State and community perspectives on illegal dumping of health care risk waste (HCRW) in the City of Tshwane, South Africa

Abstract: The management of health care risk waste (HCRW) is one of the biggest environmental and socio-economic challenges, especially in developing countries. In South Africa, the illegal disposal of HCRW has become an increasing problem which is associated with various negative impacts on human health and the environment. This study aims to explore the extent of illegal dumping of HCRW in the City of Tshwane, the capital city of South Africa. Online questionnaire surveys were used for data collection and both qualitative and quantitative methods were used to analyse the data collected. A total of 189 respondents from the City of Tshwane took part to the study. Close to 50% of the respondents indicated that they have spotted at least once HCRW illegally dumped in the city. The majority of HCRW spotted by the respondents is infectious waste with 59.57% with the majority (61.70%) of the respondents identifying the waste next to the road. Geographically, these wastes are disproportionately found in administratively defined Regions 1, 3 and 6 of the city (with a combined total of 66% out of the total population of the City of Tshwane), which also correspond not only to the most populated areas of the city but also to areas where most healthcare facilities are also concentrated. This suggests potential links between hotspots of HCRW with population size and healthcare facilities. Once HCRW is spotted, 65.59% of respondents indicated that they know what to do out of which 95.08% indicated that an identified HCRW should be reported to the relevant authority. Some of the respondents (5.17%) revealed that they do not know the relevant authority to report to and that they would rather clean it up themselves, whereas 33.33% justified their passivity on the basis that "it is none of their business". This study found that older people tend to act better whenever they spotted illegally dumped HCRW (β=0.02±0.01, P=0.03). However, people’s attitude does not depend on education level (β=0.06±0.05, P=0.24) and gender (β=-0.16±0.31, P=0.60) but gender does determine the type of attitude: female tend to have the right attitude than male (β=-1.21 ± 0.55; P= 0.027). The analysis also reveals that educated people tend to have the right attitude (β=0.27±0.11, P= 0.01). All government officials who participated in the study reported inconsistent procedures to follow when an illegal HCRW is reported to them. The inconsistencies are prevalent in different governmental departments as well as within the same departments. This is likely because of the lack of a national legal framework to directly address HCRW management. The present study therefore recommends that the government should prioritise the development and promulgation of a national legislative framework to deal specifically with HCRW. In addition, the cohesion and cooperation between different governmental departments that are responsible for the management of waste should be facilitated to ensure interdepartmental consistency. Finally, public awareness initiatives should be done to inform the public about the risks related to poor handling of HCRW.M.Sc. (Environmental Management