Environmental factors such as air pollution or poor water quality influence health and may lead to the requirement to provide health items. For example, the lack of adequate water for hygiene actions may require the provision of external sources of water or substitutes that can provide the functions needed, such as sanitizer instead of water and soap. Also, there are environmental factors affecting the way in which health items are provided or distributed. The physical and natural environment may affect the transportation of health items, e.g. high levels of humidity or rainfall might make it necessary to wrap items in impermeable packaging or tarpaulins, and how these are disposed of after the distribution.

Local environmental hazards can affect distribution such as road deterioration by landslides, or extreme weather events that prevent transportation by air or waterways.

There are also different climatic or environmental factors that might increase the use of health items or accelerate the deterioration of stored essential medical items.

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.

Air pollution
Soil pollution
Water pollution
Eutrophication
Loss of biodiversity and ecosystems
Natural resource depletion

• Water sources and soil can be affected by the accumulation of waste and leachates from piled wasted items
• Accumulation of packaging, containers, and bottles may result in blockage and contamination of waters sources and end up in rivers, lakes, and the ocean
• Solid waste may harbour disease vectors, leading to disease spread.
• Air pollution is due to the environmental impacts associated with long-haul transportation if items are not procured locally.
• Water and soil contamination due to poor hazardous chemical and health product disposal practices from healthcare facilities including any hazardous by-products and plastics.

• The distribution of health 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, untested, or expired medicines, which helps reduce immediate waste. Additionally, when distributed 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, accumulation of waste can occur in places that have limited capacity to gather, transport and dispose of that waste appropriately. Additionally, the lack of use of health items and the accumulation of waste can cause health problems because improper disposal and management of health waste can also become a vector for disease to spread within communities and can contaminate the surrounding environment.
• Procurement and distribution of safe essential medicines and medical services require 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 usually depend on fossil fuels that contribute to climate change and reduce air quality and create air and noise pollution from combustion. These emissions can also increase respiratory diseases and there is the potential increase in waste from packaging. In some settings that require the use of boats, transportation can also cause water pollution.

Properly identify health needs, health items, and health kits based on the culture and context.

Where possible, deliver environmentally sustainable items that are locally sourced. Where they are not available locally, compare the environmental impacts of long haul procurement of sustainable items versus more polluting locally sourced items. Long haul low-impact items usually still have a lower overall negative environmental impact.

– procure medical products and technologies low in chemical content or contain less hazardous alternative chemicals
– ensure safe transport, storage, use of all chemicals and medicines
– develop safe disposal
– minimise plastics

• 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 using, or promoting and monitoring the uptake of more 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 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.

• In a major Haiti earthquake response, humanitarian responders used cash for work projects to help clear solid waste from drains and watercourses, which reduced the potential spread of disease.
• In the Covid 19 response in Bangladesh, the MoH, WHO, UNICEF, IFRC, Donors, and NGOs collaborated in health coverage and medicine distribution, reducing transport emissions.
• In the Covid 19 response in Bangladesh, donors and humanitarian actors collaborated in upgrading health facilities, including the safe storage and handling of chemicals.

• Percentage increase of people using STD related items that can be reused, recycled or resold.
• Change in the number of people using hygiene items that can be reused, recycled or resold, and safely disposed of.
• Number of positive changes made to procurement processes to minimise environmental impact.
• Percentage of delivered items that were produced locally
• Percentage of health products that do not contain or create by-products that are hazardous for the environment and ecosystems

Prevention of environmental damage

• 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.
• Time, resources, and expertise to assess the environmental impacts of local versus remotely sourced health items, essential medical products, and technologies, and to procure those with the lowest impact.
• Time and expertise to procure products and items that have low or safe alternative chemicals and to develop safe management and disposal plans.