| Summary: | A dissertation submitted to the Faculty of Science, University of the Witwatersrand, Johannesburg, in fulfilment of requirements for the degree of Master of Science. Johannesburg, 25 July 2017. === In Angola, there is a high demand for orthopaedic appliances equipment, primarily as a result of the former civil war (Kapapelo, 2016), but also more recently due to lack of resources, endemic diseases such as poliomyelitis and meningitis, and an increase in road accidents among other things (República de Angola, 2015). There are eleven regional medical centres across Angola, but presently Centro de Medicina Física e Reabilitação de Luanda (CMFR) is the only hospital providing orthopaedic and prosthetic services across the country. It receives a large number of patients with different physical injuries who require this kind of service, resulting in the high demand for those orthopaedic appliances. Under the current circumstances, the CMFR finds it difficult to cope with this situation.
Given the high demand, and the lack of adequate resources at the national level, this thesis asks the question: why is there not a greater emphasis on the recycling of orthopaedic and prosthetic appliances? The thesis investigates why recycling of orthopaedic appliances waste is not happening at national level, with a particular focus on waste management regimes at CMFR. The findings interrogate the challenges faced by doctors and hospital administrators at CMFR, including the lack of capacity to execute its core mandate efficiently. This undermines the potential of increasing the local recycling and manufacture of orthopaedic appliances, which would be able to help in reducing expensive foreign importation of orthopaedic appliances materials, increase access, and thus reducing the long waiting-list for orthopaedic appliances equipment by people with disability at national level.
The initial findings showed that practices of mixing orthopaedic appliances waste with other types of both medical and urban waste in open dump areas are some of the current aspects which impede the implementation of a recycling system. The study findings also discovered that most of the stakeholders in CMFR have a very low level of commitment to managing orthopaedic and prosthetic appliances waste effectively, and / or feel disempowered to drive such initiatives in a context of a hospital already over-capacity. However, the lack of technical and financial capacity of these stakeholders and the absence of a coordinative framework greatly impede the proper orthopaedic and prosthetic appliances waste management practices at CMFR. The study therefore argues that improving orthopaedic appliances waste management largely depends on these critical factors: an effective and relevant legal framework with a specific focus on orthopaedic appliances waste management, skilled workers, and institutional strengthening in terms of funds to invest in orthopaedic appliances waste management. These issues need to be addressed in order to implement an orthopaedic and prosthetic appliances waste recycling system at CMFR. === LG2018
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