greening health sector - innovations for sustainable development
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Greening the Health Sector
Dr. Christoph HamelmannRegional Practice Leader HIV, Health and Development
UNDP Europe and Central Asia
Brown Bag DiscussionUNDP New York, 7 November 2012
Innovations for Sustainable Development
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The 3 Pillars of Sustainable Development
Economic growth
Environment Protection
Social justice
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Health and the 3 Pillars of SD
Social Justice Economic Growth Environment
Human Right to Health Health Sector and GDP Environmental Impact on Health
Universal health coverage Health Sector & Employment
Health Sector Impact on Environment
Social Protection Health and Human Capital
Social Determinants of Health Health & Innovations
Social Inclusion Investment in Health
Inclusive Growth
Gender & Health
Health & Resilience
Health Governance
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Overview
• ECIS/RBEC Health & Environment programming context
• 2012 Greening the Health Sector initiatives and projects
• Lessons learnt and next steps
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ECIS/RBEC Health & Environment programming context
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Parma Declaration
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Parma Declaration Content Focus
Ministerial Environment & Health Task Force
WHO Europe Environment & Health
MoH & MoE of 53 member states
UNDP, UNEP & others
Ministerial Board
WHO Europe Regional Committee UNECE+
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Parma Declaration Content Focus
• Climate change and health• Water and sanitation• Out- and indoor air quality• Prevention of diseases arising from chemical,
biological and physical environment• Addressing obesity and injuries through safe
environment, physical activity and healthy diet• Environment and health information system
Apply also to operations of the health sector:Greening of Health Sector
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Health Sector in the ECIS Region
• Accounts for 7.5 % of GDP• Technology intensive with significant
consumption of resources, associated with environmental pollution and degradation
• Accounts for an estimated 4.2 % of greenhouse gases (GHG) in the ECIS region
• Up to 25 % of these GHG can be reduced within short-term, more through long-term measures
• Reductions have also direct positive impact on life-years saved
Ministerial European Environment and Health Task Force Meeting, Bled / Slovenia 2011
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UNDP & UN Sustainable Procurement
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UNDP & UN Sustainable Procurement
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UNDP IntranetProgramme and Operations Policies and Procedures Home > Contract and Procurement Management > Procurement Overview > Environmental Considerations
4.0 Procedures
UNDP’s “green” procurement policy promotes the four “R” strategies:
• re-think the requirements to reduce environmental impact; • reduce material consumption; • recycle materials/waste; and • reduce energy consumption.
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Whole Product Life-Cycle Approach
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ECIS/RBEC H&E Programming Context
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ESA
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Economic Commission for EuropeReport Regional Preparatory Meeting
Public procurement47. Sustainable public procurement was supported as a first critical step to further the green economy at the national as well as the sub-national level. Concrete progress was proposed in the form of sustainable public procurement targets that could be met by an increasing number of countries over the years.
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UNDP & UN Green Procurement
• How far have we come in practice?
• What is our monitoring framework?
• What are our targets?
What is missing:
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Volker Welter, Sviatlana Kavaliova, Global Fund Partnership, PSO/BOM, Copenhagen
UNDP GF Partnership: Procurements in US $
Description 2008 2009 2010 2011
Pharmaceuticals 36,131,584 40,730,863 50,343,211 64,318,230
Health products (non-pharma-ceuticals)
22,664,462 36,319,625 69,921,736 72,303,829
Civil works NA 6,490,317 218,144 7,095,562
Other services NA 4,573,245 2,431,624 2,601,420
Total: 58,796,046 88,114,050 122,914,715 146,319,041
UNDP’s Global Fund Related Health Sector Procurements
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UNDP’s Global Fund Grants in ECIS
HIV TB MalariaBelarus Bosnia & Herzegovina Kyrgyzstan Montenegro Tajikistan Turkmenistan Uzbekistan
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ECIS/RBEC Greening the Health Sector Initiatives
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• Source of leadership, expertise and guidance• Promoting culture of measurement and responsibility in
carbon governance• Evaluation and costing of best practices and innovations,
standardization of implementation mechanisms for scale-up• Shaping policies, locally, nationally, internationally• Partnerships with government, industry and other
stakeholders
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Sector Guidance for Pharmaceutical and Medical Device Manufacturers
1
GHG Protocol Product Life Cycle Accounting & Reporting Standard
The World’s First
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Sustainable Procurement in the Health Sector
Informal UN Interagency Task Team on Sustainable Procurement in the Health Sector (IATT – SPHS)
2
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CARBON FOOTPRINT OF HEALTH SECTOR PRODUTS & SERVICES
CARBON FOOTPRINT OF OWN PROCUREMENT AND SUPPLYCHAIN
MANAGEMENT OPERATIONS
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Environmental Hazard (PBT)
• Persistence (degradation)
easily degraded
slowly degraded
• Bio-accumulationNo significant potential to bio-accumulate
Potential to bio-accumulate
• Toxicitylow, moderate, high, very high
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Environmental Toxicity Risk
Predicted Environmental Concentration:
PEC
Predicted No-Effect threshold Concentration:
PNEC
Risk calculation:
PEC
PNEC
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(6) The pollution of waters and soils with pharmaceutical residues is an emerging environmental problem. Member States should consider measures to monitor and evaluate the risk of environmental effects of such medicinal products, including those which may have an impact on public health. The Commission should, based, inter alia, on data received from the European Medicines Agency, the European Environment Agency and Member States, produce a report on the scale of the problem, along with an assessment on whether amendments to Union legislation on medicinal products or other relevant Union legislation are required.
2010/84
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Health Care Waste
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OVERVIEW OF THE GEF GLOBAL PROJECT (EEG):
Demonstrating and Promoting Best Techniques and Practices for Reducing Health Care Waste to Avoid Environmental
Releases of Dioxins and Mercury
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Pre-Qualification Programme
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design
manu-facture
use
waste
Productlife cycle
Health Market PowerUS $ 3 Billion annually
Pre-QualificationSchemes
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The overall UN footprint reduced
through set targets and timelines
Baseline indicators in sustainable
procurement established and shared publicly
Sustainability integrated into
all decision making
processes
Value all resources and a
‘Minimize Waste’ approach
Account and regulate for total cost of ownership
Report impacts of decisions on health and the environment
Agree sustainable
development definition and
structures
Agree baseline and indicators. Act to reduce
resource waste
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Informal UN IATT – SPHS Route Map
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Chief Executive Board (CEP)
HLCMProcurement Network
WG Sustainable Procurement
UNDG HLCP
Informal IATT-SPHS Organizational Link
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Global Fund Board Composition
Board Members:http://www.theglobalfund.org/en/board/constituencies/
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GAVI AllianceBoard Composition
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informal
IATT - SPHS
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Georgia: Justice for All
The World’s First3
‘Development of a full carbon footprint and marginal abatement cost analysis for Global Fund HIV and TB grants to help ascertain hot spots and
areas for action to reduce the footprint’
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HIV TB PeriodMontenegro Round 5 2005 - 2010
Round 9 2010 - 2015 Round 6 2007 - 2012
Tajikistan Round 6 P1 2007 - 2009Consolidated
R6/R8 2009 - 2011
Round 8 P2 2011 - 2014Round 6 P1 2007 - 2009
Consolidated R6/R8
2009 - 2011
Round 8 P2 2011 - 2013
UNDP Global Fund Grants in Pilot Project
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Marginal Abatement Costs
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Steering Group as Cross-Practice Work
Tajikistan1 HHD/1 EEG
Copenhagen1 BOM
BRC2 HHD/1 EEG
Montenegro1 HHD/1 EEG
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In-Built Internal Capacity Building
• Production of Quick Start Manual
• Webinar trainings course
• Provision of automated calculator and analysis
tool
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Expected Outputs
• Methodology of carbon foot printing
and MAC for global health initiatives
established and published
• Costed recommendations for action
by countries
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Next Steps
• Facilitating and supporting requests to broaden scope on country level
• Scale-up to all UNDP global fund countries• Sensitization of Global Fund Secretariat and
Board; advocacy for policy change (grant proposal criteria)
• Promoting application to other global health initiatives including policy changes through their financing institutions
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Sustainable Energy for All (SE4ALL)
Ensuring universalEnergy Access
Doubling the share ofRenewable Energy
Doubling the rate ofImprovement inEnergy Efficiency
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Greening Health Sector – link to SE4ALL
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Lessons Learnt (1)
• Use existing dynamics, drivers and partnerships to move the agenda
• Direct engagement with manufacturers, suppliers and forwarders shows results
• Use joint market power and convening role to optimize impact
• Build on commitments made by funders and policy makers and convince through progress in practice; goal: to green US $ 27 billion annual development aid for health (DAH 2011)
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Lessons Learnt (2)
• Put more emphasis on result-focused approach; provide monitoring tool, agree on milestones and targets
• Technical problems and lack of standards are to be solved as critical milestones, and not be an excuse for lack of action
• ‘Think big’ since we are dealing with one of the biggest global threats
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Lessons Learnt (2)
Stay creative
How to leverage US$ 27,000,000,000 annually
With a budget of 50k ???????
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From the Afterword by Helen Clark in "Partnerships for Global Health: Pathways to Progress" - 2012 Cambridge International Development Report, launched on 22 October 2012
“For UNDP, the message is clear: when the environment is harmed, so too is the potential to lift human development.”
“Discourse around global health needs to address the linkages between equity, sustainability and health outcomes explicitly.”
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Special Thanks to
[email protected]: @cahamelmann
Volker Welter, Jens Wandel, Camilla Bruckner, Hakan Bjorkman, Martin
Krause, Sonia Roschnik