healthcare waste management in the context of global health initiatives
TRANSCRIPT
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/
[email protected]: @cahamelmann