Avoidance, Reduction and Management of Health Care Waste

The COVID-19 pandemic has generated massive increases in the volumes of health care waste in countries across the globe, but has also spurred significant innovation and interest in alternative approaches to management of diverse waste streams. Some of these new technologies can be applied in low and middle-income countries (LMICs), however others may not be easily adopted in low resource settings. The efficiency and effectiveness of waste management interventions often remains poorly understood and is not frequently systematically addressed or investigated. Many LMICs may require support to develop waste management policies, reverse logistics contracts, and environmentally friendly waste disposal systems. Some countries have undertaken initial steps to develop healthcare waste management plans, however struggle to operationalize those plans due to a number of financial and logistical constraints.

Besides general waste (such as paper and cartons, packaging materials, plastics), the health sector produces a substantial amount of hazardous waste: laboratory waste (particularly from molecular diagnostics testing), surgical, pharmaceutical and radioactive waste; small batteries of medical equipment; X- ray related waste; equipment containing mercury; engine oil, car batteries of ambulances; inappropriate or expired insecticides; bio-hazardous waste such as samples from potentially infected persons, lab cultures, specific body fluids (e.g. TB sputum) and an increasing amount of electronic waste.

Very often appropriate policies and the capacities to deal with hazardous medical waste are insufficient; the awareness, means and knowledge how to segregate, store, transport and dispose hazardous waste is often lacking among the different stakeholders. The responsibilities between donors, implementers and partner countries often remain unclear and in most cases no budget is reserved for waste management, nor are capacity development measures to strengthen countries’ abilities to deal with waste integrated into health programmes. A number of international conventions regulate specific aspects of health care waste (e.g. transportation; mercury; pesticides), but awareness among policy makers and practitioners in the health sector is low, and oversight and enforcement mechanisms are limited.

Furthermore, it is difficult to quantify the amount of waste produced by health programs in general, and difficult to estimate the associated costs for safe disposal. Currently the Global Fund does not support any key performance indicators (KPI) or other metrics to enable tracking the volume of HCW associated with interventions, nor generate data on practices are country level (e.g. whether or not segregation of waste streams is occurring at facility level, or what fraction of waste volumes are being treated on site).

In 2019, the Global Fund engaged a consultancy firm to 1) conduct a Landscape Analysis of HCWM issues from the perspective of Global Fund investments; 2) develop a Technical Brief on Sustainable HCWM; 3) develop training materials directed towards internal stakeholders of GMD and PRs; 4) deliver 5 trainings to the Secretariat (over 1-2 days). Those were the first such publications and training sessions held by Global Fund to provide guidance for applicants and implementers on key considerations for strategic planning of HCWM interventions.

The current assignment proposes to build on the past work, to produce updated guidance materials and training content as outlined below. Given that many countries struggle to operationalize existing strategic plans and policies, we emphasize that the Terms of Reference below should focus on promoting the adoption of practical and feasible interventions, and provide step-wise guidance for country stakeholders involved in funding request development and implementation.

The assignment seeks to produce two main deliverables to guide and incentivise improved HCWM investments supported by Global Fund.

Download RFP in English