Understanding the perceptions, roles and interactions of stakeholder networks managing health-care waste: a case study of the Gaza Strip

The sustainable management of waste requires a holistic approach involving a range of stakeholders. What is often difficult is to understand the manner in which different networks, like information and interaction, are composed and work, and to enhance their effectiveness. Using social network analysis and stakeholder analysis of healthcare waste management stakeholders in the case study region of the Gaza Strip, this study aimed to understand and examine the manner in which the networks functioned. The Ministry of Health was found to be the most important stakeholder, followed by municipalities and solid waste management councils. Some international agencies were also mentioned, with specific roles, while other local institutions had a limited influence. Finally health-care facilities had a high interested in waste management, but were poorly informed and linked each other. The manner in which the network operated was complicated and influenced by differences in perception, sharing of information, access to finance and levels of awareness. In particular the lack of a clear legal framework generated various mistakes about roles and responsibilities in the system, and evidently regulation was not an effective driver for improvement. Finally stakeholders had different priorities according to the waste management phases they were involved into, however segregation at the source was identified as a key requirement. Areas for improving the effectiveness of the networks are suggested. The analysis utilized an innovative methodology, which involved a large number of stakeholders. Such an approach raised interest and awareness at different levels (public authorities, health providers, supporting actors, others), and stimulated the discussion about the adoption of specific policies, and the identification of the effective way forward.