Welcome to the SPHS Webinar Series

"Effective Communication for Innovation in Sustainable

Procurement in the Health Sector"

www.savinglivesustainably.org

December 7, 2017

Agenda

1. Welcome remarks by the moderator

2. Introduction to speakers

3. Presentations

• UNDP: Introduction to the SPHS initiative

• Health Care Without Harm: Transforming Health

Care

in the Era of Climate Change: Resilience, Mitigation

and Leadership Strategies

• ETLog Health EnviroTech & Logistics GmbH:

Reducing UPOPs and Mercury Releases from the

Health Sector in Africa

4. Q&A

Speakers

John StrongPresidentGreenhealth Exchange

Jan-Gerd KühlingManaging PartnerETLog Health EnviroTech & Logistics GmbH

Sustainable Procurement in the Health Sector

(SPHS)

Dr. Rosemary Kumwenda

SPHS Coordinator and Team Leader for Regional

HIV, Health and Development, UNDP Europe and

CIS

SPHS Webinar Series : Effective Communication

for Innovation in Sustainable Procurement in

the Health Sector, December 7, 2017

INTRODUCTION

Global perspectives on health and environment

SPHS Task Team is, through a transparent and inclusive engagement process, leveraging its normative and market power, lowering the

environmental impact of its procurement, with a final aim of improving human health and well-being.

Procurement Statistics 2015

Procurement Statistics 2013 - 2015

Procurement Statistics 2013 - 2015

Linking our work to the Sustainable

Development Goals and Key Focus Areas

More global than ever

Online Knowledge-Hub on Good Practices in

Sustainable Health Procurement and

Manufacturing:

www.savinglivesustainably.org

The SPHS global network of collaborators

Communication Statistics 2016

Looking Forward –

More Sustainable Health Policies, Strategies and

Practices

GET IN TOUCH @ www.savinglivesustainably.orgTwitter: @UN_SPHS

We look forward to working with you on a more sustainable global health sector.

Transforming Health Care in the Era of Climate Change:

Resilience, Mitigation and Leadership Strategies

John Strong, President

Greenhealth Exchange, a Practice Greenhealth Affiliate

SPHS Webinar Series : Effective Communication for Innovation

in Sustainable Procurement in the Health Sector, December 7,

2017

PRESENTATION #1

The first scientific study to link health data to U.S. climate events found that for six cases between 2002 & 2009 the health care cost totaled over $14 billion dollars (Health Affairs, 2011).

• Smog, Nationwide, 2002

• West Nile, LA 2002

• Wildfires, CA 2003

• Hurricanes, FL 2004

• Heat Wave, CA 2006

• Flooding, ND 2009

Health Costs of Climate Change

Climate Change Related Case

Study

Premature Death

IllnessTotal Health Cost by Case

Study

Ozone smog pollution

$6.3 billion $254 million $6.5 billion

Heat wave $5.2 billion $179 million $5.3 billion

Hurricane $1.1 billion $255 million $1.4 billion

Wildfire $545 million $34 million $578 million

Mosquito-borne

infectiousdisease

$190 million $18 million $207 million

River flooding $16 million $5 million $20 million

Total cost $13.3 billion $744 million $14.1 billion

Source: NRDC

Health costs in climate change related case study areas, with costs per health effect, 2002-2009

4.3

3.7

1.5 1.5

0.6

Indoor Air Pollution

Outdoor Air Pollution

HIV / AIDS Tuberculosis Malaria

Source: World Health Organization 2013-2014

Annual Global Deaths (Millions)

What transformation or success lives at the intersection of all?

Transform / Lead

Adapt / Anchor

Mitigate

Heal

Less Harm No Harm

What is the Role of theHealthcare Sector?

• Transitioning away from fossil fuels to a low carbon economy

• Fuels a clean energy/green chemistry revolution that creates millions of jobs

• Reduces health impacts from fossil fuels/toxic chemicals

• Lowers health care costs

• Helps solve the climate crisis

Climate Change: the Greatest Health Opportunity of the 21st Century– The Lancet 2015

Developing the strategy

Link to International

network of partners

Modeling innovation with

U.S. health care partners

Market Transformation

Group

Building the collaboration

with hospitals and suppliers

Sustainable Purchasing

Institute

Educating 1,400 hospitals

Elevating EPP case studies

Socializing total cost of

ownership approach

Scaling the solutions

Building demand for GX

Evaluating and specifying

better products used by

healthcare providers and

accelerating their adoption

Aggregating EPP

purchases in marketplace

and executing contracts to

drive price lower

Support women, minority-

owned businesses, local

and regional suppliers

Innovating for low-carbon,

toxic-free products and

technologies

Documenting benefits

achievedConfidential

• Energy

• Water

• Chemicals

• Food

• Waste

Identify Issue

• Packaging

• Recyclability

• Chemical/Material Make-up

• Transportation

• Manufacturing Process

• More

Establish Standards

• Market Strength Through:

Conversions & Commitment

Leverage Volume

GX Moves the Market

Signaling suppliers that change is

required

Focused on areas that make

the greatest difference

Using purchasing demand as agent

for change

To create an ecologically sustainable, equitable and healthy world by:

accelerating the adoption and use of safer, greener products by leading healthcare systems,

catalyzing innovation in next generation product development, and

inspiring similar action in other sectors.

Our Mission

33Confidential

• B Corp operated as a for-profit cooperative

• GX Member Patrons serve on Board, Contracting Committee and Product Subcommittees

• GX publishes annual public benefits report

• Each owner receives benefits reports based on their purchases

Board of Directors

Contracting Committee

Product Subcommittee

Product Subcommittee

Product Subcommittee

Our structure

Confidential

Subject Matter Experts

Current owners of Greenhealth Exchange

GX Progress Toward MissionAccelerate adoption, same or lower prices

Key Supplier Partner1,800 fully curated products in

“formulary”Beginning work with manufacturers

Results:

6% savings, increased sustainable from 31% -- 60%

7% savings, increased sustainable from 28% -- 59%

10% savings, increased sustainable from 33% -- 62%

This equaled savings of $900,000 annually for one of these systems.

Everyone across the globe has a right…

…to a safe and clean environmentwhere healthcare upholds our dictum:

First, do no harm.

Jan-Gerd Kühling

Managing Partner

ETLog Health EnviroTech & Logistics GmbH

PRESENTATION #2

Reducing UPOPs and Mercury Releases from the Health Sector in

Africa

SPHS Webinar Series : Effective Communication

for Innovation in Sustainable Procurement in

the Health Sector, December 7, 2017

UNDP

Istanbul Regional Hub for Europe and

the CIS

Key Plaza, Abide-i Hürriyet Cd. İstiklal

Sk. No/11, Şişli, 34381

İstanbul, Turkey

Reducing UPOPs and Mercury Releases from The Health Sector in Africa

Effective communication for innovation in sustainable procurement in the health

sector

- Example of an ongoing project -

…to implement best environmental practices and introduce non-incineration healthcare waste treatment technologies and mercury-free medical devices in four Sub-Saharan African countries (Ghana, Madagascar, Tanzania and Zambia) to reduce harmful releases from the health sector.

Overall project objective

Under consideration to spur sustainable

development, innovation, and the green

economy in the sector…

Reducing UPOPs and Mercury Releases from The Health Sector in Africa

Why sustainable, green procurement?

Reducing UPOPs and Mercury Releases from The Health Sector in Africa

Why effective communication?

Outcomes:

⚫POPs releases to the environment reduced

⚫Country capacity built to effectively phase-out and reduce releases of POPs

⚫Country capacity built to effectively manage mercury in priority sectors

Indicators:

⚫Amount of un-intentionally produced POPs releases avoided or reduced

⚫Progress in developing and implementing a legislative and regulatory framework for environmentally sound management of POPs

⚫Countries implement pilot mercury management and reduction activities (green economy)

Outcomes and indicators of success

Requires: Sustainable development & Innovation!

⚫Main reasons for problems with HCWM:

Missing communication strategy!

Not considering that HCWM is a cross-cutting activity

Unclear and opposing interests and responsibilities are existent

Neglecting of workflows and waste stream management aspects

Missing know-how, innovation and underestimation of importance of logistic

Healthcare Waste

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Healthcare Waste Management MoEMoH

Lessons learned

Legislative Framework:

Laws and by-laws for

HCWM on different

levels

Financial Framework:

Clear strategy in how

to finance the total

costs of HCWM

Capacity Building:

Training system for

HCWM (operational,

monitoring and institute. )

Operational HCWM:

Segregation, Collection,

Treatment and Disposal

Adapted, National

HCWM Development Plan

„HCW Action Plan“

Requirements for a sustainable procurement strategy

Healthcare Waste National plans, implementation strategies, and national policies in each recipient country

⚫National policy and regulatory framework for HCWM and mercury phase-out.

⚫National action plan including the selection of up to 1 central or cluster treatment facility, 2 hospitals, and 3 small rural health posts as models.

Legislative Framework

Building capacity to assess, plan, and implement healthcare waste management (HCWM) and the phase-out of mercury

⚫Technical guidelines and SOPs to be developed

⚫Central training for national experts (duration 2 weeks) by end of 2016

⚫Training included theoretical & practical aspects, including ToT, PPP, pricing, technical aspects, operation and maintenance etc.

⚫Participatory approach: Items and equipment specifications commonly standardized for all countries

Capacity building activities

Need of building capacity to ensure sustainable

development, innovation, and the green economy?

Capacity building activities (ToT)

ToT – applied in the countries

ToT in the countries:

⚫Including of relevant aspects in official curriculums

⚫Cooperation with local training providers

⚫Development of new curriculums (post graduation training)

Make available in the region affordable non-incineration HCWM systems and mercury-free devices that conform to BAT and international standards (for 3 health posts, up to 2 hospitals, and 1 central or cluster treatment facility)

⚫Procurement is centrally carried out by UNDP, based on a commonly agreed on equipment catalogue

⚫Equal distribution among four project countries in the first phase

⚫Equipment for the second phase will be allocated according to performance assessed in the mid-term review.

Operational HCWM

Traditional Treatment Strategy: (Advanced) Incinerator

1. Combustion chamber

2. Combustion burner

3. Post-combustion burner

4. Primary and secondary air fan with automatic throttle

5. Hydraulic automatic loader

6. Automatic upturn of 770l bin

7. Heath exchanger

8. Gas extracting fan

9. Smoke evacuation

10. Control and regulation board

11. Neutralization and filtration of gases

12. Dust recovering tank

13. Ashes door

14. By-pass (recover +filter)

Option flue

gas treatment

Reducing UPOPs and Mercury Releases from The Health Sector in Africa

Innovative, green Treatment Strategy: Steam

Treatment

►Why is steam treatment getting today popular?

Least possible environmental impacts

Easy operation and simple maintenance

Safest way of treatment, as even sterilization is possible (means

one millionth survival probabiliy of pathogens!)

Low investment and operation costs

More than 30 years experience, easy to monitor and control

Technical Advantages/Disadvantages

⚫ Incineration:

Advantages: Wider spectrum of waste which can be treated,

less volume of waste

Disadvantage: High investment & operation cost, high

maintenance demand, needed solution for (fly) ash disposal

⚫ Steam treatment system:

Advantage: Medium investment cost, low operation cost, no

hazardous by-products, more easy to operated

Disadvantage: Can only treat bio-hazardous waste, low waste

volume reduction, high electricity & water demand

► Communication!!!

⚫“Influencing” the selection process

⚫Consideration of environmental impact (water and electricity consumption)

⚫Consideration of operation cost

⚫Consideration of maintenance requirements

⚫Consideration of available infrastructure

⚫Requires strong technical specifications to ensure innovations are considered!

Technology Selection

⚫Carried out need assessment in the countries, including infrastructure assessment

⚫Preparation of specification and infrastructure requirements for installation sites (buildings)

⚫Including of equipment for infrastructure and maintenance (water, electricity)

⚫Selection of equipment by countries based on standardized items and international technical specifications

⚫Including of “minor” equipment such as PPE, waste logistic equipment, equipment for operation of central treatment centers

⚫Challenge: International tendering under consideration of UN requirements

Procurement Process

Procurement Process

Including of infrastructure equipment

Piloting of environmental questionaire

Available at: https://issuu.com/informal_int_task_team_sphs/docs/undp_environmental_questionnaire_in

⚫Effective communication for innovation in sustainable procurement in the health sector requires:

►Creation of a framework to enable sustainable, innovative procurement and communication (replication)

►Building capacity to allow beneficiaries to select right equipment (ownership)

►Standardization of equipment and development of acceptable, international technical specification for procurement

►Consideration of the existing infrastructure

►Selection of equipment under consideration of BAT aspects and affordability (operation costs, maintenance)

Lessons learned

Q & A

GET IN TOUCH @ www.savinglivesustainably.orgTwitter: @UN_SPHS

We look forward to working with you on a more sustainable global health sector.