hospital solid waste management is guided by legislation, policies, guidelines, and conventions. Effectiveness of legal framework is limited by economic and socio-political problems. Rural hospital solid waste management remain inappropriate causing environmental health risks. Developed hierarchical model can narrow the route to attain sustainable management of rural hospitals' solid waste. Proposed hierarchical model consists of five-layered strategies and acted as a guide for identifying and ranking approaches to manage rural hospitals' solid waste. Additionally, Zimbabwean government, Environmental Management Agency and Ministry of Health is recommended to collaborate to provide sufficient resources to rural hospitals whilst enforcing legal framework. Integration of all hierarchical model's elements is essential whereas all-stakeholder involvement and solid waste minimisation approaches are significant at rural hospitals.

A review on the effectiveness of integrated management system in institutional solid waste management in Zimbabwe.

Institutional solid waste management is a critical contemporary crisis in Zimbabwe due to rapid urbanisation, disease outbreaks and population growth. Traditional approach to institutional solid waste management is almost fragmented, with various departments accountable for numerous aspects of the management process. Deficiency of coordination as well as integration among responsible stakeholders and failure to include different management strategies resulted in institutional solid waste management inefficiencies. This translates to increased environmental health problems. Therefore, this review aims to assess the effectiveness of integrated management systems in institutional solid waste management in Zimbabwe. The review was compiled using already existing literature. Institutions regarded as sources of solid waste in Zimbabwe include learning and health institutions. Barracks, prisons and police camps are part of the institutions. The institutions generate hazardous, non-hazardous, biodegradable and non-biodegradable solid waste. Solid waste from institutions is indiscriminately stored, collected and disposed through landfilling, incineration, burning, open pits and on non-designated open spaces. Most of the disposal strategies are least prioritised by the waste management hierarchy, hence have potential to cause environmental health risks. Utilisation of inappropriate management strategies is exacerbated by shortage of resources, ineffective legal framework, lack of all stakeholder participation and inadequate investment in waste reduction alternatives. Integrated institutional solid waste management is effective since it enhances involvement of all responsible stakeholders and application of various waste reduction alternatives particularly those which support circular economy. Through integrated approach, quantity of institutional solid waste disposed is limited, therefore minimising environmental health risks while maximising dumpsites lifespan.

A review of the applicability of Environmental Management Systems in waste management in the medical sector of Zimbabwe.

Environmental Management Systems (EMS) are currently the cornerstone of achieving sustainability globally. Nevertheless, the question is applicability of EMS in the medical sector. Hence, the review focused on applicability of EMS in medical waste management Zimbabwe. EMS involves overall processes that facilitate reduction of dire impacts of company's activities while increasing performance. EMS framework consists of environmental policy, planning, implementation, checking, review and improvement stages. To examine applicability of EMS in management of medical sector waste, published secondary sources with information related to the topic were utilised. Analysis of strengths and opportunities of EMS was used as a base to examine its applicability in medical waste management. Zimbabwean medical sector consist of hospitals and primary healthcare facilities. Medical waste includes pathological, pharmaceutical, cytotoxic, radioactive, chemical, sharp, infectious and general waste. However, twenty-first century witnessed expansion of medical institutions to accommodate COVID-19 patients, resulting in generation of construction and demotion waste. Medical institutions in Zimbabwe are accountable for solid waste management at generation source although municipalities are responsible for conveying solid waste to landfills. Solid waste from medical sector is disposed through traditional strategies namely landfilling, incineration, open pits and open burning, resulting in water, air, and soil contamination. However, EMS can reduce quantity of solid waste disposed through waste reuse, recycle and recovery. Moreover, achievement of integrated approach, effective legislation, policies and inclusive participation in medical waste management is adopted through use of EMS. Therefore, EMS were utilised to develop an integrated sustainable medical waste management model to achieve sustainability.

Applicability of the Life Cycle Assessment Model in Solid Waste Management in Zimbabwe.

Solid waste increase is inevitable globally due to anthropogenic activities. This adds burden to waste management systems in developing countries including Zimbabwe. Currently, life cycle assessment (LCA) model is used to achieve sustainability and circular economy (CE) in solid waste management. Therefore, the main goal of this paper was to unearth LCA model applicability in solid waste management in Zimbabwe. Data sources were retrieved from databases like Scopus, ScienceDirect and Springer, although government documents were also used. In Zimbabwe, organic and inorganic solid waste is generated from various sources, namely industries, institutions and households. Solid waste management in Zimbabwe is based on traditional linear approach where waste is collected and disposed through landfilling, burning, incineration, burying, open pits or illegally. Most disposal approaches occupy base of waste management pyramid, hence posing detrimental impacts to human health, terrestrial, aquatic and atmospheric ecosystems. Management approaches are far from Agenda 21, Sustainable Development Goals (SDGs), Zimbabwe Vision 2030 and National Development Strategy 1 demands. Literature revealed that LCA model can be utilised to achieve sustainable solid waste management in countries like Zimbabwe. LCA model is essential in management of solid waste in Zimbabwe, since it assists decision makers in selecting management approaches with less environmental health impacts. Moreover, LCA enables application of waste material reuse, recycle, repairing and recovery, thus narrowing the gap to achieve CE and economic growth in Zimbabwe. Owing to LCA model implementation of waste management legislation and policies which support energy recovery and circular economy became easier in Zimbabwe.