Katharina Kummer Peiry, Executive Secretary Secretariat of the Basel Convention, UNEP

1. PREVENTING DISEASE THROUGH SAFE WASTE MANAGEMENTA Contribution to Public HealthMENA Healthcare Infrastructure Investment & Finance Summit 2010Cairo, 27-28.10.2010 Katharina Kummer Peiry, Executive Secretary Secretariat of the Basel Convention, UNEP

2. SUB-TOPICS • Introduction – Hazardous Waste and Health • How Can We Promote ‘Green’ Health-Care? • Basel Convention at a Glance • Biomedical & Healthcare Wastes under BC • BC Technical Guidelines on the ESM of Biomedical and Healthcare Wastes

3. INTRODUCTION • Healthcare facilities are among the common pollution sources, in addition to other activities/facilities. • Some health-care waste types pose hazards to the public and environmental health due to their hazardous constituents (infectious, toxic, etc.) and potentially improper management • Despite aiming at facilitating treatment for various diseases, health-cares facilities may also spread the disease agents carried in their waste materials. Image: thehindubusinessline.com

4. Introduction (2)Health-care waste issue on newsmedia (1) “50% Mumbai hospitals cut corners; sell off bio-medical waste” … Over 50% of the hospitals sell off their bio-medical waste such as worn out disposable syringes, saline bottles, suction pipes used for blood transfusion and glucose, scissors and urine bags to scrap dealers. … “This is a white-collar crime. Indulging in it can put several lives at risk. Public awareness has to be generated to stop such a trade,” said Anup Nilawar, director SMS Envoclean. Published: Tuesday, Oct 12, 2010, 2:08 IST, By Priyanka Sharma (www.dnaindia.com)

5. Introduction (3)Health-care waste issue on newsmedia (2) “Waste accounts for $850B of healthcare costs annually” … The research firm found that unnecessary care, which it defines as overuse of antibiotics and diagnostic tests, accounts for 40 percent of healthcare waste; that administrative inefficiency contributes another 17 percent of costs; that provider errors account for 12 percent of waste; that preventable conditions generate 6 percent of healthcare waste; and that lack of care coordination generates 6 percent of waste. … (www.fiercehealthcare.com)

6. HOW TO PROMOTE ‘GREEN’ HEALTH-CARE? • Your investment in health-care establishments certainly will support public health infrastructure. But, how would it ultimately turn out? • Profit, reputation? • Liability? • Experience shows that with core expertise and safe & proper waste management, many health-care establishments can support public health: • Curative (to patients) • Preventive (to the environment) • Public health & environmental problems from health-care waste can be prevented, a.o., with proper waste management (haz waste minimisation, safe disposal, etc.)

7. How To Promote ‘Green’ Health-Care? (2) • Typical ratio of haz waste over non-haz waste in total waste from clinics & hospitals is about: • 15:85 (USA, American Hospital Association) • 20:80 (Europe, Health Care Without Harm) • Treatment and disposal costsfor haz waste are relatively higher than those for non-haz waste. • It is important to segregate the originally non-haz waste from the haz waste in order to reduce volume and, eventually, costs.

8. How To Promote ‘Green’ Health-Care? (3) • It is important for investors to ensure that the management take all Occupational Health & Safety and Environmental issues be addressed at all stages of activity. • Planning • Construction • Operation • Closure • Make use of available standards, guidelines, best managemen practices such as those of the Basel Convention.

9. BASEL CONVENTION AT A GLANCE • Basel Convention (BC) on the control of transboundary movement of hazardous wastes and their disposal • The most comprehensive global environmental agreement on hazardous and other wastes • Adopted on 22 March 1989 in Basel, Switzerland • Entered into force on 5 May 1992, currently >170 Parties • Governed by Conference of Parties (COP), the last COP theme was “Waste Management for Human Health and Livelihood” at which the “Bali Declaration” was launched (refer to brochures) • Main Goal • To protect, by strict control, human health and the environment against the adverse effects which may result from the generation and management of hazardous wastes and other wastes

10. Basel Convention at a Glance (2) • Mechanism for Achieving the Goal • The control of the transboundary movement of hazardous wastes and other wastes • Environmentally Sound Management (ESM) of hazardous wastes and other wastes • ESM means addressing the waste management issue through strict controls from the generation of a hazardous waste to its storage, transport, treatment, reuse, recycling, recovery and final disposal • The Secretariat of the Basel Convention (SBC) facilitates Parties in the development of a range of projects, guidelines, mechanisms and strategies for minimizing wastes and ensuring their ESM, incl. the BM&HC waste

11. BIOMEDICAL & HEALTHCARE (BM&HC) WASTES UNDER THE BASEL CONVENTION • BM& HC wastes are BC wastes as they are listed on some annexes to the text of the Convention • Annex I • Y1 – Clinical wastes from medical care in hospitals, medical centres and clinics • Y3 – Waste pharmaceuticals, drugs and medicines • Annex III (by characteristics, a.o.) • H6.2 – Infectious substances • Annex VIII • A4010 – Wastes from the production, preparation and use of pharmaceutical products • A4020 – Clinical and related wastes

12. BC TECHNICAL GUIDELINES (TGs)FOR BM&HC WASTE MANAGEMENT • One of the TGs provided to Parties as a tool for managing the BM&HC waste which is classified as hazardous wastes under the BC. • Basis: • National guidelines from developed and developing countries; • Publication from WHO (World Health Organisation); • Paper by CEN (European Committee for Standardisation) • To be used with other considerations, esp.: • TGs for Incineration on Land; • TGs for Specially Engineered Landfill; • Legal frameworks and responsibilities of relevant CAs.

13. BC TGs on the ESM of BM&HC WastesDefinition of “Health-Care” • Medical activities such as diagnosis, monitoring, treatment, prevention of disease or allevation of handicap in humans or animals, including related research, performed under the supervision of a medical practitioner or veterinary surgeon or another person authorised by virtue of his or her professional qualifications. Image: life.com

14. BC TGs on the ESM of BM and HCW Contents (for details, please refer to http://www.basel.int/pub/techguid/tech-biomedical.pdf) • Introduction • Purpose and scope of the guidelines • General definition of biomedical and health-care waste • Hazards of biomedical and health-care waste • Field of application/source identification • Waste identification and classification/waste groups • Applicable state-of-the-art management, treatment and disposal technologies • Waste management auditing • Capacity-building • Annexes

15. THANK YOUFor Further Information on Biomedical & Health-Care Waste Management Programme: SECRETARIAT OF THE BASEL CONVENTION International Environment House 15 Chemin des Anémones Chatelaine CH-1219 Geneva, Switzerland Website: www.basel.int E-mail: sbc@unep.org, dadan.wardhana@unep.org