Why sustainable procurement

Sustainable procurement can drive positive health impacts for patients, communities and the environment. Public procurement has been identified as a key entry point for promoting more sustainable production and consumption patterns.[1][2] The role of procurement in influencing the environmental impact of health sector operations is well acknowledged and sustainable procurement practices have the capacity to reduce a significant proportion of the health sector’s greenhouse gas emissions.[3][4][5][6] For example, supply chain-related emissions account for at least 65 percent of the carbon footprint of England’s National Health Service and 82 percent of the carbon footprint of UNDP-administered Global Fund for HIV/AIDS and Tuberculosis projects in Tajikistan.[7][8]

There are three main ways in which the health sector can negatively affect the health of people and the environment.

  1. Patients, health care workers and the public around the world are exposed to environmental and health risks during the implementation of health programs - for example through direct exposure to biological or chemical agents, or health risks from improper health care waste management and the burning of waste.[9] [10] [11] [12]
  2. The production of medical products can impact on health and well-being – for example there is increasing concern about pharmaceuticals which accumulate in the environment.[13] [14]
  3. The health sector as a whole is having an impact on global climate change and planetary health – for example through emission of greenhouse gases.[15][16][17][18]

By adopting sustainable procurement policies, strategies and practices, health systems, governments and international development actors can, therefore, be drivers for a significant shift towards inclusive, green economies.[19]. This requires products and services that are compliant with environmental and social standards throughout their lifecycle.

Sustainable procurement, particularly when it can be carried out at scale, can be a key strategy to push demand for sustainable manufacturing and waste management within the health sector globally. Over the past 2 decades, Health Care Without Harm (HCWH), Practice Greenhealth and other key players have used this approach successfully to significantly reduce the impact of US and European health sectors on people and on the environment. In addition, since 2012, UNDP has built on its role as Global Fund Principal Recipient (PR), and through the Sustainable Procurement in the Health Sector (SPHS) initiative has worked with partners to strengthen sustainable procurement practices. Partners in the SPHS initiative include seven UN agencies and large global health initiatives which collectively purchase an estimated $5 billion worth of health commodities and medicines per year – much of which is produced or manufactured by countries in the South.

These approaches, even though they can demonstrate cost effectiveness, are still far from institutionalized in most developing country settings. Communities and the environment in developing countries continue to be negatively affected by health sector supply chain activities that increase greenhouse gases, deplete valuable resources and increase chemical pollution.


[1] UNDP (2015). The Green Procurement Index Health (GPIH) Phase 1 Report
[2] http://www.unep.org/10yfp/Portals/50150/downloads/Final_report_Sustainability_of_supply_chains_SPP_140630_aug19.pdf
[3] World Bank Group (2017) Climate-Smart Health care
[4] http://www.sduhealth.org.uk/policy-strategy/reporting/hcs-carbon-footprint.aspx
[5] http://www.sduhealth.org.uk/documents/Pharma_ Full_Guidance_ GHG_Nov_2012.pdf
[6] UNDP (2015). The Green Procurement Index Health (GPIH) Phase 1 Report
[7] http://www.sduhealth.org.uk/policy-strategy/reporting/nhs-carbon-footprint.aspx
[8] http://www.arup.com/projects/carbon_footprint_of_undp_administered_global_fund_grants
[9] Georgescu, C. (2011). Report of the Special Rapporteur on the adverse effects of the movement and dumping of toxic and dangerous products and wastes on the enjoyment of human rights. 2011, 18th session of the Human Rights Council: Geneva.
[10] ILO/WHO Joint Global Framework for National Occupational Health Programmes for Health Workers, 2010. http://www.ilo.org/sector/activities/sectoral-meetings/WCMS_161132/lang--en/index.htm
[11] Harhay, M.O. et al. (2009). Health care waste management: a neglected and growing public health problem worldwide. Trop Med Int Health, 2009. 14(11): p. 1414-7.
[12] Chartier, Y. et al edited (2014) Safe management of wastes from health care activities, second edition Available online at: http://apps.who.int/iris/bitstream/10665/85349/1/9789241548564_eng.pdf?ua=1
[13] http://ec.europa.eu/health/human-use/environment-medicines_en
[14] UNDP (2016) Uppsala presentation
[15] World Bank Group (2017) Climate-Smart Health care: Low Carbon and Resilience Strategies for the Health Sector https://noharm-global.org/articles/news/global/new-world-bank-report-calls-health-sector-leadership-climate/?mc_cid=56801d79a3&mc_eid=ce70de4a19#Report
[16] Eckelman MJ, Sherman J (2016) Environmental Impacts of the U.S. Health care System and Effects on Public Health. PLoS ONE 11(6): e0157014. doi:10.1371/journal.pone.0157014.  Available online at: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0157014
[17] WHO 2013. http://www.who.int/phe/publications/greening-procurement-in-the-health-sector/en/
[18] http://www.sduhealth.org.uk/documents/Pharma_ Full_Guidance_ GHG_Nov_2012.pdf
[19] WHO (2010) Health in the Green Economy: Co-benefits to health of climate change mitigation. Available online at: http://www.who.int/hia/hgebrief_health.pdf?ua=1 [Accessed on 02/05/2017].  See also WHO Health in the Green Economy series of reports.  http://www.who.int/hia/green_economy/en/