This article is written by Tshepo Mokhadi, Environmental Health Practitioner (EHP), Free State Department of Health (FSDoH), South Africa.

  • The problem: In the provision of healthcare services, hospital practices are unsustainable and harmful to the environment.
  • Why it matters: Environmental sustainability in healthcare settings can provide near-term and long-term financial savings, improve patient care and increase workforce engagement.
  • The solution: Transform healthcare service delivery and find sustainable solutions through the use of innovative digital technologies and global networks to share knowledge.

In 2012, the scope of the environmental health profession in South Africa was broadened to include environmental health services at healthcare facilities. This initiative was actioned by the National Department of Health (NDoH) across three provinces: the Free State, Gauteng and Kwa Zulu Natal. The legislative framework used to roll out this initiative was the National Environmental. Management: Waste Act (NEM: Waste Act) and the South African Waste Information System (SAWIS) regulation, which stipulated that all major waste generators should appoint Environmental Health Practitioners (EHPs) as Healthcare Waste Management Officers (HCWMO).

The start of my journey as an EHP

Bongani Regional Hospital appointed me as their first-ever EHP in January 2013, to run and execute Environmental Health Services (EHS) within the institution. In South Africa, EHS falls under Municipal Health Services (MHS), which is why the scope of Environmental Health (EH) is predominantly under local authorities and not in the health sector which is dominated by nursing and clinical practitioners. When I started my role, it soon became quite obvious from the onset that whatever an EHP was to implement, it would become the new norm.

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In the first few years of my appointment as an EHP, I identified some major challenges faced by healthcare facilities such as Bongani Regional Hospital. I hoped to find sustainable solutions for them. These challenges ranged from:

  • The use of harmful chemicals
  • No recycling initiatives
  • No Healthcare Waste (HCW) minimisation strategy
  • No sustainable hospital initiatives
  • Lack of appropriate training (accredited Continuing Professional Development (CPD))
  • Lack of resources (tools, checklists, etc)
  • Lack of food safety programmes
  • Lack of occupational health and safety programmes
  • Lack of external hygiene monitoring

Three sustainability initiatives we introduced

The journey of Bongani Regional Hospital towards sustainable, greener healthcare practices began in 2016, when I finally got to join the Global Green and Health Hospital (GGHH) network, which as the name suggests, is a global network aiming to develop greener hospitals. As the challenges we faced were piling up with little help from colleagues and other senior members of the healthcare establishment. Under the tutelage of Dr Noge (CEO) I was tasked to conduct a quality improvement plan. Through the creation of benchmarks and networking, we came across an NGO called Groundwork, a strategic partner for Healthcare Without Harm (HCWH). Through Groundwork we were introduced to the GGHH network and became familiar with the ten GGHH goals. By signing up to join GGHH and actively participating in the network, we chose the following three areas to focus on within Bongani Regional Hospital:

  • Chemicals
  • Waste
  • Leadership

The (GGHH) network is increasingly working to mobilise health care to reduce its own carbon footprint, become more climate resilient and exert leadership to help every society transition to a low carbon energy future.

From these three target areas we actioned the following goals and initiatives to curb and address some of the challenges that were identified:

  1. Chemicals
  • Establishing a transversal contract: to deliver a uniform approach towards sustainable pest control services
  • Using alternative pest control devices: focusing on non-chemical approaches for pest control under the Integrated Pest Management (IPM) concept
  • Making financial savings and improvements: departmental expenditure on pest control decreased up to 50% compared to previous years
  1. Waste
  • Reducing waste generation: the amount of waste destined for treatment, thus reducing the carbon footprint and expenditure incurred
  • Implementing a Health Care Waste Information System (HCWIS): introducing a web-based system for monitoring and evaluation of HCWMS
  • Establishing a transversal contract: to deliver a uniform approach towards sustainable waste management practices
  • Developing recycling initiatives: as stipulated in the National Waste Management Strategy (NWMS) document, zero waste to landfill sites and a circular economy
  • Using eco-charcoal: innovation through recycling paper and boxes.
  1. Leadership
  • Promoting EH as a profession in health: showcasing the broad spectrum of EH and clarifying EH roles in the health sector
  • Introducing GGHH in the Free State: undertaking presentations at district and provincial level to CEO and district directors including heads of department about GGHH’s ten goals and their relevance towards greener healthcare practices
  • Adopting Sustainable Health in Procurement Practices (SHiPP): promote sustainable procurement practices

Key takeaways from Bongani Regional Hospital

The healthcare sector has a central role and responsibility to help lead the way to a green, low-carbon, climate-resilient future by leveraging its economic, political and ethical clout. Bongani Regional Hospital epitomises the transition and commitment of FSDoH to transform healthcare delivery through just and sustainable practices. The following strategies implemented at BRH are some of our key takeaways.

Waste Information System (WIS)

The WIS is a monitoring tool that was first developed in 2015 to monitor and evaluate medical waste generation at the facility. The system has now evolved into software-based application called the EHIS.

Environmental Health Information System (EHIS)

The EHIS was recently launched on 25 January 2023 as a pilot. The system runs monitoring and evaluation functions of the following aspects of environmental health:

  • Waste
  • Food
  • Occupational health and safety
  • Water quality
  • Mortuary
  • External hygiene

Chemical goal

As for our chemical goal, the hospital developed and implemented the Integrated Pest Management system (IPM).The system introduced alternative pest control measures that could be implemented within a hospital environment to provide a more sustainable, less toxic, environmentally sound and chemically free facility, with added cost effectiveness. It was implemented in phases due to financial constraints.

Ultrasound pest repellents

Image of ultrasound pest repellent device

UVC germicidal lamp

Our germicidal lights eliminate microorganisms found in the air and surfaces to improve air quality — they disinfect the air so it becomes much cleaner. In a hospital environment, the air you breathe needs to be of top-notch quality.

Conclusion

GGHH brings together hospitals, health systems, and health organisations from around the world under the shared goal of reducing the environmental footprint of the health sector and contributing to improved public and environmental health.

The framework and roadmap to reach this goal is provided by the GGHH agenda and its ten interconnected sustainability goals for hospitals and health systems to work towards at their facilities.

With the launch of the Health Care Climate Challenge at the Paris Climate Conference in 2015, the GGHH network is increasingly working to mobilise health care to reduce its own carbon footprint, become more climate resilient, and exert leadership to help every society transition to a low carbon energy future. This case study explores the steps we have taken in Bongani Regional Hospital to go greener, with the hope that it will inspire others to follow.

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(Image credit: Unsplash)