On a Sunday morning in mid-March, SEI researcher Andriannah Mbandi got a phone call from Anthony Wainaina, Deputy Director Public Health at Kenya’s Ministry of Health, who is coordinating waste management measures related to Covid-19.
Earlier in the year, Mr Wainaina had met Dr Mbandi at a World Health Organization (WHO) training session on pollution in Ethiopia, and knew about SEI and its work on air pollution and health.
The call led to a request from the Ministry for SEI’s support in setting up a task force that would develop guidelines and standard operating procedures for managing potentially infectious waste arising from Covid-19 risk areas in Kenya.
The Covid-19 outbreak is beginning to spread across Africa, and as of 23 April there have been more than 27 000 confirmed cases and 1200 deaths across the continent. Kenya’s government has put hard restrictions into place. There is a country-wide curfew between 7pm and 5am, and people are required to wear a protective mask covering mouth and nose at any time when outside the house.
Kenya’s quarantine facilities, where the authorities confine people who, for example, are arriving into Kenya, are not geared up to deal with potentially infectious clinical waste. Some of these facilities are schools and hotels, so there was a need to ensure that better procedures for managing this type of waste were established in line with existing national health and environment regulations. Also, at the household level, people have neither been equipped with the correct type of disposal equipment for infectious waste, nor have been sensitized on how to handle potentially infectious waste. Here, also, appropriate procedures were needed to complement existing interim guidance on infection prevention and control.
SEI Africa helped to identify and recommend experts in health and environment to join the task force by looking through the experiences of other countries to share with Kenya in collaboration with the United Nations Environment Programme (UNEP) and joining the task force, which also included the Ministry of Health, the National Environment Management Authority, the Kenya Medical Research Institute (KEMRI) and the Nairobi City County government.
The task force discussed the practicalities and challenges of managing potentially infectious waste in the different risk areas – homes, public spaces and retail areas and quarantine zones – to ultimately ensure safe transportation and disposal in situations with limited incineration capacity.
“How do you behave and act in these different contexts, e.g. in a quarantine facility, in retail areas and markets or in a household, and the problems you face when having to deal with large amounts of waste that is also potentially infectious? That’s what we asked ourselves in the task force,” said Dr Mbandi.
For the task force, it proved most difficult to tackle the problem at the household level, to ensure that people follow the guidelines fully. The task force also noted that the full and effective implementation of the guidelines would be difficult without additional support for key stakeholders, such as training of county public health officials. Also, waste management processes are very different depending on household income levels and localities; it is more formally managed in high-income areas compared with low-income areas, where it is dealt with informally. The solution was to propose more support to those public health officials in each county across Kenya who are the focal points for Covid-19 and have the overall responsibility for Covid-19 waste management, including in households and in the local quarantine facilities.
Citizens experiencing the symptoms of the virus are required to self-isolate as far as possible in their homes. Public health officials visit people with symptoms in situ, and the task force advised that as part of their visits they should provide advice on how to treat the waste and where and how to dispose of it, and also provide leak-proof liner bags and containers for potentially infectious waste.
“We need to reach out to the households with the right messages, and here I believe we are helping; we’re coming with a lot of experience on co-creation and communication of knowledge, as well as expertise in how to work with communities.”
– Andriannah Mbandi, Research Fellow, SEI Africa
After long deliberations within the task force, the Kenyan Government has formally adopted the new guidelines and the standard operating procedures for managing waste arising from the use of masks and other personal protective equipment. These have also been announced to the public by the Cabinet Secretary and Minister for Health.
SEI plans to continue this partnership and make sure that the ongoing messaging to citizens is tailored in ways that resonates with communities and households.
“Proper and safe disposal of waste from PPEs, including face masks is an essential part of the wider measures that the Ministry of Health is putting in place to control the spread of Covid-19 in Kenya. We are now working with the county governments and other partners to carry out an awareness and public education campaign to sensitize the general public on how to safely handle and dispose the masks,” said Wainaina.
The work in Kenya has generated momentum and an interest in other countries in Africa, and also in Asia, where countries are keen to learn from Kenya’s approach to managing waste during the pandemic. SEI is working with UNEP on the review of current practices and responses for medical waste management for Covid-19, which will be shared with stakeholders around the world.
SEI and UNEP are now sharing this experience with ten different countries in South Asia that are developing similar guidelines.
SEI together with UNEP, KEMRI, the Ministry of Health and the Ministry of Environment are taking forward the recommendations from the first Health, Environment and Climate Change Conference in Kenya that took place in December 2019, in line with strengthening collaboration between the environment and the health sector. Such collaboration was committed to by the 2008 Libreville and the 2010 Luanda Declarations, which created the Health and Environment Strategic Alliance (HEAL) and developed The Strategic Action Plan to Scale Up Health and Environment Interventions in Africa 2019–2029.