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

The 3 Pillars of Sustainable Development

Economic growth

Environment Protection

Social justice

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

Overview

• ECIS/RBEC Health & Environment programming context

• 2012 Greening the Health Sector initiatives and projects

• Lessons learnt and next steps

ECIS/RBEC Health & Environment programming context

Parma Declaration

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+

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

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

UNDP & UN Sustainable Procurement

UNDP & UN Sustainable Procurement

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.

Whole Product Life-Cycle Approach

ECIS/RBEC H&E Programming Context

ESA

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.

UNDP & UN Green Procurement

• How far have we come in practice?

• What is our monitoring framework?

• What are our targets?

What is missing:

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

UNDP’s Global Fund Grants in ECIS

HIV TB MalariaBelarus Bosnia & Herzegovina Kyrgyzstan Montenegro Tajikistan Turkmenistan Uzbekistan

ECIS/RBEC Greening the Health Sector Initiatives

• 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

Sector Guidance for Pharmaceutical and Medical Device Manufacturers

1

GHG Protocol Product Life Cycle Accounting & Reporting Standard

The World’s First

Sustainable Procurement in the Health Sector

Informal UN Interagency Task Team on Sustainable Procurement in the Health Sector (IATT – SPHS)

2

CARBON FOOTPRINT OF HEALTH SECTOR PRODUTS & SERVICES

CARBON FOOTPRINT OF OWN PROCUREMENT AND SUPPLYCHAIN

MANAGEMENT OPERATIONS

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

Environmental Toxicity Risk

Predicted Environmental Concentration:

PEC

Predicted No-Effect threshold Concentration:

PNEC

Risk calculation:

PEC

PNEC

(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

Health Care Waste

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

Pre-Qualification Programme

design

manu-facture

use

waste

Productlife cycle

Health Market PowerUS $ 3 Billion annually

Pre-QualificationSchemes

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

Informal UN IATT – SPHS Route Map

Chief Executive Board (CEP)

HLCMProcurement Network

WG Sustainable Procurement

UNDG HLCP

Informal IATT-SPHS Organizational Link

Global Fund Board Composition

Board Members:http://www.theglobalfund.org/en/board/constituencies/

GAVI AllianceBoard Composition

informal

IATT - SPHS

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’

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

Marginal Abatement Costs

Steering Group as Cross-Practice Work

Tajikistan1 HHD/1 EEG

Copenhagen1 BOM

BRC2 HHD/1 EEG

Montenegro1 HHD/1 EEG

In-Built Internal Capacity Building

• Production of Quick Start Manual

• Webinar trainings course

• Provision of automated calculator and analysis

tool

Expected Outputs

• Methodology of carbon foot printing

and MAC for global health initiatives

established and published

• Costed recommendations for action

by countries

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

Sustainable Energy for All (SE4ALL)

Ensuring universalEnergy Access

Doubling the share ofRenewable Energy

Doubling the rate ofImprovement inEnergy Efficiency

Greening Health Sector – link to SE4ALL

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)

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

Lessons Learnt (2)

Stay creative

How to leverage US$ 27,000,000,000 annually

With a budget of 50k ???????

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.”

Special Thanks to

christoph.hamelmann@undp.orgTwitter: @cahamelmann

Volker Welter, Jens Wandel, Camilla Bruckner, Hakan Bjorkman, Martin

Krause, Sonia Roschnik