Healthcare waste management assessment and strategies for global fund projects

United Nations Development Programme

'Saving Lives Sustainably'

Healthcare Waste Management Assessment and Strategies for Global Fund Projects

Dr. Christoph Hamelmann, UNDPJan-Gerd Kühling, ETLog

Presentation at The Global FundGeneva, 15 April 2015

The Guiding Principles

Following Primum Non Nocere Guarding Human Rights Acceptance of Polluter Pays Supporting Greening the Blue Supporting UNDP Environmental and

Social Standards

Assessing Practice and Potential Impact

To assess the possible environmental impact of GF grants, rapid assessments on healthcare waste were carried out

Pathways of Environmental Footprint Related to Healthcare Waste

Example: HIV / AIDS Grants

General waste Infectious waste from HIV and STI

testing Sharps waste (including syringes

from PWID) Pharmaceutical waste (ARVs or

medicines for the treatment of opportunistic infections)

Example: TB Grants

General waste Infectious waste from testing

including highly infectious waste (BSL 3 labs)

Chemical waste Sharps waste Pharmaceutical waste (first- and

second-line anti-TB medicines)

Tanzania - medical waste. © 2013 by Global Environment Facility

Tanzania - medical waste inside. © 2013 by Global Environment Facility

Example: Malaria Grants

General waste Infectious waste from

testing and sharps waste Pharmaceutical waste

Toxic chemical waste (indoor spraying, contaminated packing, disposal of used LLINs)

What are we talking about…

Hazard identification for ARVs and ACTs - Example: Efavirenz (based on MSDS)

Hazard identification for Efavirenz:o Hazard statement(s) : H400 Very toxic to aquatic life. o Precautionary statement(s): P273 Avoid release to the

environment.

Potential health effects of Efavirenz: o Inhalation: May be harmful if inhaled. o Ingestion: May be harmful if swallowed. o Skin: May be harmful if absorbed through skin. o Eyes: May cause eye irritation.

Overview – Waste Streams

International Agreements

Name of Convention Topic

Basel Convention Transboundary movement of hazardous waste

Stockholm Convention Persistent Organic Pollutions (POPS) e.g. Dioxins, PCB, DDT

Rotterdam Convention Consent Procedure for Certain Hazardous Chemicals and Pesticides

Vienna Convention/ Montreal Protocol

Protection of the Ozone Layer

ADR International Carriage of Dangerous Goods by Road

Minamata Convention Anthropogenic emissions and releases of mercury

Sample Impact for GF Grants

Name of Convention Examples of potential interventions

Basel Convention Tracing of to-be-returned pharmaceuticals / chemicals from countries to supplier

Stockholm Convention Usage of alternative treatment systems for infectious waste instead of incinerators; substitutions

Rotterdam Convention Selection of pesticides for spraying (malaria)

Vienna Convention/ Montreal Protocol

Refrigerator without CFC (chlorofluorocarbon) and HCFC (hydrochlorofluorocarbon)

ADR Requirements on transport and transport packing for hazardous goods and waste

Minamata Convention No supply of mercury containing medical devices (thermometer, sphygmomanometer)

Waste Management Systems Country Level

Waste management systems do often not exist

Basic waste logistic equipment is often inadequate

Hazardous and non-hazardous waste is collected together

Frequent accidents are reported (needle stick)

Responsibilities are unclear Grant budgets dedicated for financing

waste management are largely missing

Tanzania - healthcare waste was improperly disposed. © 2013 by Global Environment Facility

Waste Management Systems Country Level

Healthcare waste treatment and disposal infrastructure generally weak

Simple incinerators exists which create environmental problems (dioxins)

Taking Responsibility

UNDP is developing a practical HCWM toolkit for Global Fund practitioners and policy makers

Target: Environmental Safeguarding Integrated in all GF NFM Grants

WHO Core Principles (HCW)

Sustainable Procurement in the Health Sector (SPHS)

Establishment of evidence-based standards

Implementation of environmental product specifications and procurement criteria

Engagement with suppliers / manufacturers and global health financing agencies

Sustainable Procurement in the Health Sector (SPHS)

Three dimensions: Greenhouse gas

emissions (GHG)

Resource depletion (water, energy and material consumption)

Chemical pollution

Sustainable Development Aid

USAID Sustainability Policy Statement DFID Corporate Social and Environmental Responsibility Statement

What the Others Do…

Environmental Safeguarding is today a standard in nearly

all international major health projects.

Multilateral Financing Institutions Environmental Policies

Gavi Environmental Statemento Commitment to minimize the

impact on the environment

UNITAID Green Procurement Policyo UNITAID supports the 4 R’s strategy

- Re-think the requirements to reduce environmental impact- Reduce material consumption- Recycle materials/waste- Reduce energy consumption

United Nations Development Programme

TowardsSustainable Development Goals

Helen Clark

Keynote Address to Preparatory Session for the 3rd International Conference On

Financing for Development United Nations, New York, November 2014

‘The SDGs require major changes to be made in how public monies are

used to address international challenges.’

United Nations Development ProgrammeSaving Lives Sustainably

Protecting Millions of People Against Malaria in Chad © 2015 The Global Fund (Andrew Esiebo)

United Nations Development Programme

christoph.hamelmann@undp.orgTwitter: @cahamelmann

Christoph HamelmannUNDP

Jan-Gerd KühlingETLog

Kristian SteeleARUP