A study related to the management of medical and pharmaceutical wastes in Beni mellal-Khenifra region: Beni mellal city as a case of study

S. Msaad, N. Abbadi, M. Mbarki, S. Rabi, N. Belkhouya, A. Gamouh 1 Laboratory of Applied SpectroChemisry and Environment. Faculty of Sciences and Technologies, University of Sultan Moulay Slimane (BP) 592, Beni Mellal, Morocco. smsaadi@yahoo.fr 2 Laboratory of Biological Engineering. Faculty of Sciences and Technologies, University of Sultan Moulay Slimane (BP), 592, Beni Mellal, Morocco. 3 Laboratory of Chemical Processing and Applied Materials .Multi-disciplinary Faculty, Sultan Moulay Slimane University (BP), 592, Beni-Mellal, Morocco


Introduction
Medical waste management is of major concern due to the potentially high risks to both human health and the environment caused by inadequate waste management practices [1] as the world accumulates more wastes which can be seen as any useless, unwanted or discarded substance or material, irrespective of whether or not such substance or material has any other or future use [2]. Hospitals and medical centers are not the exception. The development of medical technology has increased the production of different types of wastes, which can threaten the environment and Jeopardize human health [3]. Among these wastes, we have pharmaceutical wastes, which are seen as one of the hazardous wastes class in the hospital [4].
According to the International Health Organization, in its note in 2007, it is stipulated that there was not inexpensive options, which have no effect on the environment, for eliminating hospital wastes with safety.
In Morocco, the management of wastes is a priority for the Government to protect the environment and people's health without forgetting also that the mismanagement of health care waste poses risks to people and environment [5]. In keeping with this , Dr. Anjali along with other experts in their article claim that Improper management of health care waste can have both direct and indirect health consequences for health personnel and to the environment [6]. Since many years, the quantity of wastes produced continues to increase to the extent that it has created a challenge for the workers working in this domain; hence the quantity produced is estimated by 21 000 tons per year [7].

Abstract
After having conducted an investigation about landfill in Beni Mellal city, Medical and Pharmaceutical Wastes (MPWs) are unloaded mixed with household and similar wastes. The objective of the present study aims primarily at determining the source of medical and pharmaceutical wastes, evaluating and analyzing their management at the level of Beni Mellal city, ameliorating the quality of collecting and consequently minimizing the management costs of these wastes. First of all, we have created database concerning the location of health centers (HC). After, we have conducted a survey with the help of a questionnaire distributed in different public and private health centers. Then we have carried out a research on MPWs in Dustbins existing around the health centers. We have also made an analysis of the management system of MPWs inside The Regional Hospital Center (RHC) in Beni Mellal. Afterwards, we have made a comparison between some hospital centers in Morocco when it comes to the management costs of MPWs.Based on the results obtained; we have suggested some solutions to master the management system of MPWs in addition to the scenarios for optimizing the costs linked with this service.
As part of its strategy to the problematic of MPWs, the Moroccan Government, through its ministry of health, encourages private sector to invest in private processing units.
The Moroccan Government has adopted a number of laws in the domain of MPWs management which are as follows:  In the past, there has been a problem in law. Huge quantities of hospital wastes are eliminated without any prior processing, simply by landfill or burial method, which is viewed as one of the popular methods because all wastes after minimization or treatment need access to land or final disposal [8] as it is indicated in figure 1.
In reality, this method does not eliminate the harmfulness of wastes, but they have an effect, especially because improperly dispose of medications potentially pose environmental risk [9], and the disposal of pharmaceutical wastes depends on Multiple factors. For example, a particular pill, depending on its characteristics, could be hazardous waste [10]. These wastes constitute a reservoir of microorganisms which can cause some diseases, like SIDA, hepatitis A and B, Gastroenteritis, skin diseases, and the list is long [11]. According to the Article entitled "Medical Waste Management Community Health Centers" written Mohamad Saadati along with other researchers, Some hazardous agents such as HIV, Hepatitis B and hepatitis c, are transferrable through medical wastes [12].
Our study is the first study carried out in the domain of MPWs at the level of Beni Mellal region; it is about the problematic of managing medical and pharmaceutical wastes at the level of Beni Mellal and the objectives are to: -Analyze and evaluate the management system of MPWs at the level of Beni Mellal city.
-Suggest some solutions and scenarios for optimizing the costs linked with this service .
-Ameliorate the quality of collecting and handling wastes. or develop an Efficient strategy for pharmaceutical wastes disposal [13], by providing good health care risk waste management practices [14]. We have visited the landfill of Beni Mellal two times a week during three months.

Material and Methods
We have created database concerning the location of health centers. After, we have conducted a survey with the help of a questionnaire (see annex1), and we have looked for MPWs in the dustbins existing around the health centers. We have analyzed and evaluated

Health Centers in Beni Mellal:
We have identified 29 health centers existing in different areas in Beni Mellal city, where its location is indicated in the map of annex 2. The number of each type of health center is illustrated in the table 1 below: Conducting a survey with the help of a questionnaire inside the health centers in Beni Mellal. We have conducted an investigation inside a number of health centers, and the results are the following:  Given the sensitivity of the sector and for the confidential reasons, just 33% of health centers have answered the questionnaire.  60 % of the participants know about the legal framework of MPWs.  100% of the participants have confirmed that MPWs have hazardous effects on public health and environment.  50% of the participants investigated have benefited from a training in relation to the management of MPWs  100% the centers inquired have made some conventions with private operators about the management of MPWs.  100% of health centers inquired have appointed a person responsible for monitoring the management of MPWs.  Sorting out and MPWs conditioning constitute 100% in the private health centers and less in the public ones.  100% of health centers investigated have a place for storing MPWs.

Carrying a survey about MPWs in the garbage bins around the health centers.
This investigation is demonstrated in (Figure 3). We have looked for MPWs in every dustbin existing near the health centers. The result of this operation is negative. There are no MPWs in those dustbins. We have looked for medical wastes in garbage bins existing around the Health Centers three times a week in different places during four months.

Analyze and Evaluate the Management System of MPWs inside RHC in Beni Mellal
The objective of this stage in our study is to make an audit inside RHC in Beni Mellal so as to see the degree of respecting the procedure of managing MPWs inside every service.
The amount of hospital wastes, Household and similar wastes produced by RHC in Beni Mellal is indicated in the table below. After analyzing the quantity of MPWs produced by RHC in Beni Mellal, it is observable that the maternity section produces more MPWs (see the quantity produced in the graph below).   The analysis of MPWs management costs in different health centers shows that the costs are not fixed. Consequently, the costs vary depending on the requirements of each health center (The special conditions document).
The analysis of different previous results has led us to formulate the following remarks:  The necessity of enhancing training and sensitization side of the staff working in those health centers for better understanding of the process of eliminating MPWs;  Private health centers master well the management of MPWs better than the public ones;  Periodic maintenance of materials of managing MPWs inside RHC is a factor determining the process of management;  The cost of eliminating MPWs inside Beni Mellal city is slightly high, and it depends basically on how far are they from the processing sites and the quantity to be processed.

Conclusion and perspectives
Our work has brought up results which are the first in the domain of managing MPWs at the level of Beni Mellal region. These results have led us to diagnose the mode of managing MPWs at the level of the region and detect the defects that exist. Improving the management system of MPWs at the level of each health center is necessary. This improvement focuses on sensitization and staff training, offering equipment for handling MPWs. There must be necessarily a control over these health centers by paying unexpected visits and suggesting some improvements every time if necessary.
Given its potentials and geographical vocation, Beni Mellal city has an important industrial zone, and installing a processing unit for MPWs with a great amount of capacity would allow to:  Reduce the costs of transporting MPWs;  Minimize the duration of MPWs storage; hence the energy consumed by the refrigerators will be reduced and the risk of infected wastes will be diminished as well;  Encourage different private health centers to adhere to this unit with competitive prices, hence the probability of finding these wastes in the landfill decreases;  Possibility of managing MPWs at the regional level;  Offering more job opportunities at the level of the region.