Health Care

Blog | African Hospitals Are Becoming Leaders on Environmental Practices

By: Susan Wilburn, Sustainability Director, Global Green and Healthy Hospitals, HCWH; and Ruth Stringer International Science and Policy Coordinator.

The annual meeting of the African regional health care waste management and mercury elimination project was held 1-3 June in Istanbul, Turkey in the offices of the UNDP. It was a great to have the team together for a very productive meeting and collaborative atmosphere for the exchange of ideas and solutions to address the common barriers to the successful management of health care waste and elimination of mercury-containing measuring device.

The project is being organized by United Nations Development Program (UNDP), the World Health Organization and Health Care Without Harm. The aim of the project, which will run until 2020, is to disseminate non-incineration waste treatment and substitute mercury containing medical devices in four African countries: Ghana, Madagascar, Tanzania and Zambia.

The regional and country teams met to review accomplishments of the past six months and review work plans for the next six months. The annual board chaired by the manager of the UNDP Istanbul Regional Hub (IRH), met and approved reports and the budget for the remainder of 2017 and 2018.

Four participants from each of the four participating countries presented their progress since the inception meeting last September. In addition to representatives of the Ministries of Health, Ministry of Environment, UNDP and technical expert from the four project countries, the Director of the Scientific Practical Institution of the MOH responsible for a similar project in Kyrgyzstan participated and shared good practice examples, curricula development and successful installation of autoclaves to treat health care waste.

A ‘Green bag lunch’ was organized for all UNDP staff in the Istanbul office with a program highlighting the African project and the collaboration between the project and the joint work of UNDP and HCWH for sustainable procurement in the health sector. All of the country partners requested additional training from UNDP and HCWH to raise awareness of the opportunity that procurement presents for integrating sustainability criteria.

The lunchtime seminar opened with the showing of HCWH’s 20th anniversary video followed by the manager of the IRH thanking HCWH for putting the health, environmental and human aspects into context for the following presentations.

On the third and final day, the group traveled together to tour a large central waste management facility with autoclaves to treat the health care waste from Istanbul hospitals. We were privileged to visit the famous ancient Mosque of Suleyman in Istanbul during the holy month of Ramadan, and to join thousands of people in the iftar evening meal at sunset.

Now we are entering the practical phase of the project where all of the planning starts to become concrete. As the Minamata Convention on Mercury comes into force in August of this year, the four countries will lead the continent in demonstrating best available technologies and best environmental practices. Non-mercury medical devices will be delivered in September, and swapped for the mercury containing ones currently in use.

Early next year, the installation of autoclaves to treat infectious health care waste to prevent the production of dioxins and other Persistent Organic Pollutants (POPs) will begin. In addition, Tanzania is constructing a biodigester for organic waste at one of its hospitals, which will dispose of the waste safely, and has the side benefit of generating methane gas that can be used as a fuel.

All of the hospitals involved in the project receive membership to Global Green and Healthy Hospitals, will soon be using GGHH Connect and are sharing their experiences in webinars organized by HCWH’s strategic partner in South Africa, groundWork.

June 12, 2017Global

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Health Care Leaders Denounce Paris Withdrawal

Climate change has been called “the biggest global-health threat of the 21st century,” so it’s no surprise that U.S. health care systems, associations, and clinicians joined the growing chorus of voices expressing dismay at Trump’s announcement to withdraw the United States from the Paris Agreement.

Health care providers understand the dangers climate change poses to human health, hospital infrastructure, and their bottom line.

Despite expressions of disappointment and concern, health system leaders voiced confidence in their ability to forge ahead, recommitting to address climate change and protect the health of their patients and communities.

“The good news is that progress on climate solutions will continue to accelerate as cities, hospitals, schools, and businesses are increasingly showing the way toward a low-carbon future,” said Gary Cohen, Health Care Without Harm’s CEO and founder.

Read our full blog, featuring powerful statements from the health care sector, and join us as well as the thousands of local and state leaders and businesses, in taking action to protect the health of our people and planet.

June 9, 2017Global

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New World Bank Report Calls for Health Sector Leadership on Climate

Released at World Health Assembly, “Climate-Smart Health Care” Outlines Low-Carbon and Resilience Strategies for the Health Sector

Geneva-- The World Bank Group’s health and climate directors released a report today establishing a new framework for health systems in every country to become leaders in addressing climate change. The report is a joint production with Health Care Without Harm (1).

In its title, the report coins the term Climate-Smart Health Care, an approach that sets forth both low-carbon and resilience strategies. These strategies are designed for the development community, ministries of health, hospitals and health systems to deploy while addressing the health impacts of climate change.

James Close, Director of the World Bank’s Climate Change Group and Olusoji Adeyi Director of Health, Nutrition, and Population at the Bank jointly write: "The health sector has a substantial role to play in both mitigating climate change through the adoption of low-carbon strategies, while also building resilience to climate impact."

While few countries have undertaken healthcare carbon footprint measurements, and further study is necessary to more comprehensively quantify healthcare’s contribution to climate change, the report makes a rough, first-ever estimate of health care’s global emissions. It conservatively finds that health care generates 5% of world-wide greenhouse gas emissions, amounting to 2.6 billion metric tons of CO2e in 2011.

"By reducing their emissions and becoming more resilient, health systems in every country can become leaders in contributing to both health and climate solutions," says Josh Karliner, an International Director at Health Care Without Harm and one of the report’s authors.

Key findings include:

  • Health ministries can invest in affordable carbon reducing, health-focused initiatives in renewable energy, energy efficiency, local transport systems, sustainable and safe water use, safe waste disposal, and the purchase of locally and sustainably produced food.
  • There are several co-benefits to climate-smart healthcare, including improved health through a reduction in environmental pollution and climate change, as well as more efficient, less costly health systems and stronger local economies.
  • A climate-smart approach, including system design that decentralizes care, relying more on both prevention and telemedicine, can provide effective, cheaper care.
  • In low-resource, energy-poor settings, powering healthcare with low-carbon solutions can enhance access to care, contributing to climate resilience and the advancement of universal healthcare for the poor and most vulnerable.
  • Development institutions can support and fund health systems and sector actors to adopt key elements of climate-smart healthcare.
  • Development institutions can advocate that industries in the healthcare supply chain develop low-carbon and environmentally sustainable manufacturing and distribution practices.
  • Health systems can build climate resilience through investment in two areas:
    • Health system strengthening that prepares for the climate change’s environmental and health impacts; and
    • disease-specific responses to address the changing burden of disease related to climate change.

“Ultimately, climate-smart healthcare will strengthen health sectors and communities by ensuring access to clean and independent energy, safe water, clean transport, and clean waste disposal mechanisms,” says Timothy Bouley, Health and Climate Specialist at the World Bank. “It will stimulate the development and supply of sustainable products, while also preparing the sector for a future of known and unknown health-related climate hazards.”

HCWH will continue to work in collaboration with the World Bank Group to develop and implement Climate-Smart Healthcare in institutions, in countries, and with health systems around the world.

Download Report

Blog Post | Connecting Climate Change and Health for Better Development

Co-authors: Olusoji O. Adeyi, World Bank


Climate change is already having real, measurable impacts on human health, and those impacts are expected to grow. Low- and middle-income countries are seeing the worst effects as they are most vulnerable to climate shifts and least able to adapt given weak health systems and poor infrastructure. The good news is that the cumulative impacts of climate change on health have been extensively discussed for decades and understanding is growing.

Over the past three years, the WBG has worked in consultation with experts and development partners to establish a major program addressing climate change and health.

The program has been built with two primary considerations in mind: (i) establishing a knowledge base to inform development lending and (ii) ensuring this work directly supports our clients. 

We have also undertaken a new analysis of climate connections to the health sector. Working with leading partners in the space, like Health Care Without Harm, we have uncovered an enormous opportunity both for our own portfolio and for others designing and operating health systems. This new report, Climate-Smart Healthcare: Low Carbon and Resilience Opportunities for the Health Sector, is a first of its kind, linking climate change, the health sector, and development. It describes in-depth approaches for building and sustaining health systems that are prepared for climate change and provides tools and resources to help practitioners turn this knowledge into action.

Read the blog post

Webinar Presents New Report: Climate-Smart Health Care: Low-Carbon and Resilience Strategies for the Health Sector

On June 27/28, report authors Timothy Bouley (Global Health and Environmental Specialist, World Bank), Josh Karliner (International Director of Program and Strategy, HCWH), and Susan Wilburn (Sustainability Director, Global Green and Healthy Hospitals) participated on a webinar during which they presented an overview of the report as well as shared tools, resources, and opportunities for on the ground implementation of climate-smart health care by hospitals, health systems, and health care facilities around the globe.



(1) The report, Climate-Smart Health Care: Low-Carbon and Resilience Strategies for the Health Sector, is a joint production of the World Bank Group (Health Nutrition and Population Global Practice, and Climate Change Cross-Cutting Solutions Area), Health Care Without Harm and Mobilizing Action Toward Climate Change and Health. Six HCWH staff and senior advisers are among the nine authors.

May 30, 2017Global

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Global Treaty Against Mercury Pollution Enters into Force

On May 18th, the world took an historic step forward in the fight against mercury pollution as the European Union and seven of its member States ratified the Minamata Convention on Mercury, thereby exceeding the 50-party requirement for the treaty to enter into force. 

The Minamata Convention tackles primary mining of mercury, mercury use, trade, emissions and disposal, and the phase-out of mercury products such as thermometers and blood pressure devices.

Health Care Without Harm (HCWH) has led the work to substitute these mercury-based medical devices with accurate, affordable alternatives for the past 15 years. HCWH has worked with thousands of hospitals and health systems, dozens of ministries of health and several United Nations organizations to advance the cause of mercury-free health care, while also successfully advocating for strong measures to phase-out these devices via the Minamata Convention.

“This work began with a single thermometer in a single hospital and grew into a worldwide initiative to align health care practices with a global environmental health imperative,” said Josh Karliner, an International Director with Health Care Without Harm.   “The health sector has led by example in dozens of countries, substituting mercury-based medical devices with safer alternatives, and helping forge a path for the Minamata Convention to protect public health from mercury pollution.”

In health care settings, mercury may be released from thermometers, blood pressure devices, gastrointestinal and other mercury containing medical products, as well as dental amalgam.

"Over the past fifteen years, health professionals around the world committed to eliminating mercury-containing products as the only way to avoid their polluting presence in the environment and people’s bodies," said Veronica Odriozola, Executive Director of HCWH in Latin America, and one of the leaders of this effort.   "We are pleased to see more than 50 of the world’s governments endorsing efforts undertaken by so many of our health care colleagues to rid the world of mercury pollution by ratifying the treaty."

“The health sector has led by example in dozens of countries, substituting mercury-based medical devices with safer alternatives, and helping forge a path for the Minamata Convention to protect public health from mercury pollution," said Josh Karliner, International Director of Program and Strategy, HCWH

HCWH worked closely with both the World Health Organization (WHO),  and the UN Environment Programme (UNEP) to support the transition from mercury-based measurement devices to digital and other alternatives.   From 2008-2014, HCWH and WHO collaborated in a global initiative aimed at demonstrating the feasibility of phasing out of mercury-based thermometers and sphygmomanometers in health care and their substitution with accurate, economically viable alternatives.  A component of the UNEP Mercury Products Partnership, the Mercury-Free Health Care Initiative achieved significant success in raising awareness among ministries of health, health systems and thousands of hospitals on every continent that it is possible to develop and implement policies and procedures to make the switch away from mercury.

On 16th August 2017, the Minamata Convention will become legally binding, obliging countries to no longer purchase mercury thermometers and blood pressure devices by 2020, and to seek to phase-down their use of dental amalgam.  An updated list of Parties to the Convention can be found at

May 25, 2017Global

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Argentina Ratifies the Minamata Convention, the International Agreement to Eliminate Mercury

Buenos Aires, 27 April 2017 – The Argentinian Congress approved the ratification of the Minamata Convention to eliminate the use of mercury by 2020. In doing so, Argentina became the 43rd country to ratify the agreement. 128 countries in total signed the Minamata Convention at a diplomatic meeting that took place on October 10th, 2013 in Kumamoto, in the south of Japan.

“The ratification of the Minamata Convention is excellent news for the environment and human health", said Verónica Odriozola, executive director of Health Care Without Harm (HCWH) – Latin America. HCWH worked for 15 years to advocate for the elimination of mercuyr and collaborated with the health sector to take the lead by replacing medical devices such as thermometers and blood pressure measuring devices that contain this toxic metal. "Over the years, health professionals have committed to eliminating mercury-containing products as the only way to avoid its contaminating presence in the environment and on human beings throughout the world”, explained Odriozola.

Mercury is a global pollutant that affects human and environmental health. There are numerous sources of mercury emissions to the environment, including the health care sector through the breaking of thermometers and blood pressure measuring devices containing this metal.

Read more (in spanish)

May 11, 2017Global

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Health Organization Leaders Launch Global Campaign on Air Pollution

Unmask My City (UMC) is global initiative by doctors, nurses, public health practitioners, and allied healthcare professionals dedicated to improving air quality and reducing emissions in our cities.

May 2nd -- Launching today on World Asthma Day, Unmask My City, a global initiative in 10 cities on five continents, aims to promote practical solutions and create tangible policy changes that drive a clear, downward global trend in urban air pollution by 2030.

This will result in significant reductions in illnesses and deaths as well as greenhouse gas emissions. Through Unmask My City, health professionals are becoming a visible force supporting or driving healthy air campaigns in their countries protecting the environment and health of people.

Health Care Without Harm’s partners in India, Brazil, and South Africa have joined Unmask My City to call for locally-tailored solutions, such as establishing health protections in marginalized communities in Chennai, India; ensuring that health is considered in the permitting process for power plants in Emalahleni, South Africa; and mobilizing health care organizations to engage in the air pollution debate in São Paulo, Brazil. 

This global initiative is coordinated by the Global Climate and Health Alliance together with the Health and Environment Alliance, Health Care Without Harm, the US Climate and Health Alliance, and the UK Health Alliance for Climate Change.

Air pollution is responsible for one in nine deaths worldwide, and touches everyone -- 92% of the human race live in places that do not meet World Health Organization air quality guidelines (1). This growing cloud of pollution has catapulted air pollution towards the top of the list of avoidable risk factors for ill health, with an unacceptably high burden of disease.

“From a public health perspective, wearing masks to protect against air pollution is a solution of last resort -- our goal should be prevention first and foremost,” said Jennifer Wang, Healthy Energy Initiative Coordinator for Health Care Without Harm. “To address the root causes of air pollution, we need decisive action from policymakers and cooperation across sectors, including the health sector. By working together to tackle air pollution, we're saving lives, saving money, and preserving our planet.”

Health care organizations in Brazil are increasingly taking on leadership in combating climate change among other essential environmental public health issues. “UMC campaign is mobilizing Brazilian members of the Global Green and Healthy Hospitals Network for the improvement of air quality in the city of São Paulo,” said Vital Ribeiro from HCWH’s strategic partner, Projeto Hospitais Saudáveis. “We believe the health sector can make a real difference in the fight against air pollution and climate change, and contribute to significantly improve the quality of life of 12 million people living in São Paulo.” 

“Air pollution is robbing citizens of their right to a healthy life. It is imperative that the public health community take charge and engage with the government to frame suitable policies to protect public health and environment,” Shweta Narayan, Healthy Energy Initiative – India.

These are just some examples of locally-defined approaches from Health Care Without Harm’s partners involved in Unmask My City. As part of this global health community, we’re incredibly energized and committed to continue to promote solutions to air pollution, to protect our health and our climate.

Fact Sheet and Quote Cards


Download Fact Sheet


All photos and quote cards belong to Unmask My City


1. World Health Organization. WHO | WHO releases country estimates on air pollution exposure and health impact [Internet]. WHO. 2016 [cited 2017 Apr 10]. Available here.

May 2, 2017Global

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Global Green and Healthy Hospitals Reaches New Membership Milestone- 25,000 Hospitals and Health Centers

The first quarter of 2017 has been an exciting and productive one for Global Green and Healthy Hospitals (GGHH). In the first four months of the year we have surpassed our membership target for the entire year, and an important milestone in the growth of the network: GGHH members representing over 25,000 hospitals and health centers around the globe.

As of today, GGHH has 797 members in 47 countries on 6 continents who represent the interests of over 25,600 hospitals and health centers.

While hospitals and health systems from every continent continue to join GGHH, much of the recent growth comes from a new partnership with the Public Health Foundation of India (PHFI) and the creation of the Health and Environment Leadership Platform (HELP).

Launched in February of this year, HELP engages hospitals, health centers, and health systems around India to form a concerted voice for environmental sustainability in the sector and demonstrate leadership to address the impacts of environmental risk factors for ill health. Nineteen institutions, representing over 3,000 hospitals and health centers are participating in HELP, all of whom make up the newest cohort of GGHH members.

The continued growth of GGHH signifies both the rising interest of hospitals, health systems, and health organization around the globe in reducing their impacts on environmental and public health, as well as the collective power and voice of the health sector to act as a catalyst for transformative change. We are thrilled to be working with PHFI and all of our other members as we move forward in this work together.

We welcome our new members from India!

  • PSG -Institute of Medical Sciences & Research (representing 1 hospital)
  • Environment and Child Health of CIAP
  • National Neonatology Forum of India (NNF)
  • National Accreditation Board for Hospitals & Healthcare Providers (NABH)
  • Association of Healthcare Providers (AHPI)
  • National Board of Examination (NBE)
  • Delhi Medical Association
  • Bhagat Hospitals
  • Council on Energy Environment and Water (CEEW)
  • Cancer Institute Chennai (representing 1 hospital)
  • Associations of National Board Accredited Institutions (ANBAI)
  • Lal Path labs limited
  • Consortium of Accredited Healthcare Organizations (CAHO)
  • Catholic Health Association of India (CHAI) (representing 2,925 health centers)
  • Aravind Eye Care System (representing 10 hospitals)
  • Apollo Hospitals (representing 40 hospitals)
  • NATHEALTH (representing 21 hospitals and 12 health centers)
  • Indian Academy of Pediatrics
  • Global Association of Physicians of India Origin (GAPIO)

See our full members list here.

Learn how GGHH members are creating climate smart health care

GGHH members are using their innovation, ingenuity, and investments to transform the health sector and foster a healthy future for people and the planet. To learn about the accomplishments and successful projects, check out our Case Studies library.

May 1, 2017Global

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Introducing Mariano De Donatis, HCWH’s New International Managing Director

HCWH is pleased to introduce Mariano De Donatis as our new International Managing Director. With over twelve years of experience working with civil society networks and coalitions to influence change at the national and global level, Mariano brings a tremendous amount of experience to help build and strengthen collaboration, management and governance for HCWH.

Prior to joining HCWH, Mariano worked as Oxfam´s Global Programme Manager, leading its advocacy work in BRICSAMIT countries - Brazil, Russia, India, Indonesia, China, South Africa, Mexico and Turkey. He led multi-issues campaigns, managed a flagship program to empower civil society networks and supported the Oxfam confederation's development in the Global South.

Immediately before, Mariano worked at the Global Call to Action Against Poverty coalition (GCAP) and at CIVICUS Alliance in various positions. As CIVICUS’s Global Convening & Outreach Manager, Mariano led the development and implementation of an organizational and network development plan. He led a team that strengthened the secretariat capacity while also strengthening CIVICUS, which has more than 900 members in 140 countries, as global network.

Mariano was born in Argentina and he has lived in five countries across four continents. He has a masters degree in Social Policy and Development from the London School of Economics and Political Science (LSE) and a major in Economics from the University of Buenos Aires. As an activist Mariano has been involved in several regional and global initiatives to support active citizenship and sustainable development, participating in informal networks that use an innovative approach to civic engagement and new social movements.

Mariano currently lives in Mexico City but will soon be based out of HCWH’s Latin America Regional office in Buenos Aires.

April 25, 2017Global

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Australia | Role of Environmental Health in the World Congress on Public Health

Protecting our environment and responding to the health impacts of climate change were among the top issues discussed during the 15th World Congress on Public Health. The event took place from April 3-7 in Melbourne, Australia. Held every 2-4 years by the World Federation of Public Health Associations (WFPHA), the Congress serves as an international forum for the exchange of knowledge and experiences on key public health issues with the aim of contributing towards protecting and promoting public health at national and global levels.

Fiona Armstrong, Executive Director of the Climate and Health Alliance (CAHA), HCWH’s strategic partner in Australia, and CAHA member Grace Fitzgerald ran a workshop on “The role of public health professionals in advocating for policy change: a case study”. This session presented climate change framed as a health issue, and explored the ways in which health professionals can act to use their influence. Click here for Armstrong and Fitzgerald's workshop slides.

In addition, Fiona Armstrong and Carol Behne, Sustainable Healthcare Project Officer at CAHA, participated in a session on Climate Change. Armstrong presented on CAHA's campaign for a National strategy on Climate, Health and Wellbeing, including progress to date and future plans. Behne discussed about the Global Green and Healthy Hospitals (GGHH) program and its objective to protect public health through environmental sustainability in healthcare. They shared cases studies from GGHH members that demonstrated the mitigation, adaptation and leadership efforts possible from the health sector in addressing climate change. Click here to see Armstrong’s presentation and click here for Behne’s presentation.

"Rubbish is a resource, not waste"

As part of the Congress, Western Health, a member of GGHH, hosted a field trip demonstrating their work to improve environmental sustainability and protect public health. Delegates from Australia, New Zealand, Indonesia and England participated in the visit to learn how Western Health is planning to achieve their strategic aim of “being socially responsible and using resources sustainably.” They toured the facility and its features such as their waste/recycling segregation areas, organic waste dehydrator, and e-water taps (electrolyzed water for cleaning/sanitizing without chemicals).

Catherine O’Shea, Sustainability Officer at Western Health, left the group with a powerful message to take home: "Rubbish is a resource, not waste".For more information on this event, click here.

Lifetime Achievement Award for Excellence in Global Health

During the event, Dr. Peter Orris, Senior Adviser to HCWH, received the Lifetime Achievement Award for Excellence in Global Health in recognition of Dr. Orris’ work in the context of the WFPHA’s Environmental Health Working Group and in campaigns to improve environmental health. For more information on the award Dr. Orris received, click here.

The Lancet Planetary Health

During the Congress, the Lancet launched a new journal on Planetary Health, which will join The Lancet Public Health and The Lancet Global Health. It will provide a third pillar in an open-access program covering the interplay between health and the determinants of health in our living and physical world.

“A new reality is emerging. Planetary health is an exciting opportunity for finding alternative solutions for a better and more resilient future. The Lancet Planetary Health invites you to submit the best (and still missing) scientific evidence that can strengthen the case for policy action and can help write a new narrative for planetary health”, says the report. To download it, click here.

April 17, 2017Global

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Blog | Do Hospitals Do More Harm than Good?

Blog post written by Luqman Yesufu; GGHH Campaign Manager, Membership Outreach and Engagement in Africa; groundWork

Posted on: groundWork

The members of the Global Green and Healthy Hospital network aim to ensure that they do no harm while providing health services.

The prevention of illness, injury and disease is an essential part of healthcare. We engage in healthy life style habits such as exercising and not smoking to prevent obesity and lung cancer. We vaccinate our children regularly to stimulate immunity and thus protect them from disease. We educate young boys and girls in order to promote safe sex and thus prevent the spread of HIV and AIDS and other sexually transmitted infections. On the basis of this, there is remarkable evidence to show that prevention works better than treating a disease. If this is the case, the health care sector must lead by example by engaging in more sustainable practices that are aimed at preventing disease and promoting good health without compromising patient care and safety.

Hospitals produce enormous amounts of waste, but only a small portion (about 15%) is actually infectious or poses high risk; 75% – 85% of the waste is categorized as normal municipal waste which has low risk to ill health, except of course if it is burnt. This should be music to the ears of hospital administrators, especially as the bulk of the money spent on treatment and disposal of medical waste is actually spent on the infectious waste. So, since you produce less, you should spend less. Unfortunately this is not the case, as hospitals in South Africa pay over the odds to get their waste treated and disposed of. There are two main reason for this: poor leadership and poor waste management practices.

The acceptable form of treatment and disposal of medical waste in South Africa is to burn it using incineration. This often leads to toxic fumes being released into the atmosphere at concentrations that are harmful to health when inhaled. Often, the incinerators cannot deal with the amount of waste coming, so it is turned away at the gate if it cannot be burnt immediately. Which is how it ends up in a residential area – as in the case of Roodepoort – or on the beach front – as in the case of Durban. The recent discovery of tons of medical waste, packed floor to ceiling in a suburban west Johannesburg house, as well as the tons of medical waste spread across Durban beach last year, has drawn attention to the problems experienced in the disposal of this waste stream. Hospital management needs to take up leadership responsibilities to ensure that waste is properly segregated to ensure that what gets to the incinerator is actually very little.

Those charged with the responsibility to ensure hospital waste is managed properly are the health care waste officers. They are not only trained in managing hospital waste but they are even mentioned in the Health Care Waste Regulations as ”A health officer who is registered and qualified as an environmental health practitioner”. This group of professionals needs to be supported by hospital management so that they can do exactly what they are trained to do, which is ensure that health care waste is managed in such a way that it does not cause harm to the patient, staff and the community.

The idea of prevention of injury and disease is a key reason why health care waste management should be a priority in health care institutions. We don’t want to cause harm to a person in the name of providing care. In fact, it should be considered a violation of a person’s human right and a crime against humanity if the public is still exposed to infectious or hazardous waste from hospitals. Hospital management therefore needs to take more responsible and sustainable actions in dealing with their waste and the people responsible should be given the proper mandate and support to do this.

Just some of the Global Green and Health Hospitals heroes doing amazing work to make their health facilities sustainable, gathered in Pietermaritzburg during groundWork’s community planning meeting. Credit: groundWork

We recently sat down with *Dineo to discuss some of the issues and challenges faced by health facilitators. This is what was discussed:

Luqman: What is your role as a health facilitator and what are the challenges that limit you from adequately doing your job.

Dineo: My role is to develop waste management policies, train the staff and advise management on how to improve our waste systems, better the environment and protect the public. I also do inspections to find out about the hazardous tools we use and I develop corrective action plans. The challenges I face include staff. I was just recently employed and I have no staff to train. If I want to implement a recycling project, I can have all the ideas, identify proper disposal areas and find boxes, but there’s no one here to actually do the proper separation and disposal. I feel there is also lack of support from management. Maybe it’s because they don’t really understand my role, the post is fairly new, maybe it wasn’t introduced to them properly. You find that your immediate supervisor is supporting you, but when you get to finance managers or CEOs, your plans get turned down. They feel support components are not that important.

Luqman: How do you overcome these challenges?

Dineo: Trying to get through to management is very difficult. You can only write reports, invite them to meetings and try to communicate with them, but changing their minds is up to them. I just keep writing to them, expressing the challenges that I am facing and recommending that they give me a team to work with. When the feedback is negative, everything comes to a standstill. At some point, you have to go out yourself, because you see that your duties aren’t being carried out. I end up going out to the garden services people, who are contractors and not directly employed by the facility. I ask them to do collections for me. I give them small incentives for this work, like buying them cool drinks or cigarettes. Clinical orderlies are supposed to be doing this job in the interim: this was the decision taken by management. But they don’t see waste management and collection as their duty. So they feel like they are doing it as a favour to me. If one person doesn’t feel like collecting or transporting the waste that day, they don’t do it.

Luqman: Why is it problematic for the garden services people to be doing this job?

Dineo: I think it’s problematic because they are contracted to do other work. They might not be immunized, they are not given proper Personal Protective Equipment (PPE) to do such duties. It’s just not the right thing to do. You have not protected the people but have asked them to do dangerous work. They are also not trained to do this job. I have trained them on a basic level, but I still have fears because they aren’t mandated to do this work. But dangerous medical waste would pile up everywhere if I didn’t have their assistance.

Luqman: Why is it important for there to be better waste management facilities in hospitals?

Dineo: People don’t see the value because it’s things we don’t see with our eyes. People don’t understand that waste can make us sick. The waste generated from health institutions is full of bacteria, bodily fluids, blood; there’s a lot of infected people with HIV or TB. If we don’t manage this waste properly, any person can come and touch this waste and infect themselves. There’s a risk of health workers being infected and there’s also issues of cross contamination. The waste sometimes ends up in general waste and this increases the possibilities of needle prick injuries. Again, we’re trying to look after the environment. We don’t want to pollute the environment, the ground water. We don’t want our waste ending up in our communities and affecting our children and the public. These days you find children playing in dump sites. They might come across needles. If we don’t take care of our needles, our children will play with them and infect each other. Even the workers and the patients here have to be protected. We are also trying to decrease the spread of infectious diseases and the mortality rate.

Luqman: How many needle prick accidents have you had as a result of poor waste disposal?

Dineo: In our hospital, we have near misses. Sometimes when the needle buckets are full, the nurses will remove them from their work-spaces and place them in the passage way. Sometimes you find no one is collecting in the passage; maybe I’m not at work or I’m attending a meeting. Our institutions also have kids. Sometimes you find that they come and fiddle with the needles. Sometimes we find needles in the general waste, but so far we haven’t had any injuries. On average we have about two near misses a month. Last year we had more staff to deal with collection, but we’ve lost those staff members, so the number of near-misses is rising. The near misses are usually reported by the cleaners. Sometimes they find a needle on the floor while they are cleaning. Other times we catch kids while they are playing with medical waste.

Luqman: What would you like to see done differently

Dineo: It would be nice to have waste handlers in our structures and to work with management that understands the importance of waste management. We don’t have people who can be our power when it comes to operations. We have a well-structured waste area but it is not overseen by anyone. It’s not being cleaned. *The name of the health officer has been changed, to protect the identity of the individual

*The name of the health officer has been changed, to protect the identity of the individual

April 10, 2017Global

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