Providing adequate laboratory and diagnostic capacity, supplies and quality assurance

VEHA - Field Implementation Guidance

Welcome

Health

Essential Healthcare - Outbreak preparedness and response (Communicable diseases)

Diagnosis and case management

Providing adequate laboratory and diagnostic capacity, supplies and quality assurance

Context

Overview

Environmental factors causing/contributing to the needs and affecting the humanitarian activity

Environmental factors such as air pollution or poor water quality may impact health, requiring the provision of health items. For example, the lack of adequate water for hygiene activities may require the provision of external sources of water or substitutes such as sanitizer instead of water and soap. Different climatic or environmental factors may increase the use of health items or accelerate the deterioration of stored essential medical items.

Health-care waste includes general waste that is comparable to domestic waste as well as hazardous infectious waste such as pathological waste, sharps, chemicals, pharmaceuticals, genotoxic waste, radioactive waste, and heavy metals such as from broken mercury thermometers. Poor management of healthcare waste exposes health care workers, waste handlers, and the community to infections, injuries, poisoning, and pollution by toxic elements or compounds such as mercury or dioxins that are released during incineration. If properly segregated, much of health care facilities’ general waste stream can be safely recycled. Additionally, a number of the products used in health services (for example, cleaning fluids, disinfectants, some medical devices, electronic equipment, etc.) contain hazardous chemicals that can cause occupational risks as well as downstream health impacts through pollution and inadequate disposal.

Implications

Gender, age, disability and HIV/AIDS implications

Women and girls are disproportionately affected by the lack of access to basic water, sanitation, and hygiene facilities, due to their needs during periods of increased vulnerability to infection around menstruation and reproduction cycles. Additionally, other groups may have special needs in terms of hygiene practices. For this reason, disaggregate and understand the different groups of people in the community that may have special needs and behaviours when performing hygiene actions. For example, women may be provided with disposable or reusable menstrual pads which will need to be handled after every use. as a consequence, women may need special and additional messages tailored to handle these specific items and the messages need to be created accordingly women’s beliefs. Regarding other groups such as persons with disabilities or HIV/AIDS, create special messages explaining actions that are environmentally sensitive regarding special items they may be using. Regarding sexual health items, messages need to be oriented towards the safe disposal of items such as condoms. Condoms cause problems by clogging sewage drains.

Girls and women in low-resource and emergency contexts without access to adequate menstrual hygiene management facilities and supplies can experience stigma and social exclusion while also foregoing important educational, social, and economic opportunities.

Impacts

Environmental impact categories

Air pollution
Soil pollution
Water pollution
Deforestation
Desertification
Eutrophication
Climate change
Loss of biodiversity and ecosystems
Natural resource depletion

Summary of Impacts

Potential environmental impacts

Water sources and soil can be affected by the accumulation of waste and leachate from piled wasted items. Also, the accumulation of packaging, containers, and bottles may result in blockage and contamination of waters sources and end up in rivers, lakes, and the ocean.
Hazardous infectious waste pollutes air, soil, water and spreads disease.
Air, water, and soil pollution and health impacts from hazardous chemicals in cleaning fluids, disinfectants, some medical devices, and some electronic equipment.
Air pollution due to the environmental impacts associated with transportation if items cannot be sustainably sourced locally.

Impact detail

Detailed potential environmental impact information

Hazardous infectious waste such as pathological waste, sharps, chemicals, pharmaceuticals, genotoxic waste, radioactive waste, and heavy metals such as broken mercury thermometers can enter the environment, polluting air, water, and soil, making people sick. Poor management of healthcare waste exposes health care workers, waste handlers, and the community to infections, injuries, poisoning, and pollution by toxic elements or compounds such as mercury or dioxins that are released during incineration. Many products used in health services (for example, cleaning fluids, disinfectants, some medical devices, electronic equipment, etc.) contain hazardous chemicals that can cause occupational risks as well as downstream health impacts through pollution and inadequate disposal.

Delivery of items can have negative effects on the environment if not well planned or the needs and behaviour of individuals and communities are not appropriately assessed. Good medicine management also prohibits the use of unsafe, unapproved, or expired medicines, which helps avoid immediate waste. Additionally, when delivered items do not match with the cultural preferences of affected communities, items may be unused and may accumulate. Also, when items are used but the resulting waste is not properly managed, waste may be piled in places with poor waste management facilities.

Any lack of adoption and use of health items and the associated accumulation of waste can cause health problems because improper disposal and management of health waste can harbour disease vectors that may spread within communities and contaminate the surrounding environment.

Availability of safe essential medicines and medical services include transport, storage, and the cold chain for vaccines as well as for the collection and storage of blood products. Delivery of items can be affected by the environment as hazards can impact the transportation of essential medicines, e.g.: if roads are flooded medicines cannot be transported by vehicle. Transportation activities normally use fossil fuels which release greenhouse gasses and affect local air quality. This can increase respiratory diseases. There is a potential increase in waste from packaging. In some settings that require the use of boats, transportation can also cause water pollution.

Guidance

Summary

Summary of environmental activities

Properly identify health needs, health items, and health kits based on the culture and context.
Where possible, deliver sustainably produced locally produced items.

Detail

Detailed guidance for implementing suggested environmental activities

If properly segregated, much of health care facilities’ general waste stream can be safely recycled. Elements that can be recycled or repurposed after initial use should be introduced while understanding the behaviour of the people in need and providing them with items they are comfortable to use, or supporting them in understanding and adopting sustainable alternatives, in order to avoid waste of elements due to unused attitudes.
Strategic selection of items for distribution can reduce resource consumption and waste generation. Consult the national essential medicines list for selection as well as the future need of the items post-crisis, and if multi-functional items are an option.
Increase efficiency by procuring products, equipment, or services that consume less energy and have a lower environmental impact during their in-use life and at the disposal.

Ensure that communities are sensitized to the need to manage hygiene kit packaging, particularly if they are experiencing flu-like symptoms.
When identifying and selecting items procure to choose options with safe but low amounts of packaging that protects the items from external contaminants while packaging various components of a set as one unit versus individual units.
Search for biodegradable options that can be safely and easily disposed of after use or that are made from sustainable sources or using sustainable processes. However, while biodegradable materials avoid the risk of persistence that plastics present, the industry for effectively handling and composting these materials is not universally available and may not be cost-effective. In addition, biodegradable materials may not meet the health and durability standards required for certain types of assistance.
The procurement and preparation of items can often be designed to reduce packaging or to substitute with packaging that is more environmentally friendly or reusable. Finally, repurpose items that are shipped for the operations, for example, using bags to grow plants and using disappearing ink if branding is an issue. Reusing and repurposing can both reduce waste and create real value for beneficiaries of humanitarian assistance.
Consider providing reusable containers that allow for a safe refill. Design a recycling plan for items that cannot be reused. Also, consider, when feasible, biodegradable packaging.
Consider the environmental conditions, expiration dates, and energy demands of certain essential medical products and technologies. For example, if a medical product requires a refrigerated environment that is powered by energy, try to find an alternate product or use an efficient renewable power generator.
Reducing demand by looking for opportunities to buy and use less, constantly questioning whether procured products are necessary, supporting interventions that reduce demand for products or use them more efficiently, and ensuring that procured products are not wasted
Procure when possible, health items, essential medical products, and technologies locally and when doing so, determine that the environmental impact of those local items is comparably less than transported/imported items. Determine how sustainable the processes are for producing those items because environmental impacts on water, soil, and air can be higher in local industries due to the lack of appropriate technologies. Locally available or sourced materials reduce environmental impacts associated with transportation and distribution. However, the provisioning and regeneration capacity of local sources should be considered.
Oversight of quality and sourcing of goods and services can be more challenging with local stakeholders, for instance, there may be less control over the quality, environmental impact during production, and solid waste management. Mechanisms to address these challenges, including raising awareness and capacity of local stakeholders to understand and pursue opportunities to engage throughout the supply chain, must be established.
Ensure not only the most efficient mode of transportation but also the least detrimental for the environment (e.g.: use one big truck instead of several small vehicles).
Prioritise low-carbon alternatives in the design and operation of the built environment, procurement and purchasing, energy efficiency, energy sourcing, retrofitting, and equipment.

Lessons Learnt

Lessons from past experiences

New laboratories constructed in Bangladesh for Covid-19 testing implemented new efficient processes to reduce waste and prevent disease spread from health waste.
Humanitarian actors, in responding to the Global Covid-19 response, supported the local manufacture of PPE, sanitisers, and Covid-19 testing kids in most low-income fragile countries. This significantly reduced transport emissions.

Activity Measurement

Environmental indicators/monitoring examples

# of health facilities where hazardous waste has been assessed and measures implemented to separate waste, recycle where appropriate, and treat, remediate, destroy or contain hazardous waste.
# of items demonstrated to be environmentally sustainably procured
Percentage of procured items that were produced locally and produced sustainably.

Priority

Status

High

Main Focus

Focus of suggested activities

Prevention of environmental damage

Implications

Resource implications (physical assets, time, effort)

Field and desktop research to understand the needs and behaviours of people. Costs can vary from the normal items (more/less). Also, extra time to investigate sustainable products to be procured locally, and products free of hazardous materials. Time and research on understanding the existing capacity and availability of items on the field (local items and workforce), if done in coordination with a local actor could require less time. Requires coordination with procurement and logistics teams. Can take longer to action changes.

Additional time to source sustainable products and determine whether they can be procured locally. Requires coordination with procurement and logistics teams. Can take longer to action changes.