The Min­istry of Plan­ning and De­vel­op­ment has em­barked on a na­tion­al study to an­swer the ques­tion: In the on­go­ing glob­al pan­dem­ic are home health­care wastes han­dled in a safe and en­vi­ron­men­tal­ly sound man­ner in Trinidad and To­ba­go?

This is the main fo­cus of a na­tion­al on­line sur­vey launched on Sep­tem­ber 1st by the Min­istry of Plan­ning and De­vel­op­ment, in co­or­di­na­tion with the Basel Con­ven­tion Re­gion­al Cen­tre for Train­ing and Tech­nol­o­gy Trans­fer for the Caribbean, and with sup­port from the Unit­ed Na­tions En­vi­ron­ment Pro­gramme (UN­EP).  The out­come of this sur­vey is to ad­dress gaps with­in the na­tion­al waste man­age­ment sys­tem to min­i­mize the risks posed to san­i­ta­tion and health work­ers, the gen­er­al pub­lic, negate any ad­verse en­vi­ron­men­tal im­pact, and op­ti­mize a na­tion­al waste sys­tem. All re­spons­es will be kept strict­ly con­fi­den­tial and are anony­mous.

Al­though na­tion­al guide­lines ex­ist for man­age­ment of bio­med­ical waste gen­er­at­ed from home health­care, there is cur­rent­ly a gap in the dis­pos­al of this waste stream as there is no es­tab­lished sys­tem in place. As a re­sult, home health­care wastes can be­come co-min­gled with do­mes­tic waste and en­ter the mu­nic­i­pal sol­id waste stream go­ing to land­fills. This presents a threat of in­fec­tion and in­jury to hu­mans and pol­lu­tion of the en­vi­ron­ment- The COVID-19 pan­dem­ic has in­tro­duced a new con­cern re­sult­ing in in­creased gen­er­a­tion of this type of waste from house­holds, there­by ex­ac­er­bat­ing the sit­u­a­tion.

This sur­vey there­fore aims to col­lect in­for­ma­tion on the knowl­edge, what is known; at­ti­tudes, what is thought; and prac­tices, what is done by house­hold­ers that gen­er­ate bio­med­ical waste. The da­ta from this Knowl­edge, At­ti­tude and Prac­tices (KAP) Sur­vey will serve as the ba­sis for iden­ti­fy­ing the strengths, needs and bar­ri­ers to be tar­get­ed for clos­ing these gaps, in ac­cor­dance with best prac­tice ap­proach­es.

Plan­ning and De­vel­op­ment Min­is­ter Camille Robin­son-Reg­is em­pha­sizes the need for this na­tion­al re­search in the con­text of Gov­ern­ment’s goal of plac­ing the en­vi­ron­ment at the cen­tre of so­cial and eco­nom­ic de­vel­op­ment.  The Min­is­ter al­so added that the project con­tributes to Trinidad and To­ba­go’s achieve­ment of the glob­al Sus­tain­able De­vel­op­ment Goals (SDGs), es­pe­cial­ly SDG 12, ‘Re­spon­si­ble Con­sump­tion and Pro­duc­tion’.

Im­prop­er seg­re­ga­tion and dis­pos­al of bio­med­ical waste can have many di­rect and in­di­rect im­pli­ca­tions on not on­ly the en­vi­ron­ment but on hu­man health as well.  These are as fol­lows:

●   Bio­med­ical waste is a source of tox­ic and haz­ardous pol­lu­tants.

●   Spread of ill­ness through hu­man and an­i­mal pop­u­la­tion- by air, land or wa­ter.

●   Harm to per­sons han­dling waste: needle­stick in­jury and sharps in­jury in­ci­dents from at-home di­a­bet­ic lancets for ex­am­ple can in­crease the risk to the health of waste han­dlers.

●   Risk of in­fec­tion from con­ta­gious dis­eases and pathogens which are not on­ly are a haz­ard to health­care work­ers in­side health­care fa­cil­i­ties but al­so to do­mes­tic waste han­dlers that deal with co-min­gled bio­med­ical waste gen­er­at­ed from homes head­ing to the land­fills.

●   Dump­ing or in­dis­crim­i­nate dis­pos­al of wastes in­clud­ing bio­med­ical wastes con­tributes to pol­lu­tion of the air, wa­ter and soils, im­pacts wildlife such as en­tan­gle­ment and in­ges­tion as well as sec­ondary im­pli­ca­tions to the en­vi­ron­ment e.g. flood­ing. 

With the ad­vent of the COVID-19 pan­dem­ic there has been an in­crease in the gen­er­a­tion of bio­med­ical waste es­pe­cial­ly through the var­i­ous per­son­al pro­tec­tive equip­ment (PPE) be­ing re­quired (e.g. masks, gloves, shields etc.). These dis­pos­able type PPE are usu­al­ly made of plas­tics, some of them polypropy­lene the same as those used for straws and bot­tles and can per­sist in the en­vi­ron­ment for long pe­ri­ods. This has there­fore added to the plas­tic, par­tic­u­lar­ly sin­gle use plas­tic pol­lu­tion prob­lem, neg­a­tive­ly im­pact­ing our ecosys­tems and con­tribut­ing to all the re­lat­ed plas­tic pol­lu­tion is­sues, as plas­tic does.

It has been es­ti­mat­ed that the amount of plas­tic waste gen­er­at­ed world­wide since the out­break is 1.6 mil­lion tonnes per day (Ben­son, Bassey and Palanisa­mi, 2021).

It is en­vis­aged that this project will im­prove the ca­pac­i­ty of the coun­try to al­le­vi­ate the pres­sures with­in the bio­med­ical waste man­age­ment sec­tor and to strength­en the na­tion­al ca­pac­i­ty to ad­dress any deficits. At­ten­tion will al­so be giv­en to pub­lic aware­ness and knowl­edge trans­fer as it per­tains to prop­er man­age­ment of bio­med­ical wastes, in­clud­ing at the house­hold lev­el. The out­come of this project is to al­so min­imise the risks posed to health care work­ers, waste han­dlers, the na­tion­al com­mu­ni­ty, and the en­vi­ron­ment from im­prop­er han­dling and dis­pos­al of bio­med­ical waste.

De­f­i­n­i­tion of Terms

(as out­lined in the Code of Prac­tice for Bio­med­ical Waste Man­age­ment Trinidad and To­ba­go)

Bio­med­ical waste may be de­fined as any sol­id or liq­uid waste which may present a threat of in­fec­tion to hu­mans, in­clud­ing non-liq­uid tis­sue, body parts, blood, blood prod­ucts, and body flu­ids from hu­mans and oth­er pri­mates; lab­o­ra­to­ry and vet­eri­nary wastes which con­tain hu­man dis­ease-caus­ing agents; and dis­card­ed sharps.

Home health­care waste in­cludes used ex­pired phar­ma­ceu­ti­cals, in­con­ti­nence pads, dress­ings, sy­ringes, hy­po­der­mic nee­dles, sharps and some in­fec­tious waste such as swabs, tis­sues, etc.  Home health­care waste is al­so gen­er­at­ed through self-care or home users where pa­tients are pro­vid­ed with de­vices to ad­min­is­ter med­ica­tion, are on home dial­y­sis or are di­a­bet­ics. Waste types in­clude, used sharps and sy­ringes.

Back­ground of the UNDP and BCRC’s broad­er project

(A project led by the Min­istry of Plan­ning and De­vel­op­ment)

In light of the cur­rent COVID-19 pan­dem­ic, the Unit­ed Na­tions En­vi­ron­ment Pro­gramme (UN­EP) ex­tend­ed tech­ni­cal as­sis­tance to coun­tries in the Latin Amer­i­ca and Caribbean re­gion to in­te­grate the en­vi­ron­ment in­to their re­sponse and re­cov­ery from the COVID-19 cri­sis. The Min­istry of Plan­ning and De­vel­op­ment was able to suc­cess­ful­ly mo­bilise tech­ni­cal guid­ance and fi­nan­cial re­sources from UN­EP to sup­port chem­i­cals and waste man­age­ment in Trinidad and To­ba­go for the na­tion’s COVID-19 re­sponse and re­cov­ery. As such, this four-month project has been de­vel­oped with an ob­jec­tive of ad­dress­ing ar­eas of con­cern with­in the ex­ist­ing bio­med­ical waste man­age­ment sys­tem in Trinidad and To­ba­go, to not on­ly as­sist with im­me­di­ate med­ical re­lat­ed emer­gen­cies but al­so fu­ture con­tin­gency plan­ning.

There are three main com­po­nents of the project; Knowl­edge, At­ti­tude and Prac­tices (KAP) Gap Analy­sis of Bio­med­ical Waste Man­age­ment, in­clud­ing KAP sur­veys on home health­care waste (house­holds), health in­sti­tu­tions and waste con­trac­tors which have been launched; an As­sess­ment of the Cur­rent sta­tus of Bio­med­ical Waste Man­age­ment; and a Sen­si­ti­za­tion and Ca­pac­i­ty Build­ing Pro­gramme on Bio­med­ical Waste Man­age­ment.

This UN­EP fund­ed project is be­ing ex­e­cut­ed na­tion­al­ly by the Min­istry of Plan­ning and De­vel­op­ment.

The Min­istry of Plan­ning and De­vel­op­ment is al­so the project fo­cal point and chair of a mul­ti stake­hold­er com­mit­tee which com­pris­es the Min­istry of Health, the En­vi­ron­men­tal Man­age­ment Au­thor­i­ty (EMA), the Trinidad and To­ba­go Sol­id Waste Man­age­ment Com­pa­ny Lim­it­ed (SWM­COL), the To­ba­go House of As­sem­bly (THA) Di­vi­sion of Health, Well­ness and Fam­i­ly De­vel­op­ment, and the Basel Con­ven­tion Re­gion­al Cen­tre for Train­ing and Tech­nol­o­gy Trans­fer for the Caribbean (BCRC-Caribbean).

The BCRC-Caribbean is al­so fa­cil­i­tat­ing project ad­min­is­tra­tion on be­half of the Min­istry of Plan­ning and De­vel­op­ment. A Pub­lic/ En­vi­ron­men­tal Health Spe­cial­ist and a Com­mu­ni­ca­tions Spe­cial­ist have been con­tract­ed to con­duct the project works.