Presentation given by Dr. Christoph Hamelmann during the ISWA 2015 World Congress, Antwerp

1. Dr. Christoph Hamelmann
Regional 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 Diaz
Consultant to the SPHS and UNDP Regional
HHD Team for Greening Health Systems with
focus on Sustainable Procurement

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. What the others do…
Environmental Safeguarding
is today a standard in nearly
all international major
health projects.

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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)

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

12. 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)

13. 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

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

15. Support of the Implementers
Taking Responsibility:
UNDP is currently active to develop a
practical toolkit for healthcare waste
management

17. 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

18. 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

19. Sustainable Procurement
in the Health Sector (SPHS) - Network
UN-SPHS internal Gov./EU/Other
organizations
Suppliers/Manufac
turers
Overall
≈ 900 ≈ 590 ≈ 2000 ≈ 3500
Network list summary
Contacts in 92 countries covering all
the regions

20. 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.org
twitter: @cahamelmann