Healthcare Waste Management in the Context of Global Health Initiatives

Dr. Christoph HamelmannRegional Team Leader and Senior Advisor

(Europe, Central Asia and Arab States)HIV, Health and Development

Coordinator, Sustainable Procurement in the Health Sector (iIATT-SPHS)

Healthcare Waste Management in the Context of Global Health Initiatives

Ignacio Sanchez DiazConsultant to the SPHS and UNDP Regional

HHD Team for Greening Health Systems with focus on Sustainable Procurement

Pathways of Environmental Footprint Related to Healthcare Waste in Global Health Initiatives

WHO core principles (HCW)

Governments should: Include adequate budgets for the management of

healthcare waste (HCW) Request donors, partners and other sources of

external financing

Donors and partners should: Include HCW management components in their

health programme assistance Include budget for sound management of HCW

generated through their programmes Include HCW management in health systems

strengthening components

What the others do…

Environmental Safeguarding is today a standard in nearly

all international major health projects.

Example GAVI

Started to take responsibility already in 2007

HCW included in Injection Safety activities (in GAVI context)

Supported dozens of countries in the development of HCW management plans

Included HSS for waste management in the grants

HCW equipment and budgeting for HCW services is a standard in all grants today

Example GEF/UNDP Global Project

Supporting the Stockholm Convention

Demonstrating and promoting the use of best practices and techniques for healthcare waste management in 7 countries: o Argentina, India, Latvia, Lebanon, Philippines,

Senegal, Tanzania, Vietnam

Goal: to protect public health and the global environment from the impacts of dioxin and mercury releases

Examples of Non-Incineration Technologies Demonstrated by the GEF/UNDP Project in Different Countries

Autoclave technologies• Autoclave and shredder – Senegal, Vietnam,

Philippines• Very large autoclave (5 tonnes/day) and compactor -

Vietnam

Advanced hybrid autoclave systems• Hybrid autoclave with internal shredding - Lebanon• Rotating autoclave - Latvia

Microwave technologies - Latvia

Alkaline hydrolysis technology for anatomical waste - Latvia

Vietnam: large autoclave

Lebanon: hybrid autoclave

Latvia: rotating autoclave

Latvia: microwave

Gonin, Etienne: “UNDP’s activities on Health Care Waste Management: reducing human exposure to dioxins and furans”. April 2015. PowerPoint Presentation

Example Ebola response Support by UNDP, GEF, Government of Korea (USD 4 million) and

Government of South Africa

Supporting health systems of Ebola-affected countries

Autoclaves as alternative to burning waste in open pits, barrels or inexpensive incinerators

Close-up of the Ebola-infected waste in the red zone. They pour kerosene and burn it at night. Note syringes on the ground.

Example of situation in waste treatment in Ebola area (photos from Jorge Emmanuel and Babacar Ndoye)

Gonin, Etienne: “UNDP’s activities on Health Care Waste Management: reducing human exposure to dioxins and furans”. April 2015. PowerPoint Presentation

New affordable non-incineration technology is now available for Africa

Multiple vacuum autoclave with sterilization at 134 deg C Manufactured by Medi-Clave Pty Ltd (Pretoria, RSA) Developed in collaboration with the

GEF/UNDP Project 175 liters per cycle, 1 to 1.5 hours per cycle Dimensions: 1.1m x 1.5m x 2m high Certified to meet or exceed international

autoclave standards (ASME, STAATT) Includes boiler, all stainless steel construction Special trolley with barrel to collect waste;

the whole barrel slides into the autoclave to be sterilized

After treatment, the barrel can rotate to dump out treated waste

Gonin, Etienne: “UNDP’s activities on Health Care Waste Management: reducing human exposure to dioxins and furans”. April 2015. PowerPoint Presentation

Sample Impact for Global Fund Grants

Name of Convention Possible consequence

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

Rotterdam Convention Selection of pesticides for spraying (malaria)

Vienna Convention/ Montreal Protocol

Refrigerator without CFC (chlorofluorocarbon) and HCFC (hydrochlorofluorocarbon)

ADR (European but 48 states are party)

Requirements on transport and transport packing for hazardous goods and waste

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

Assessing the Impact of GF Grants

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

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)

Waste Management Systems• Waste management systems do often not

exist

• Basic waste logistic equipment does not exist

• Hazardous and non-hazardous waste is collected togehter

• Frequent accidents are reported (needle stick)

• Responsibilities are unclear

• Budgets for financing consumables and waste services are missing

Available Infrastructure Healthcare waste treatment and disposal infrastructure extreme

weak Simple incinerators exists which create environmental problems

(Dioxin)

Support of the Implementers

Taking Responsibility:UNDP is currently active to develop a practical toolkit for healthcare waste

management

Sustainable Procurement in the Health Sector (SPHS)

Establishment of evidence-based standards

Capacitation of UN procurement officers, suppliers and health actors

Engagement with key stakeholders from the health sector

http://iiattsphs.org

Sustainable Procurement in the Health Sector (SPHS)

Focus on three dimensions

Greenhouse gas emissions (GHG)

Resource depletion (water, energy and material consumption)

Chemical pollution

www.iiattsphs.org

Sustainable Procurement in the Health Sector (SPHS) - Network

UN-SPHS internal Gov./EU/Other organizations

Suppliers/Manufacturers

Overall

≈ 900 ≈ 590 ≈ 2000 ≈ 3500

Network list summary

Contacts in 92 countries covering all the regions

http://www.slideshare.net/undpeuropeandcis/healthcare-waste-management-assessment-and-strategies-for-global-fund-projects

http://www.slideshare.net/undpeuropeandcis/healthcare-waste-environmental-safeguarding-of-global-health-initiatives

http://www.eurasia.undp.org/content/rbec/en/home/library/hiv_aids/rapid-assessment-healthcare-waste-global-fund/

christoph.hamelmann@undp.orgtwitter: @cahamelmann