Integrated life cycle assessment-systems thinking approach for medical waste management in Ghanaian hospitals

Ebenezer Aquisman, Asare and Dickson, Abdul Wahab and Elsie Effah, Kaufmann and Rafeah, Wahi and Zainab, Ngaini and Archibold, Buah Kwofie (2025) Integrated life cycle assessment-systems thinking approach for medical waste management in Ghanaian hospitals. Cleaner Water, 4. pp. 1-46. ISSN 2950-2632

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Abstract

This study integrates life-cycle assessment (LCA) with systems-thinking to evaluate medical-waste treatment options in five Ghanaian hospitals (KBTH, KATH, CCTH, BRH, UCCH). Using a functional unit of 1 kg mixed hospital waste, inventories were modelled in Brightway2/biosphere3 and characterised with CML v4.8 across eight impact categories. We compared current practice and five improvement scenarios and ranked options via entropy-weighted TOPSIS. Autoclaving emerged as the optimal treatment method with a TOPSIS score of 0.994 (CI: 0.992–0.997), followed by pyrolysis (0.990) and microwave treatment (0.986), while incineration plus landfill performed worst across toxicity and climate indicators. Reductions reported herein are relative (%) changes versus the baseline scenario at each facility. Scenario analysis demonstrates that smaller facilities can achieve complete impact reductions (-100 %) across most environmental categories through improved segregation and technology adoption, while larger facilities show varied improvements ranging from − 56.4 % to − 84.8 % relative to the baseline. Sensitivity analysis indicated that incineration and landfill treatments are highly sensitive to waste composition and segregation efficiency. Systems-feedback analysis highlights wastesegregation efficiency and emission controls as dominant levers. Findings indicate that upgrading segregation to ≥ 80–95 % and deploying non-burn technologies can yield large relative reductions in human-toxicity and climate-change impacts, supporting Ghana’s policy goals. This combined LCA–systems framework provides a transparent, replicable decision basis for hospital and regional planners. This is the first Ghana-focused framework that integrates LCA, systems thinking, and MCDA to rank hospital waste-treatment choices under uncertainty, quantifying facility-specific, relative impact reductions. It operationalizes evidence into a replicable decision tool for Cleaner Production in LMIC health systems. Practical relevance: across five Ghanaian hospitals, pairing non-burn treatment with ≥ 80–95 % segregation delivers 56–100 % relative reductions in toxicity indicators and ~75–89 % in climate-change impacts versus baseline. The integrated LCA–systems–MCDA tool is directly usable by hospital planners for Cleaner Production decisions.

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