Sociology of Health and the Environment: The Management of Infectious Medical Waste at the University Hospital (CHU) of Abidjan/Cocody, from Sorting to Incineration, Côte D’ivoire
Abstract
This study aims to draw the attention of actors involved in the management of infectious medical waste to the potential risks posed to human health and the environment. Cocody University Hospital (CHU de Cocody), due to its central role in the healthcare system, was selected as the research site. To achieve the study’sobjectives, scientific literature and results from field surveys were mobilized. Our investigations show that the informal and inadequate management of hospital waste at the CHU of Cocody is strongly linked to the neglect of established standards issued by the Ministry of Health as well as socioeconomic constraints. Waste sorting, which should be performed at the source by healthcare staff, is frequently bypassed. This failure greatly complicates the management of infectious medical waste. The repeated breakdowns of the incinerator are largely due to improper sorting practices, resulting in some infectious waste being diverted to landfills. Such waste becomes a source of contamination for soil, air, and both surface and groundwater, posing serious risks to all individuals exposed to it. The research highlights how social actors develop strategies that operate outside formal norms to meet their own interests.
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Introduction
The Ivorian population, or more precisely the resident population as defined in the General Population and Housing Census (RGPH), increased from 6,709,600 inhabitants in 1975 to 29,389,150 inhabitants in 2021. This represents a significant demographic expansion over a span of fifty years. Regarding the use of healthcare services, the national rate of access to health facilities rose from 67% in 2016 to 70.17% in 2020. This increase, attributed to improved technical capacities in healthcare facilities, led to a higher number of patient visits. Combined with numerous health interventions, including vaccination campaigns, the result is a substantial rise in the production of medical waste.
The management of this waste—estimated at 25.55 tons of solid waste per day, or approximately 9,325.09 tons annually—is a major public health and environmental concern. Poor sorting practices persist, with 38% of public institutions failing to separate waste at the source. This elevates the proportion of infectious, sharp, and hazardous waste.
Healthcare facilities have recently benefited from rehabilitation and equipment upgrades through a large five-year program (2016–2020) implemented by the Government and its international partners. The Ivorian health system, like many others globally, is mixed and pluralistic, comprising both public and private actors. According to the 2020 National Health Statistical Survey (RASS), Côte d’Ivoire has 3,831 healthcare facilities, with 60% belonging to the public sector and 40% to the private sector.
The healthcare system is structured into three levels—primary, secondary, and tertiary—organized in a pyramidal form. Cocody University Hospital, a key component of the tertiary level, was chosen as the research site. This study aims to raise awareness among actors responsible for infectious medical waste management regarding the risks such waste poses to human health and the environment. Scientific literature and survey data were used to formulate recommendations.
Conclusion
The management of infectious medical waste is an essential component of healthcare activities within all health facilities. Despite its importance, it continues to represent a major public health concern. Medical waste management, particularly at the Cocody University Hospital, remains a significant challenge that requires urgent attention and sustained corrective action. The government has undertaken several initiatives aimed at improving waste management practices. These include training specialists in the field, integrating medical waste management modules into the university curriculum for medical and paramedical students, and organizing workshops and awareness programs. Additionally, regulatory frameworks, codes of practice, and the National Plan for the Management of Medical Waste (PNDGS) have been introduced to guide healthcare institutions in adopting appropriate procedures.
However, despite these efforts, the management of infectious medical waste in healthcare facilities—and especially at the Cocody University Hospital—remains inadequate. Observations from this study indicate that waste is not being handled in accordance with established standards. This highlights the need for stronger monitoring systems, improved infrastructure, enhanced staff training, and stricter enforcement of regulations to ensure safe, effective, and compliant waste management practices.
CONFLICT OF INTEREST The authors declare no conflict of interest.
