1) The document discusses healthcare waste management in the context of global health initiatives. It notes that healthcare waste systems often do not exist in developing countries and hazardous waste is mixed with non-hazardous waste. 2) UNDP is developing a toolkit for healthcare waste management and has assessed the environmental impact of Global Fund grants by examining waste from HIV/AIDS programs, which generates infectious, sharps, and pharmaceutical waste. 3) Infrastructure for treating and disposing of healthcare waste is often weak, with simple incinerators causing environmental problems. A project is reducing releases of dioxins, mercury, and pathogens from healthcare waste.

1. 1
Ignacio Sanchez Diaz
Greening Health Systems Specialist
UNDP Istanbul Regional HHD Team
UN informal Interagency Task Team onSustainable
Procurement in the Health Sector (iIATT-SPHS)
International Healthcare Waste Conference, Londo
April 14-15, 2016
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Healthcare Waste Management in the
Context of Global Health Initiatives

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

3. 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

4. Healthcare Waste Management Toolkit
Taking Responsibility:
UNDP is currently active to develop a practical
toolkit for healthcare waste management

5. Assessing the Impact of GF Grants
To assess the possible environmental
impact of GF grants, rapid assessments
on healthcare waste were carried out

6. 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)

7. Waste Management Systems
 Waste management systems do often not exist
 Basic waste logistic equipment does not exist
 Hazardous and non-hazardous waste is collected
together
 Frequent accidents are reported (needle stick)
 Responsibilities are unclear
 Budgets for financing consumables and waste
services are missing

8. Available Infrastructure
 Healthcare waste treatment and disposal infrastructure extreme weak
 Simple incinerators exists which create environmental problems (Dioxin)

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

10. UPOPs and Mercury
Project: Reducing UPOPs and Mercury release in the Health Care Sector
Partners: UNDP, GEF, WHO and HCWM
Countries: Ghana, Madagascar, Tanzania and Zambia
Toxin or
Pathogen
Originates from Health Effects
Dioxins • Burning of medical waste in the open
• Burning of medical waste in low-technology
incinerators
• Cancer of soft tissues, lung, liver and
stomach
• Birth defects
• Reproductive disorders
Mercury • Broken Mercury containing thermometers and
sphygmomanometers, Hg containing laboratory
chemicals, etc.
• Damage to the brain, nervous system and
kidneys
• Developmental disorders;
• Lower IQ
HIV,
Hep. B & C and
other pathogens
• Inadequate disposal, handling and
reuse/recycling of contaminated syringes and
other waste items
• 240 million Hep. B infected people
• 130 million Hep. C infected people
• 35 million HIV/AIDS infected people
(2015)
Gonin, Etienne: “Reducing UPOPs and Mercury release in the Health Care
Sector”. February 2014. PowerPoint Presentation

11. Project Components
1. Disseminate technical guidelines, establish mid-term evaluation criteria and technology
allocation formula, and build teams of national experts on BAT/BEP (Regional
component)
2. Develop Health Care Waste National plans, implementation strategies, and national
policies in each recipient country (National component)
3. a. Make available in the region affordable non-incineration HCWM systems and
mercury-free devices that conform to BAT and international standards (Regional
Component)
3. b. Demonstrate HCWM systems, recycling, mercury waste management and mercury
reduction at the model facilities, and establish national training infrastructures (National
component)
4. Evaluate the capacities of each recipient country to absorb additional non-incineration
HCWM systems and mercury-free devices and distribute technologies based on the
evaluation results and allocation formula. (Regional Component)
5. Expand HCWM systems and the phase-out of mercury in the recipient countries and
disseminate results in the Africa region (National and regional component)
6. Monitoring, learning, adaptive feedback, outreach, and evaluation.
Gonin, Etienne: “Reducing UPOPs and Mercury release in the Health Care
Sector”. February 2014. PowerPoint Presentation

12. International Environmental
Conventions on Chemicals
This novel and unique tool will allow
procurement practitioners to measure and
monitor the status and progress of healthcare
procurement related to the compliance with
International environmental Conventions
The indicators proposed as part of this guide are
intended to serve as a building block of the
GPIH and the compliance with International
environmental Conventions might be considered
as one of the pillars for the development of the
Index

13. INTRODUCTION
Checklist, Indicators and Guidance

14. Automated Report Dashboard

15. INTRODUCTION
SPHS Task Team is, through a transparent and inclusive
engagement process, and by leveraging its normative and
market power, lowering the environmental impact of its
procurement, with a final aim of improving human health
and well-being.
INTRO with UNDP LOGO 7 UN agencies and
3 multilateral health financing institutions
SPHS Task Team

16. Engagement with the key stakeholders
from the global health aid market
CTION
SPHS Task Team is, through a transparent and inclusive
engagement process, and by leveraging its normative and
market power, lowering the environmental impact of its
procurement, with a final aim of improving human health
and well-being.
3,500 institutions/experts in
our global network and 92
countries
SPHS Task Team

17. INTRODUCTION
Key objectives

18. savinglivesustainably.org

19. THANK YOU FOR YOUR
ATTENTION.
19
IGNACIO SANCHEZ DIAZ
Greening Health Systems Specialist
UNDP Istanbul Regional HHD Team
UN informal Interagency Task Team on Sustainable
Procurement in the Health Sector (SPHS)
ignacio.sanchez.diaz@undp.org
twitter: @SanchezDIgnacio
MIRJANA MILIC
SPHS Associate Coordinator
UN informal Interagency Task Team on Sustainable
Procurement in the Health Sector (SPHS)
mirjana.milic@undp.org
Twitter: @milic_mirjana
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