The impact of COVID-19 has put a strain on healthcare systems throughout the world. Investing in the sustainable use of energy and water, sound management of medical waste and advanced digital solutions would ease the burden and help improve the health of people and the planet.
A second wave of COVID-19 is hitting many countries, putting additional stress on their already heavily loaded health systems. As a result of the pandemic, the increasing amount of medical waste generated and the energy and water use in healthcare facilities, among others, can pose further risks to the health of the people and the planet if not managed sustainably, diminish the hope for a rapid recovery, and derail the 2030 Agenda for Sustainable Development and Paris Agreement.
Medical waste is a problem that goes beyond the COVID-19 crisis. Unsound management of medical waste could cause “knock-on” effects on human health. Studies reveal that over a half of the world’s population is at risk from health threats and 5.2 million people die each year because of diseases related to unmanaged medical waste. For example, medical waste handlers were found to have higher infection rates of Hepatitis B and C than non-medical waste handlers in Ethiopia.
In the COVID-19 context, the sudden increase in the number of used masks, gloves and other personal protective equipment (PPE), as well as other types of medical waste, were found to exceed the handling capacity of many healthcare facilities and the capacity of designated medical waste management facilities, where they existed. In Indonesia, for example, 1,480 tonnes of COVID-19 medical waste was produced from March through June 2020. Yet of a total of 2,889 hospitals, only 82 have licensed incinerators on their premises as of July. The long distances from hospitals to final medical waste disposal sites can also increase the risk of illegal dumping, cross-contamination and disease transmission to those who are in close contact of medical waste.
In addition, unsound management of medical waste could have negative environmental implications. For example, an increased amount of discarded single-use plastic PPE has been found in the Mediterranean Sea since the pandemic. And, inadequately designed or operated landfills can lead to groundwater pollution and the poor monitoring of the flue gas after incineration can contribute to ambient air pollution that kills many more people.
Putting in place sound management
Tackling these challenges requires first and foremost a sound management system for medical waste as a critical part of the overall efforts of greening health infrastructure systems. Furthermore, environmentally sustainable and climate-resilient healthcare facilities – from water, sanitation and hygiene (WASH) to energy use and medical products and technologies – are necessary for a green health infrastructure system. Such systems are vital components of the COVID-19 response that aims to help countries build back better, while improving resilience to the health crisis and mitigating impacts on development, environment and society.
As part of the COVID-19 response, national guidelines for sound medical waste management must be put in place where such cross-sector policy documents do not exist, and need to cover the entire life cycle of medical waste and address identification, collection, separation, storage, transportation, treatment and disposal. This normally requires inter-departmental collaboration and systems-level approaches to infrastructure governance and provision, involving public health, environment, municipal solid waste management and sometimes transportation departments.
Often, the selected waste treatment technology does not need to be state-of-the-art incineration furnaces or high-temperature steam autoclaves. Instead, it can be selected according to the local conditions. For example, if sanitary landfills are not feasible, controlled dumps can be set up relatively quickly in emergency cases to avoid open dumps or accumulation of medical waste in healthcare facilities. Of particular importance is the implementation of these policies to sustain the efforts. Building the capacity of health system practitioners is therefore also critical.
Good practices have been shared from across the globe. Kenya released national guidelines for the management of COVID-19 waste and formulated specific procedures that apply to communities, public places, healthcare facilities and COVID-19 isolation centres. The Central Pollution Control Board (CPCB) of India introduced a labelling and colour-coding system for waste separation and storage. A hospital in China shared its practice covering classified packaging and pretreatment, collection and transportation and centralized disposal. Spain made clear instructions to segregate COVID-waste from the municipal/household solid waste. Mexico has designated temporary storage, including area, container, time limits, standardized in protocols.
Towards a more integrated health system
In the medium to long term, more integrated approaches could be explored to move beyond just medical waste management towards a more sustainable and inclusive health system as a whole. Such approaches could involve retrofitting existing healthcare facilities with sustainable energy and water supplies, adopting new medical waste treatment systems and technologies, applying circularity by optimizing the use of resources and minimizing the release of waste into the environment, and constructing new health infrastructure that are “better from the start” and designed with flexibility for resilience to crises.
The United Nations Development Progamme (UNDP) has piloted and demonstrated several solar PV projects in the health sector in Libya, Namibia, South Sudan, Sudan, Zambia and Zimbabwe. These can help release the burden of energy demand for delivering essential services of healthcare facilities, especially in some developing countries where basic energy supplies are unstable, and reduce the use of on-site, small-scale fossil fuel generators, which is a contributor to ambient air pollution and associated GHG emissions. Several hospitals in Canada have adopted similar practices such as using renewable energies and, additionally, recycling waste, and the Partnership for Action on Green Economy (PAGE) has supported Mongolia to use LED lights in hospitals with increased energy efficiency.
These efforts could in turn benefit health infrastructure systems with increased resource efficiency and reduced operation and maintenance costs in the long run.
Digital solutions
Digital health infrastructure has played a significant role in combating the pandemic. Many countries launched COVID-19 tracking apps, such as SwissCovid, to warn people of potential close contact of positive patients. Canada developed an app, ArriveCAN, which has been successful in tracking people entering the country from abroad and ensuring they complete their mandatory 14-day quarantine. The Chinese medical platform DX Doctor offers online consultation, telemedicine and other medical services.
These digital solutions, with electronic medical records and real-time data from wearables, will advance the sector further with the help of big data and more accessible high-quality online medical training. Moreover, digitalization in general has provided many opportunities to increase energy and resource efficiencies, such as smart metres in hospitals for more efficient utilities and online tracking and monitoring system for medical waste. These developments will make health infrastructure systems more transparent, efficient and flexible, and help raise the quality, making societies better prepared and more resilient ahead of the next pandemic or crisis.
Supporting greener health infrastructure systems
However, many countries find that they lack capacity, flexibility and resilience to respond to the current pandemic, especially to the changing risks and demands. This suggests that investment in health infrastructure overall has long been deprioritized in relation to other revenue generating economic infrastructures.
Principles for recovery must be applied for investing in sustainable and resilient infrastructure, and economic considerations should be balanced with investments in social infrastructure to promote health, well-being and gender equality, bringing wider benefits to communities.
In fact, various studies and statistics from the World Health Organization, International Labour Organization and many other institutes have shown evidence that the health sector is a major contributor to jobs creation and inclusive economic growth, which has even a more important role to play in the economic recovery phase from the COVID-19 pandemic. Doing its part, the Africa Office and Resources and Markets Branch of the United Nations Environment Programme are collaborating to support African countries – primarily Kenya and Ethiopia – in greening health infrastructure systems and fostering regional and South-South cooperation.
As health infrastructure systems are often reliant on finance from the public sector, the investment gap needs to be filled by governments with adequate fiscal support and prioritization. Other economic incentives such as direct payment transfer for medical waste treatment and renewable energy subsidies can also play an important role in creating an enabling environment for the financing of greener health infrastructure systems in the future.
