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Country : Mozambique HDI 0.354 Population [mio] 18.537 Summary Despite limited human resources, the management structure at all levels is well defined and training sessions have already been initiated since 2002. Biomedical Waste Management Regulations were introduced in 2003. This regulatory framework is nevertheless difficult to implement due to a severe lack of infrastructures specifically in rural area, inadequate training and supervision, and insufficient financial resources.

Comments

Introduction
Since the current legal framework doesn’t provide practical answers to numerous unsolved issues, current efforts focus on finalizing both the Policy and Strategy as well as elaborating the NAP and strengthening the NSC.

1. Management / institutional aspects
Coordination and supervision at central level are under the responsibility of the Department of Environmental Health and a staff of two people allocated to this effect. A senior waste management advisor, working under the MMIS Project, provides technical support to this small team.
At provincial level, coordination and monitoring is under the responsibility of environmental health officers.
In central hospitals, Hygiene and Cleanness & Infections Prevention Control committees are in charge of HCWM.
Within other HCFs coordination and supervision of HCWM issues is under the responsibility of the head of the HCF.

2. Training aspects
Training on HCWM has been provided since 2002 and focuses at helping health workers implement the 2003 biomedical waste legislation. Main topics addressed are:
- performance-based legislation
- continued improvement of best practices
- occupational health and safety for health care workers
- segregation & colour coding system
- risk management
- the hierarchy of waste management
- the principles of adult learning
- protecting the environment and public safety

3. Regulatory aspects
The Biomedical Waste Management Regulations approved in February 2003 contain the following salient points:
1) All HCFs must develop a biomedical waste management plan that must be approved by the MOH.
2) Waste must be segregated in minimum of five categories: general, infectious, anatomical waste, sharps and other categories (chemical, radioactive, pharmaceutical and cytotoxic waste).
3) The elimination of sharps should be achieved in the following order of preference: (a) sterilisation through autoclaving and then burial, (b) high temperature incineration, (c) chemical sterilisation and burial, (d) cement encapsulation, and (e) low temperature incineration and burial.
4) Infectious waste must be treated before disposal. This can be achieved through: (a) autoclave sterilisation and then burial, (b) high temperature incineration, (c) chemical sterilisation and burial, (d) low temperature incineration and burial or (e) disposal at a sanitary site under technical supervision.
5) The protection of all workers and the community from biomedical waste exposure must be observed.
6) Waste must be destroyed at the facility where it is produced unless an approved plan for transportation and final processing of waste is adopted.
7) Final disposal of biomedical waste must not have a negative impact on the environment.

Unfortunately, these procedures and conditions are not coupled with a provision of means and material through which they can be achieved. The severe lack of infrastructure specifically in rural area, inadequate training and supervision, and insufficient financial resources are the main barriers for the success of these regulations.
Mozambique has no environmental regulation specific for incineration. However all projects potentially impacting the environment are subject to Environmental Impact Assessments (EIAs) as established in the Environmental Law and in conjunction with the Environmental Impact Assessment Regulations and Standards of quality of air and water.

4. Financial aspects
Due to limited availability of funds at national level for health care in general and since many departments in HCFs lack basic necessities, waste management is often the last program to receive funds.
This critical situation is also linked to a lack of awareness and understanding of the importance of proper HCW disposal.

5. Technological aspects
At central, provincial and certain rural hospital high temperature incineration is usually practised.
In smaller HCFs, either low temperature incineration or burial is the most common way of disposing of HCW.

6. Other issues
In certain regions of Mozambique, the families demand that the placenta be disposed of in their homes following traditional ceremonies. If this occurs, it is recommended that the placenta is delivered to the family in conditions that prevents the transmission of infections.