My thesis proposed that improving waste management in developing countries could be achieved by becoming part of the system at a local level, researching the system relative to some goal or need of the system. Demonstrating the practical success and more importantly the process of focused, locally based development work is important so as to offer a practical, complimentary alternative to larger, relatively slower 'top-down' development efforts.
I implemented my thesis at the 100-bed Chitral District Hospital, Chitral, NWFP, Pakistan. This involved improving the previously intractable problem of hazardous health care waste management at the hospital. I also investigated the waste management problems of Chitral town as a whole, but could not implement my ideas at that scale due to a lack of start-up funding.
The approach to the issue of health care waste management at the Chitral hospital focused on discovering, understanding and then altering the significant reasons behind the current local situation. Involving and asking the local people along with my own investigations allowed me to quickly build an accurate picture of the key variables that contributed to the local situation, and how these variables interacted. I discovered that there were numerous aspects contributing to the problem, but also found that they could be grouped into three main elements: organizational, technical and financial.
The main organizational challenges at the hospital were a lack of education, knowledge and empowerment on HCWM (Health Care Waste Management), no direct responsibility for addressing HCWM at the hospital, and no serious direction or instruction from the Health Department regarding HCWM. In this area the main improvements stemmed from reorganising existing resources rather than adding more - changing work practices, disposal habits, improving awareness and education on HCWM, and creating a formal structure that assigned direct responsibility for waste management.
The solutions to the technical challenges at the Chitral hospital were based on international recommendations for HCW management in developing countries, with some local tailoring. Because of the initial low level of experience with HCWM at the hospital, the most important aspect was designing elements that worked - and kept on working. Because of this, we chose the simplest, most robust solutions. These focused mainly on locally made bins, a simple and robust handheld imported needle destruction unit, and hazardous health care waste disposal pits.
Project finances were the invisible underpinning to the entire process. Without the seed-funding and institutional support that I attracted, the process would have been impossible to implement. Rs 50,000 ($A1,667) was obtained from the Australian High Commission, with Rs 100,000 from IUCNP, paid in two instalments over the following year. The demonstrated maxim was that donor money is available for good ideas. But there is a catch. Donor money tends to be mainly available only in “one-off” packages, so it was important to design the program to operate either at a small profit or at a very low net loss that could be accommodated within the existing hospital budget. In the event, there were income savings from better cooperation between the MC and the hospital that meant the hospital no longer had to continually hire a tractor, and selling the used X-ray fixer for silver recovery provided a small additional income. These two items alone covered ongoing costs of the program - without even considering the environmental, public health, and amenity bonuses.
A revised, qualitative 'quantum' model of the cost/benefit curve for use in development planning is also proposed.
This thesis demonstrated that even in the most seemingly intractable health-care waste management situations, with minimal funding and resources, it is possible to achieve sustainable improvements by working from within and designing an interactive process focused on solving the significant elements to the problem.
The successful change of perceptions and acceptance of responsibility demonstrated at the Chitral Hospital highlights the fact that just one skilled development facilitator (resource person), using a participatory process focused on issues considered by the local people as highly significant, can act as a catalyst to achieve sustainable development - in this case, a sustained improvement in HCWM.
Readers of this thesis and visitors to the Chitral District Hospital may identify with the problems faced and the methods used to attempt to achieve practical improvements. From this, they may gain fresh insights into their own waste management issues and the process by which they attempt to solve them.