Climate-smart healthcare waste management in urban primary health care facilities in Abuja, Nigeria: A situation analysis, proof-of-concept comparative baseline assessment of environmental sustainability practices and system readiness across four facilities
This proof-of-concept study assessing four primary healthcare facilities in Abuja, Nigeria, reveals that while waste segregation is largely functional, critical gaps in treatment and disposal—specifically the reliance on open burning and lack of renewable energy—result in significant environmental and climate risks, thereby validating the need for the proposed ClimateSENSE intervention to enhance climate-smart waste management practices.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Every day, primary health care clinics in cities like Abuja, Nigeria, treat patients, deliver babies, and run laboratory tests. This essential work generates a steady stream of medical waste, ranging from used bandages and empty medicine bottles to sharp needles and contaminated gloves. While much of this trash is harmless, a significant portion is hazardous. If not handled correctly, it can spread disease to the people who collect it, the patients who visit the clinic, and the surrounding community. Beyond the immediate risk of infection, the way this waste is disposed of has a growing impact on the planet. In many low-resource settings, the most common way to get rid of medical trash is to burn it in open pits. This practice releases toxic fumes and greenhouse gases into the air, contributing to climate change and local air pollution. As the global health community increasingly recognizes that fighting disease and protecting the climate are linked goals, there is a pressing need to understand how these clinics currently manage their waste and where they might fail.
A team of researchers from eHealth Africa recently stepped into this gap to take a close look at four primary health care facilities in Abuja. Their goal was not to survey every clinic in the region, but to test a new way of measuring how ready these facilities are to handle waste safely and sustainably. They wanted to see if a structured checklist could reveal the hidden strengths and weaknesses of the system, from the moment a piece of waste is created to the moment it is destroyed. The researchers visited four distinct clinics: two government-run centers in busy peri-urban areas, one in a lower-density neighborhood, and a private clinic operated by the research organization itself. Over the course of their assessment, they watched how staff worked, interviewed doctors and cleaners, checked logbooks, and inspected the physical spaces where waste was stored and treated. They looked for everything from the availability of color-coded bins to the functionality of machines designed to sterilize dangerous materials.
The study revealed a system that works well in some places but breaks down at the most critical moments. The clinics were surprisingly good at the first steps of the process. Staff generally knew how to separate different types of waste, and color-coded bins were usually available at the point of care. Sharps, like needles, were mostly kept in puncture-proof containers. However, as the waste moved further down the chain, the system faltered. The researchers found that while some facilities had machines called autoclaves—devices that use steam and pressure to kill germs in medical waste—many of these machines were either broken or not being used correctly. In several clinics, the equipment was present but silent, or the staff lacked the training and the logbooks needed to ensure the sterilization process was actually working. Without a reliable way to treat the waste, the facilities were forced to rely on the only option available to them: burning.
Open burning was the primary method of disposal in three out of the four clinics. The researchers observed soot marks and ash residues that confirmed this was a routine, daily practice rather than an occasional emergency measure. What made this particularly dangerous was that the waste being burned was often a mix of plastics, rubber, and organic materials, and the staff used fuel accelerants like petrol or used engine oil to get the fires started. This combination releases a cocktail of toxic chemicals into the air. The study also highlighted a major blind spot: the clinics simply did not know how much waste they were producing. Most facilities did not weigh their trash or keep records of the volume they generated. When the researchers tried to estimate the amount of carbon dioxide these clinics were releasing into the atmosphere based on the number of patients they saw, the results were stark. The four facilities were estimated to emit roughly 7.7 tonnes of carbon dioxide per year from their waste alone. This number was based on a standard calculation, but the researchers noted that the clinics' own guesses about their waste volumes were wildly inconsistent and unreliable, suggesting the real environmental impact could be even harder to track than currently thought.
Despite these significant gaps, the study offered a glimmer of hope by showing that better performance is possible within the same context. One of the private clinics, which had more resources and a dedicated management team, scored much higher on the readiness assessment. This facility had functional treatment equipment, kept records of its waste, and even began tracking its carbon emissions. It proved that with the right support, a primary health care center in Abuja could manage its waste in a way that protects both people and the planet. The researchers concluded that the biggest failures were not due to a lack of knowledge among the staff, but rather a lack of functional infrastructure and reliable systems. The clinics had the tools to separate waste, but they lacked the tools to treat it safely without burning it.
The findings suggest that fixing this problem requires more than just training; it requires a structural shift. The researchers are now designing an intervention that will provide solar-powered autoclaves to replace the reliance on open burning. By using renewable energy to power the sterilization machines, the project aims to cut both the health risks and the carbon footprint of these clinics. The study also emphasizes the need for better data. Until clinics start weighing and recording their waste, it will be impossible to measure progress or hold systems accountable. This initial look at four facilities serves as a proof of concept, demonstrating that a detailed audit can pinpoint exactly where the system is failing. It shows that while the current reality involves open fires and broken machines, a cleaner, safer, and more climate-smart future is within reach if the right investments are made in the infrastructure that sits between the patient and the trash bin.
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