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Waste Management

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Waste management shall be regarded an integral part of the supply chain, as a result of use and expiry of health products. Inadequate and inappropriate handling of health-care waste can have serious public health consequences and a significant impact on the environment.

“Pharmaceutical waste includes expired, unused, spilt and contaminated pharmaceutical products, prescribed and proprietary drugs, vaccines and sera that are no longer required, and, due to their chemical or biological nature, need to be disposed of carefully. The category also includes discarded items heavily contaminated during the handling of pharmaceuticals, such as bottles, vials and boxes containing pharmaceutical residues, gloves, masks and connecting tubing.” Source: Safe management of wastes from health-care activities, 2nd ed., World Health Organisation, 2014.

Pharmaceutical waste management in countries

In Belarus, Bosnia and Herzegovina, Kirghizstan, Tajikistan, Uzbekistan, Zimbabwe, as part of Global Fund support, assessments of the country set up for managing health care waste were conducted to understand its environmental impact as well as safety concerns.
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The assessments, performed with national partners, led to formulate recommendations to develop national strategies for waste management, to strengthen and improve existing systems as well to coordinate financial sustainability of routine and new activities for waste management. Some of the assessments lead to technical support to develop country guidelines, tools and infrastructural projects to improve health waste management.

In Zimbabwe, infrastructural support included the installation of two pharmaceutical grade incinerators at the central and regional level to support the disposal of pharmaceutical waste. Equipment, processes and training of staff related to deconditioning and disposal/recycling of plastic and cardboard packaging before incineration have been put in place. On the normative side, a Pharmaceutical Waste Management Plan for Pharmaceuticals and Health Products for Zimbabwe to be adopted and endorsed by the national competent authorities has been drafted with UNDP’s technical assistance.

UNDP has also provided support for the installation of incinerators for pharmaceutical waste in Afghanistan, Chad, Sao Tome and Principe, Sudan and Zambia as well as for the training on their use.

Waste management of cytotoxic cancer medicines

UNDP’s recent involvement in the procurement of cancer medicines for Eastern European and Central Asian countries has been complemented by observations on waste management practices at dispensation level.
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Gaps have been identified in safe handling and waste management of cytotoxic medicines in visited hospitals. UNDP will be conducting an analysis with 5 countries on the preparation of anti-cancer products and management of related waste in 2018. In coordination with WHO, UNDP is planning to develop a manual and a training package to address the identified needs for safe handling and waste management of cytotoxic medicines.

Cytotoxic waste, identified as a high-risk activity, is waste associated with cytotoxic (chemotherapeutic or antineoplastic) medicines. Cytotoxic medicines have the ability to kill or stop the growth of certain living cells and are used in chemotherapy of cancer, but are also used as immunosuppressive agents in organ transplantation and in treating various diseases with an immunological basis. Cytotoxic waste includes materials, equipment, and residue that are contaminated by cytotoxic medicines. It represents a high risk for medical staff and patients as well as for the environment. They should be properly collected, stored, transported and destroyed by incineration above 1200°C.

Upstream reduction of health products’ waste

Two main axes of work are being undertaken by UNDP to reduce waste production upstream. One is to strengthen areas of the PSM cycle such as quantification, inventory control, LMIS, procurement and distribution planning in supported countries.
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Building capacity in PSM helps reducing overstocks and product expiry, resulting in waste of financial resources and increased need for pharmaceutical waste management. Secondly, UNDP has been engaging with ARV manufacturers to optimize medicines packaging and reduce resulting waste. This practice, which has been piloted in a few countries, will be incrementally applied to other categories of medicines for which UNDP pools demand and procurement on behalf of supported countries. The optimization of packaging to reduce upstream waste requires coordination with manufacturers and national regulatory authorities to comply with international and national standards for medicine labelling. With increased experience and lessons learned, the UNDP’s piloted approach for optimizing medicines packaging could be replicated into national procurement systems.

Guidance

WHO has produced guidance for safe management of waste in health systems, including waste of health products. Back in 1999, WHO also developed guidance for disposal of unwanted pharmaceutical products following emergencies.

Following the rapid assessments of healthcare waste in selected Global Fund supported countries, UNDP has developed Healthcare Waste Management Toolkit:

For additional reading on the management of health waste, the following resource is proposed: