Environmental sustainability

Overview

Climate change is the greatest health threat of the 21st century, with environmental factors accounting for a quarter of the global burden of disease (The Lancet 2018; World Health Organization 2016). At the same time, the health sector is a major contributor to the global climate crisis and environmental degradation. If the global health sector were a country, it would be the fifth largest emitter of greenhouse gases in the world (Health Care Without Harm 2020). These multi-directional linkages between health and planet underscore the need for integrated action that simultaneously safeguards human health and the natural environment, a focus called for by the trans-disciplinary field of ‘planetary health.’

With its large policy and programmatic portfolios on health, environment, climate change mitigation and adaptation, governance, and other connected areas, UNDP is uniquely placed to support multi-sectoral policies and programmes on planetary health to respond to the complex and growing health burden caused by climate change, pollution, environmental degradation and threats to biodiversity, in partnership with the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), the World Health Organization (WHO), the United Nations Environment Programme (UNEP), Global Environment Facility (GEF) and others.

UNDP’s approach

UNDP’s framing on planetary health is operationalized through two primary areas:

1. supporting multi-sectoral policies to respond to the growing burden of environmental threats including pollution and climate change, with a particular focus on the most vulnerable.
2. building resilience in the health sector, including through integration of measures for sustainability in health programmes.

UNDP’s approach to environmental sustainability in the health sector is aligned with the priorities of key partners, including the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), Gavi, the Vaccine Alliance (Gavi) and the World Health Organization (WHO). The Global Fund encourages partner countries to develop and strengthen comprehensive, sustainable, climate-smart procurement, supply and waste management systems that support the avoidance, reduction and management of health-care waste, including health-care waste that is generated under Global Fund grants (GF RSSH Information). Gavi is committed to scaling up its investments in proven interventions for climate-resilient health systems, including by helping countries to reduce their footprint related to health care, as underlined in its 2021–2025 Strategy.

UNDP works closely with WHO, particularly drawing on its expertise in building climate-resilient health systems and helping countries to track national progress in protecting health from climate change. This includes joint efforts to integrate health into the implementation of nationally determined contributions to the Paris Agreement. It likewise partners with civil society organizations, research institutes and foundations to expand research and multi-stakeholder participation, including youth, in movements linking health and climate. UNDP also helps to connect investments and expertise from environmental funding mechanisms such as the Global Environment Facility and Green Climate Fund with those of health-specific financing partners.

Along with the World Bank and the United Nations Department of Economic and Social Affairs (DESA), UNDP is a co-convener of the WHO-led Health and Energy Platform of Action, which mobilizes political commitment, support and resources to ensure universal access to clean and sustainable energy to protect health.

Resources and examples

UNDP sustainable procurement in the health sector programme

UNDP hosts the secretariat and participates in the United Nations Informal Interagency Task Team on Sustainable Procurement in the Health Sector (SPHS). The taskforce brings together seven United Nations agencies (UNDP, United Nations Environment Programme – UNEP, United Nations Children’s Fund – UNICEF, United Nations Population Fund – UNFPA, United Nations High Commissioner for Refugees – UNHCR, United Nations Office for Project Services – UNOPS, World Health Organization – WHO) and three multilateral health financing institutions (Gavi, the Vaccine Alliance – Gavi, Global Fund to Fight AIDS, Tuberculosis and Malaria – Global Fund, Unitaid). The annual cumulative purchasing power of the taskforce for health products is around $5 billion, which gives opportunities to influence and pilot business models for improving environmental, social and economic sustainability. With increased health spending during the pandemic, this figure has risen two-fold in the last 2 years.

UNDP’s Sustainable Health Procurement programme strives to promote sustainable production and consumption practices by ensuring products and services purchased have the lowest environmental impact and contribute towards positive social results. The UNDP approach to sustainable health procurement also leads towards considerable cost benefits and resource efficiencies in health procurement.

UNDP is committed to sustainable procurement as a gradual approach through working in partnership with manufacturers and other partners and by strategically leveraging the health procurement architecture as a market mechanism for change. This will foster a market transition towards more sustainable production, procurement and consumption practices for health products. Among many others, UNDP has organized five Global manufacturers fora in five different regions (Philippines 2018, Tanzania 2019, Saud Arabia 2020, Colombia 2021 and United Kingdom 2022). The Global manufacturers forum has become a popular event for policy makers, manufacturers, academia, CSOs and suppliers of health commodities and equipment to gather and share expectations, lessons and feedback.

In 2020, UNDP launched the  Sustainable Health Procurement Guidance Note, as part of the Sustainable Health in Procurement Project, and has been developing different approaches to include sustainability in its health procurement practices. The main strategy comprise: optimizing medicines packaging; reducing CO2 emissions by optimizing health product procurement transport scenarios; and influencing suppliers in long-term agreements with UNDP to introduce sustainability in their business models through the monitoring and review of sustainability criteria. These sustainability approaches to procurement are carried out closely with national counterparts; the work at the country level serves as a basis for countries to start embedding sustainable practices in their own procurement activities.

Additionally, UNDP worked with Healthcare Without Harm to develop and launch the chemicals of concern to health and environment guidance document. This document includes a list of chemicals of concern to human health and the environment. The list is based on systematic evidence reviews from authoritative sources, which identify chemical and material hazards of concern that are carcinogenic, mutagenic, endocrine disrupting and reproductive hazards (health hazards) and bio- accumulative and persistent to the environment and/or listed in International Environ­mental instruments (Conventions)

Pharmaceutical packaging optimization

Rethinking the necessities of packaging helps to reduce waste, optimize shipments and save costs which can be reinvested in health activities and in strengthening national supply chains.

UNDP is engaged in packaging optimization of health products and further investigating areas for innovation of product  waste management. The packaging reduction project is conducted in partnership with manufacturers and freight forwarders to identify areas of opportunity, redesign packaging specifications and to calculate metrics to measure the impacts through capacity enhancement, reduced emissions and cost savings achieved.

UNDP has worked extensively with antiretroviral manufacturers and national regulatory authorities on packaging optimization to reduce product waste and increase cost-effectiveness. In 2016-2017, it piloted a Reduced Packaging Initiative piloted in Zimbabwe, South Sudan, and Equatorial Guinea. The new packaging resulted in a 55 per cent increase in shipping capacity per container and an additional reduction of 57 per cent of CO₂ per unit for the Zimbabwe trade lane. Up to US$1.20 million in savings have been generated for 2.5 million packs delivered under the UNDP Reduced Packaging Initiative. Work is ongoing to extend this approach to other countries and to a wider range of antiretrovirals procured through UNDP. This entails substantive work with national regulatory authorities to ensure compliance with labelling requirements.

With increased experience and lessons learned on medicines packaging optimization, UNDP’s approach can be adapted and replicated by national procurement systems and by other players involved in health procurement.

CO₂ emissions reporting and reduction

Monitoring, measuring, reporting health product transport’s CO₂ footprints and rethinking procurement planning and transport help reduce environmental impact and gain cost efficiencies.

UNDP is committed to reducing its CO₂  footprint, including the CO₂ footprint of health procurement to reduce the impact of climate change. Since 2015, UNDP has been collecting CO₂ data as part of long-term agreements with specified antiretrovirals first line suppliers to measure, monitor and reduce CO₂ impacts in partnership with freight forwarders. All collected data is captured as business intelligence analytics and visualized through a dashboard that is monitored on a quarterly basis. The UNDP procurement planning capacity engagement and data provided by UNDP country offices is also used to switch to more efficient freight options that provide reduced emissions per shipment, resulting in significant CO₂ reductions and freight cost savings.

Environmental and social sustainability scorecard initiative and call-off criteria for tendering

Leveraging its global health procurement architecture, UNDP’s environmental and social sustainability initiative incrementally builds a dialogue and a demand for sustainable pharmaceutical production and procurement.

UNDP is committed to working in partnership with manufacturers to meet demand for better social and environmental due diligence in pharmaceutical manufacturing and procurement. The UNDP environmental and social sustainability scorecard initiative leverages the UNDP health procurement architecture within its signed long-term agreements and contract management process. By strategically selecting health products of high volumes, this approach encourages manufacturers to follow sustainability manufacturing criteria under the UNDP Sustainable Health Procurement Programme, as part of the ongoing procurement contracts.

UNDP has designed an environmental and social sustainability scorecard  initiative, which, as specified within the suppliers’ contract, requires manufacturers to provide comprehensive information, data and supporting documentation about manufacturing facilities.

The information is compiled in a UNDP sustainability scorecard and is regularly reviewed to identify opportunities to include environmental sustainability within pharmaceutical manufacturing facilities and processes. Through the collection of relevant data on suppliers’ environmental practices, it is possible to establish and monitor the baseline of adopted environmental criteria. A continuous two-way dialogue is opened with manufacturers to discuss challenges and potential for improvements in pharmaceuticals manufacturing, therefore setting incremental industry best practices.

Sustainable Health in Procurement Project (SHiPP)

UNDP together with Health Care Without Harm (HCWH) implemented the Sustainable Health in Procurement Project (SHiPP). The first phase of the project addressed the intersection between health, human rights and the environment in 10 countries (Argentina, Brazil, China, India, Moldova, South Africa, Tanzania, Ukraine, Vietnam and Zambia). SHiPP was designed to promote procurement practices that consider environmental and social impacts, as well as cost-efficiency and affordability when defining how processes can be sustainable, and to mainstream gender and human rights including anti-corruption, transparency and accountability.

Through the SHiPP, countries have adopted new standards and guidelines to promote sustainability in the health sector. For instance, Brazil has developed a plan to ban mercury medical devices; India has established guidelines and criteria for Bio-Medical Waste and Infection Control Management; and South Africa approved an acquisition plan for biogases and air quality monitoring.

Purpose

Pharmaceutical waste management is regarded to be an integral part of supply chain management and the product life cycle, as a result of the use and/or expiry of health products. Inadequate and inappropriate handling of health-care waste can have serious public and global health consequences and a significant impact on the environment. Governments can better protect public and planetary health by reducing the volume and toxicity of the wastes produced and by implementing a range of environmentally and socially sound waste management and disposal options. Solutions exist to develop and popularise technologies, products and concepts that will help drive countries to a zero waste, low-carbon, toxics-free, circular economy.

Pharmaceutical waste includes expired, unused, spilt and contaminated pharmaceutical products, prescribed and proprietary drugs, vaccines and sera that are no longer required, and, due to their chemical or biological nature, need to be disposed of carefully. The category also includes discarded items heavily contaminated during the handling of pharmaceuticals, such as bottles, vials and boxes containing pharmaceutical residues, gloves, masks and connecting tubing.“

Source: World Health Organization, 2014. Safe Management of Wastes from Health-care Activities, 2nd edition.

While there is currently no international convention that directly covers medical waste management, several environmental conventions have important implications for health-care waste. These include 1) the Basel Convention, which aims to protect human health and the environment against the adverse effects from the generation, management, transboundary movement and disposal of hazardous and other wastes; 2) the Stockholm Convention, a global treaty to protect human health and the environment from highly dangerous, long-lasting chemicals; 3) the Rotterdam Convention, which promotes shared responsibilities and cooperation among parties in international trade of certain hazardous chemicals to protect human health and the environment from potential harm; and 4) the Minamata Convention, which addresses measures to reduce the human environmental impact of mercury. Countries’ legislation and regulations for health care waste should be aligned with these conventions to ensure compliance with international environmental and health standards. The UNDP Health Care Without Harm questionnaire (2017) is available to support health procurement stakeholders’ compliance with environmental conventions. 

UNDP’s approach

As part of support from the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), UNDP helped to conduct rapid assessments of national set-ups for managing health-care waste, with a view to understand the  environmental impacts and safety concerns, in Belarus, Bosnia and Herzegovina, Kyrgyzstan, Tajikistan, Uzbekistan and Zimbabwe. These assessments resulted in the development of the Healthcare Waste Management Toolkit Package for practitioners and policy makers.

The assessments also recommended the development of national strategies for waste management, to strengthen and improve existing systems to coordinate the financial sustainability of routine and new activities for waste management. Some of the assessments led to the development of country-level guidelines, tools and infrastructural projects to improve health-waste management.

In Zimbabwe, UNDP provided infrastructural support to the country’s health procurement and supply chain management system which included the installation of two pharmaceutical-grade incinerators at the central and regional levels to facilitate the disposal of pharmaceutical waste. Prior to this, it helped to put in place equipment, standard operating procedures and training of staff related to the deconditioning and disposal/recycling of plastic and cardboard packaging. On the normative side, UNDP provided technical assistance to the Ministry of Health and Child Care to develop the Pharmaceutical Waste Management Plan for Pharmaceuticals and Health Products.

UNDP has also provided support for the installation of incinerators for pharmaceutical waste in Afghanistan, Chad, São Tomé and Principe, Sudan, and Zambia, and for training on their use.

In Eastern Europe and Central Asia, where UNDP supports several governments with the procurement of medicines, UNDP’s technical assistance includes support to assess and provide lessons on waste management practices at the dispensation level. 

In 2020, amid the COVID-19 pandemic, UNDP commissioned Engineers Without Borders to conduct a rapid assessment of the prevailing health care-waste systems and legal frameworks, to inform the development of a generic strategy to improve health-care waste management in consultation with relevant stakeholders across the globe. As part of inter-agency support to COVID-19 vaccine readiness and deployment plans, UNDP is working with the World Health Organization and the United Nations Children’s Fund (UNICEF) to help countries scale environmentally and socially sustainable disposal of immunization waste.

Upstream reduction of health product waste

UNDP undertakes two main axes of work to reduce waste production upstream. One is to strengthen areas of the procurement and supply chain cycle, such as quantification, inventory control, logistics management information systems,, and procurement and distribution planning in supported countries. Building capacity in procurement and supply chain management helps reduce overstocking and product expiry, which result in the waste of financial resources and an increased need for pharmaceutical waste management.

UNDP also engages with antiretroviral manufacturers to optimize medicine packaging and reduce resulting waste. This practice, which has been piloted in a few countries, will be incrementally applied to other categories of medicines for which UNDP pools demand and procures on behalf of supported countries. The optimization of packaging to reduce upstream waste, requires coordination with manufacturers and national regulatory authorities to comply with international and national standards for medicine labelling. With increased experience and lessons learned, UNDP’s piloted approach for optimizing medicine packaging could be adapted and replicated by national procurement systems.

Tools and guidance

UNDP has developed the Health-care Waste Management Toolkit, based on several rapid country assessments of health-care waste management set-ups in 2015, to support the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), UNDP and other practitioners and policymakers. The toolkit consists of:

Part A – Rational for Environmental Safeguard Policies
Part B – Waste Stream Concept Development

The UNDP/SPHS Sustainable Procurement Guidance Note (2020) is a useful resource for integrating sustainability strategies in health procurement processes. It details steps of the sustainable health procurement approach, creation of an action plan and integration of the action plan into procurement planning, solicitation design, contract management and responsible supplier engagement.

UNDP’s partner Health Care Without Harm offers a range of health-care waste management resources, including guidelines and assessment tools, on its website. Additional guidance, including from the Global Fund and the World Health Organization (WHO), are available below.

Overview

Health facilities need power. Clinics, maternity wards, operating rooms, medical warehouses, and laboratories rely on electricity to power the lights, refrigerate vaccines, and operate life-saving medical devices. An inability to carry out these essential services puts lives at risk. All too often, particularly in remote areas, health facilities face significant power shortages. A World Health Organization (WHO) review revealed that 25 per cent of health facilities in sub-Saharan Africa had no access to electricity, while only 28 per cent of health facilities and 34 per cent of hospitals had what could be called “reliable” access to electricity (without prolonged interruptions in the past week).

In 2017, UNDP spearheaded the Solar for Health (S4H) initiative as a means of connecting two vital sectors – energy and health – to help countries advance universal health coverage while protecting the environment. Through the initiative, UNDP supports countries to install solar photovoltaic systems at health centers and storage facilities located in poor and hard-to-reach areas.

This helps to ensure constant and cost-effective access to electricity for uninterrupted health services, while also mitigating the impact of climate change and advancing multiple Sustainable Development Goals (SDGs). Broader development benefits of solar energy can also include the creation of green jobs and the development of local manufacturing and markets for solar power. By training women as solar technicians to install and maintain solar panels, the initiative also helps countries advance SDG 5 on gender equality and women’s empowerment.

S4H builds on the much larger investment and knowledge generated by UNDP’s robust energy portfolio focused on expanding access to clean energy, including the promotion of renewable energy and energy efficiency, in more than 82 countries. The lack of access to clean energy has significant and wide-ranging impacts on people’s health across the world. UNDP focuses on three key pillars of the health-energy nexus: electrification of rural health centres, clean cooking, and enabling cities to switch to sustainable transport. These have been further elaborated under the Energy for Health work areas.

UNDP’s approach

To date, and largely funded through the Global Fund to fight AIDS, Tuberculosis and Malaria (Global Fund), as well as Innovation Norway and the European Union humanitarian fund, UNDP has supported the solar electrification of some 1,000+ health centres and storage facilities in 15 countries (Zimbabwe, Sudan, Zambia, South Sudan, Namibia, Liberia, Libya, Malawi, Yemen, Angola, Nepal, Uganda, Chad, Lebanon and Eswatini). UNDP has also supported research on the ground to assess which innovative finance mechanisms can help scale these activities in Malawi, Zimbabwe, Liberia, Namibia and Zambia..

The objectives of S4H are to promote high-quality health services; contribute to climate-resilient health systems; and reduce health sector carbon emissions. Key elements of UNDP’s support to countries through S4H include:

• supply of solar equipment and support for installation
• maintenance, technology transfer, and institutional capacity development
• solar energy promotion and awareness raising
• regulatory and policy framework setting for solar energy provision
• understanding of the climate change – energy – health interlinks
• developing innovative finance mechanisms

UNDP continues to build on the lessons and results from implementation of S4H in these countries to help others conceive, plan and implement solar energy photovoltaic systems based on the needs arising from unreliable or unavailable electricity to health system facilities. The energy needs of the health sector are often exponential. Thus, S4H is designed to ensure flexibility, meaning that it can be initiated with relatively small contributions and scaled up as funding becomes available and additional needs are identified.

In addition, as part of national COVID-19 vaccine readiness and deployment plans led by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF), UNDP is working with government and United Nations partners to scale reliable energy solutions for vaccination across the COVID-19 cold chain. This includes building on S4H experiences to deploy solar technologies to support the transport and last mile distribution of vaccines and green the underlying infrastructure for vaccination.

Resources and examples

Additional details on the objectives and support that UNDP provides to countries under Solar for Health (S4H) can be found in this Information Note.

Sustainable financing for S4H

In 2019-2020, UNDP commissioned KOIS and Diff-er to conduct a feasibility study to design a sustainable financing mechanism to accelerate the Solar for Health (S4H) programme in prioritized countries, and to provide UNDP and the local governments with information to determine further financing and implementation options of the proposed S4H financing model. The study looked at a demand-side analysis, supply-side analysis, and the design of the S4H financing structure in five countries: Namibia, Liberia, Malawi, Zimbabwe, and Zambia.

Through the S4H initiative, solar power systems are facilitating strong, reliable and resilient health services, even in some of the most challenging contexts. 

• In Yemen, 72 Health facilities, powered by solar, are providing vaccines and other medicines, schools are able to continue, and small businesses can run late into the night.
• In Chad, in 2020 solar power systems were installed in 150 health facilities with a focus on pre- and antenatal care for women, childbirth and medication storage, and also to help them respond adequately to public health issues such as malaria, and now, COVID-19.