Medical Waste: briefing

Meeting report

This Report is a Contact Natural Resource Information Service
Taking Parliament to People, and People to Parliament

ENVIRONMENTAL AFFAIRS AND TOURISM PORTFOLIO COMMITTEE
3 October 2000
BRIEFING ON MEDICAL WASTE BY THE DEPARTMENTS OF WATER AFFAIRS AND FORESTRY, HEALTH AND ENVIRONMENTAL AFFAIRS AND FORESTRY

Documents handed out:
Briefing by the Department of Water Affairs and Forestry (see Appendix 1)
Briefing by the Department of Health

SUMMARY
The Committee heard evidence from representatives of the three departments on the current situation with regard to the disposal of medical waste. The fragmentation of responsibilities between the three departments with regard to the various stages of medical waste management created a difficult environment to ensure the adequate management and delivery of a medical waste disposal system. The Committee identified the need for more information on the issue, and agreed to meet again in 2001 to take the issue further.

MINUTES
The Chairperson, Ms Gwen Mahlangu, (African National Congress), began the meeting by identifying some of the key areas of concern with relation to medical waste. She noted that waste disposal through incineration was the most common method, and that there were harmful consequences associated with incineration. There were other solutions available that were documented by organisations such as the USA Environmental Protection Association and Greenpeace. The burning of plastics or any material containing PVC was a further issue that should be looked at. The Portfolio Committee needed to try and find a way forward for medical waste management.

The Chairperson stated that the Departments of Water Affairs and Forestry, Health and Environmental Affairs and Tourism had been invited to brief the committee. The issue of medical waste was a key issue. The violations that had been experienced and publicised in the media, for example in Cape Town and Gauteng, were worrying. Therefore a report was needed by Parliament on the issue.

Department of Water Affairs and Forestry
Ms Tolmay Hopkins, made a presentation to the committee. (The presentation is attached below as appendix 1.)

Department of Health
After the presentation, Mr Thebe Pule, presented his submission.

Department of Environmental Affairs and Tourism
Mr Jerry Lengoasa proceeded to highlight key issues with relevance to his department. He noted that issues relating to humans within the environment, so called 'brown issues' were not sufficiently covered by the Environmental Conservation Act, or the National Environmental Management Act (NEMA). The area of medical waste was governed by a range of different laws. The Department of Environmental Affairs and Tourism was therefore engaging in a process of undertaking an environmental law review. New chapters would thereafter be added to NEMA.

Mr Lengoasa stated that the National Waste Management Strategy and Action Plans did include issues relating to medical waste. However the issue was linked to information flow and the required legislation framework that was still needed.

To implement better medical waste strategies, the Department of Environmental Affairs and Tourism had begun to initiate a pilot project in co-operation with the Danish government and the Gauteng Province. The first stage of the project was to perform a situation analysis to be able to identify the quantities of waste produced. The project would then aim to provide a regulatory framework for the generators, transporters and disposers of medical waste. The regulatory framework would provide for the flow of information and the proper accounting of the waste.

Mr Lengoasa commented that currently private medical institutions were required to indicate how they would dispose of their medical waste before they were given a license. However, government institutions did not have the same requirement. He noted that as the majority of medical waste seemed to come from government institutions, this was a problem that needed to be addressed.

In terms of taking practical action, there was a need to implement the Strategic Plan and the Action Plans. The implementation programs will need to be tested jointly with the Department of Water Affairs and Forestry, who were part of the development of the strategy. In the short term their needs to be trilateral discussions between the Departments of Water Affairs and Forestry, Health, and Environmental Affairs and Tourism.

Mr Lengoasa acknowledged that there had not been much work done with the municipalities. In 2001 the department was hoping to secure R2 million to do a case study on the Cape Metropolitan Council to see how the systems were implemented at a local government level.

The Chairperson thanked the presenters for their input. She noted that in the USA, 53% of dioxin emissions were from incinerators.

Discussion
Ms Chalmers (ANC) stated that there were problems with the incinerators in the Port Elizabeth area that were causing negative health effects on the local population. New upmarket scrubbers had been installed, but had not worked. Other incinerators had been shut down. The incinerator technology was old fashioned. Of particular concern was the burning of plastic or any product that contained chlorine, as this produced toxic gasses. She noted that there were reports on new technologies in the USA, such as the Plasma Waste Converter. These technologies were cleaner, and had bi-products such as usable gas.

Ms Verwoed (ANC) noted that Ms Hopkins, in her presentation, had indicated that there were strict criteria that were being applied for testing alternative technology. In the past, the "best practicable means" test was applied to improving pollution emitters. This test included whether the improvements would be economically viable to the polluter. As a result polluters with biological and chemical problems continued operating, as solutions were not economically viable.

Ms Verwoed further noted that other countries were reducing the numbers of incinerators, while South Africa was increasing the use of incinerators. She queried whether using small incinerators was not dangerous, as incineration required extremely high temperatures and was a very technical process. She asked whether this was really a solution therefore for small clinics, as had been suggested by the Department of Health.

The three presenters had noted that legislation governing medical waste was fragmented. The Department of Health was responsible for regulating the activities at the medical institutions that produced waste. The Department of Environmental Affairs and Tourism was responsible for regulating the disposal of medical waste through incinerators. Where incineration was not possible due to the incinerators being closed for alterations, or where the backlog of medical waste was becoming a health hazard, the Department of Water Affairs and Forestry was responsible for regulating the dumping of medical waste at land fill sites. The dumping option was not the preferred option, and was only used when incineration was not immediately possible.

Ms Verwoed noted that the Portfolio Committee encouraged the breakdown of this fragmentation in legislation and responsibility. She asked how it would be possible to combine the legislation. She noted that 850 tons of medical waste was reported to have been 'lost' last year, and that the issue was therefore urgent. She asked how long the process would take to sort the situation out. She agreed with the presenters that the waste needed to be reduced at source, and asked what steps were being taken.

Ms Ramatsomai (ANC), commented on the suggested use of small-scale incinerators for rural clinics, noted that in urban areas NGO's, the media and communities exposed illegal dumping and bad practices. She asked how the monitoring of these issues would be possible in remote rural areas.

Mr Macnamara (Democratic Party) stated that the questions asked had covered most of his concerns. However he requested that information be provided on the extent of the problem. For example, data should be provided on how much waste was being disposed of legally and how much was being disposed of illegally? Further, information should be provided on who the biggest culprits of illegal dumping were.

Ms Nqodi (ANC) asked for the numbers of incinerators by Province and nationally. She noted that hospitals lacked the finances for general maintenance and faced issues such as electricity shut downs and unhealthy water supply. How would these situations be improved, and would these institutions be able to handle and maintain the small incinerators.

Ms Nqodi stated that she believed it would be of more benefit to do a case study of local government implementation in one of the less developed provinces, rather than in the Western Cape. She asked whether any of the provinces were being assisted financially on the issue of medical waste.

The Chairperson asked who was responsible for issuing permits, how often the permits were renewed, and how the monitoring was carried out.

Ms Hopkins (Department of Water Affairs and Forestry) responded to some of the questions. She noted that the licensing of waste disposal landfills and dumps was her department's responsibility. The focus to date had been on large waste dumps and hazardous sites. They were now beginning to focus on incinerators and dumping permits. The department had only agreed to the dumping of medical waste in a landfill at one site as a result of the incinerator in the area being repaired at the time. The backlog and storage of the medical waste had become hazardous, and therefore it was disposed of under special conditions in the landfill. She noted that approximately 1200 tons of medical waste was produced in Gauteng every month. She did not have figures for any of the other countries.

Mr September (ANC) asked whether the Department of Water Affairs and Forestry was satisfied with what it was doing, and asked how active the department was.

Ms Hopkins responded that the mandate for the Department of Water Affairs and Forestry was limited by the legal framework. The department had no control over the production and transport of waste, which was problematic.

Mr Lengoasa (Department of Environmental Affairs and Tourism) noted that the regulation of the generation of medical waste was controlled by Health. There was a vacuum in the regulatory framework with regard to the transportation of medical waste. The recent situation in Johannesburg was a good example. The city metro owned an incinerator. The city issued contracts to transport the waste from the city institutions to the city incinerator. However, there was no control or monitoring as to whether it actually is disposed of.

On the disposal side, the incineration is regulated by the Department of Environmental Affairs and Tourism. However, if it cannot be incinerated, the Department of Water Affairs and Forestry is in control of regulating the landfill solution. Therefore a large part of the problem was in the structure of the system itself. The disposal mechanism of choice at the present time is incineration. How ever, most incinerators do not meet required guidelines. When an incinerator breaks down, the waste is stockpiled. This either occurs on the site of the incinerator, or at an illegal place. The alternate method for immediately disposing of the stockpiling waste is to dispose of it at a landfill.

Ms Hopkins (Department of Water Affairs and Forestry) added that in the instances where waste was landfilled, this was a short-term solution to alleviate the backlog and protect workers on the storage sites.

Ms Rabinowitz (Inkhata Freedom Party) asked who was responsible for monitoring and finding illegal dumps, investigating the issue and pressing charges.

Ms Hopkins (Department of Water Affairs and Forestry) noted that the department was only mandated to issue permits. All government departments and institutions were relied upon to inform them when illegal dumping occurred. The Department of Water Affairs and Forestry would then act.

The Chairperson asked what happened when a permit expired.

Ms Hopkins replied that permits were issued for the lifespan of the landfill site. However the sites were evaluated every 5 years.

Ms Chalmers (ANC) asked whether the stockpiling of medical waste was a health risk.

Ms Hopkins replied the waste could become a health risk, or a nuisance. The storage of the waste at sites was governed by a storage code.

Mr September (ANC) asked whether the department was able to monitor all the waste. Ms Hopkins replied that it was not in the mandate of the Department of Water Affairs and Forestry to monitor all medical waste.

Ms Verwoed (ANC) asked for information on the licensing of incinerators, and how many were operating legally and illegally.

Ms Nqodi (ANC) asked whether there was constant monitoring of landfill sites if they were only evaluated every five years.

Ms Rabinowitz (Inkhata Freedom Party) asked who was responsible for paying inspectors to check up on medical waste issues.

Ms Hopkins (Department of Water Affairs and Forestry) noted that permits for land fill sites were of a general nature, with specific amendments being provided for on the specific occasions when medical waste needed to be dumped. The local government structures had environmental health officers who were responsible for constantly evaluating any risk to the communities' health.

Ms Verwoed (ANC) added that each local government health department should be checking anything that could affect the health of their areas. They would therefore be the ones most likely to discover and find illegal dumping, and be able to monitor related issues. She strongly believed that there should be strong communication with local government, and that the South African Local Government Association (SALGA) should be contacted.

Mr Lengoasa (Department of Environmental Affairs and Tourism) noted that there were numerous processes that required a licence from the air pollution control office. There were different types of incinerators, with most licensed medical waste incinerators currently being in the medical facilities. The Department of Health planned to implement the incinerator program. The Department of Environmental Affairs and Tourism had closed or denied authorisation to many of these incinerators, and were accused of creating a crisis. The Department of Environmental Affairs and Tourism believes that the option of large regional incinerators needs to be looked at, one that can run continuously. Current processes were inefficient, as incinerators were not operating all the time, and took many hours to reach the required temperature and to cool down. The daily start up and shut down was inefficient, and limited the lifespan of incinerators. The study currently being undertaken in Gauteng suggested that the two currently authorised incinerators could be sufficient to handle the medical waste load. Of concern would be when these incinerators broke down.

In response to the query on the number of officials monitoring the problem, Mr Lengoasa noted that there were only 7 official air pollution control officers nationally, covering large areas and all types of air pollution. The Department of Environmental Affairs and Tourism was therefore currently only operating by responding to complaints, which was not an ideal situation.

Mr Lengoasa stated that the lifespan of permits for incinerators varied. The process was still controlled by the 1965 Air Pollution Act. Temporary licenses were given, around three years, to incinerators to test their emissions. If the requirements were not met, then the plant would be evaluated to see what improvement could be made. Another temporary licence would then be issued. As the requirements were guidelines, there was no point at which the Department of Environmental Affairs and Tourism could say the plant would be shut down. This was a major structural weakness in the law.

The Chairperson noted that there was information on the Internet as to how other countries dealt with medical waste, and referred members to sites such as Greenpeace and the USA's EPA.

Ms Hopkins (Department of Water Affairs and Forestry) noted that there were three applications to test alternative solutions currently in South Africa. These were for microwave, electro thermal and plasma waste technologies. These were being evaluated as alternatives.

Mr Pule (Department of Health) noted that before alternate technologies were applied, the department would have a look at them.

Ms Verwoed (ANC) commented that given the current crisis, and the availability of international research, she was concerned that she was not hearing from the departments that they were actively following up on new technologies.

Mr Lengoasa (Department of Environmental Affairs and Tourism) noted that the disposal mechanisms were largely being driven by the private sector. Internationally and locally disposal was being outsourced. He noted that there might well be alternative technology which could be cheaper. However, existing policy supported the use of existing technology.

Mr September (ANC) commented that the law reform process would be finalised in January. There was a clear message that the departments were not able to deliver at present. It was therefore vital to work out a process of getting local populations and NGO's to work together with the departments. The disposal must not become a private initiative, as their key motive was to make money. Government has a responsibility to protect people. He hoped that when the Portfolio Committee met in January on the issue they would get a written report on the alternative technologies.

Ms Verwoed (ANC) agreed that alternative technologies were vital. She commented that a lot of the incineration took place inside of government hospitals. She was suspicious and concerned when the development was just left to the private sector. The Department of Environmental Affairs and Tourism was responsible for a safe and healthy environment, and the current situation, with only seven officials monitoring air pollution, was not working. Therefore the government must not just create an enabling environment, but must encourage both the private and public sector. Incentives must be created. The Portfolio Committee must take up the issue to ensure that the Department takes active steps.

Ms Chalmers (ANC) commented that the management of medical waste was in a crisis. She asked the Department of Health if they were looking at a long-term solution. The doctors, and medical personnel needed to find proactive ways of managing the issue within hospitals. The use of plastics should not be as easy, and recycling of medical waste where appropriate should be looked at. She asked whether this was on the agenda of the department of health.

Mr Pule (Department of Health) replied that there was a plan to look at health care waste. There were currently regulations being finalised on the environmental conditions of facilities, and the Department is looking at revising the bureau of standards procedures. The management of waste would be governed by a code of practice from the generation to separation. There was a need to work with department staff on the waste issue, and would become a part of the management function of health care institutions.

On the subject of small-scale incinerators, Mr Pule noted that an agreement had been reached with the Department of Environmental Affairs and Tourism on the use of small-scale incinerators in rural areas. Research with provinces had shown that the waste from clinics could be handled sufficiently by small-scale incinerators. In the long term, all the provinces would need to find funding to perform the type of analysis that was being undertaken by the Gauteng province. The Department of health was going to be creating an implementation strategy to increase resources in the provinces and local government through using a district system.

The Chairperson stated that the problem of medical waste was bigger than the committee had originally thought. This would therefore have to be the first of many meetings needed to unpack the issue. South Africa's current preferred route was incineration, however other countries were moving away from incineration. Very little was being done to ensure incinerators were operating within the guidelines, and functions were being outsourced to private companies. South Africa needed to be careful of given this responsibility to those wanting to make money. The Portfolio Committee would try and circulate as much information as possible.

The Chairperson commented that a debate was needed in the National Assembly to sensitize other Parliamentarians and members of the public on the issue. Communities needed to play a role by reporting complaints. There was very little control on incinerators, and medical waste in general. The Portfolio Committee would therefore commit to returning on this issue in the future.

Ms Mari Lou Roux (Grassland Society) stated she was pleased to hear that and Environmental Impact Assessment (EIA) was going to be conducted on the plasma converter. There was very little technical information on the converter, and the company was playing hiding techniques in terms of producing information. Reports from the Healthcare without harm network had reported that they thought the converters would not work and were a scam. Ms Roux further noted that if expensive technology was used in future, people would still dump if they could not afford to process their medical waste.

The representatives from the three departments agreed that the meeting had been beneficial, and that a co-operative solution needed to be found. Mr Lengoasa (Department of Environmental Affairs and Tourism) agreed that alternative technologies were important, especially if the government was the principle owner and operator of existing technology, as they should then address their responsibility.

The Chairperson thanked the presenters for their input. The task ahead was a difficult one that was now understood, and everyone needed to work together. The committee would meet again on the issue in early 2001.

The Portfolio Committee moved on to the issue of a salmon farm off Walker Bay. This part of the meeting was not covered.

1. LEGISLATIVE FRAMEWORK FOR THE MANAGEMENT OF MEDICAL WASTE

Control over the management of medical waste is fragmented and different departments have the mandate to control different aspects. The following Acts are of relevance in the management of medical waste:

1. Human Tissues Act, 1983 (Act 56 of 1983)

Infectious waste is defined as "any waste which is generated during the diagnosis, treatment or immunisation of humans and animals; in the research pertaining to this; in the manufacturing or testing of biological agents - including blood, blood products and contaminated blood products, cultures, pathological wastes, sharps, human and animal anatomical wastes and isolation wastes that contain or may contain infectious substances" (Minimum Requirements, 1998). The Human Tissues Act, 1983 (Act 56 of 1983), which is administered by the Department of Health, stipulates that all human anatomical parts have to be incinerated. In terms of the Minimum Requirements all medical waste has to be incinerated at a licenced incinerator in order to render the waste sterile and ensure that it is unrecognisable as of medical origin.

2. Environment Conservation Act, 1989 (Act 73 of 1989)

Disposal facilities have to be permitted in terms of section 20 of this Act, which is governed by the DWAF. Disposal facilities include all areas used for the accumulation, treatment and disposal of waste. Incinerators and waste treatment facilities therefore has to be permitted in terms of (or exempted from) this Act. Although priority was given to the permitting of hazardous, large and medium waste disposal sites in the past, Departmental guidelines have been developed to assist in the permitting of these facilities. The Department is now actively involved in permitting these facilities.

Incineration is a scheduled process and therefore the EIA requirements as defined in sections 21, 22 and 26 of this Act are relevant. This is governed by the provincial department for the environment.

3. Atmospheric Pollution Prevention Act, 1965 (Act 45 of 1965)

All scheduled processes which include incinerators have to be licenced in terms of this Act. This is governed by the Department of Environmental Affairs and Tourism (DEAT).

4. Other legislation that are of relevance to the management of medical waste include the following: