Table of contents

1. Guidance documents and tools
2. Product specifications and criteria
3. Health Care Without Harm and Practice Greenhealth resources
4. Additional resources

1. Guidance documents and tools

• Sustainable Procurement Guide
• Sustainable Procurement Guide - Executive summary
• Sustainable Procurement Index for Health (SPIH): This tool was jointly developed by Health Care Without Harm and the United Nations Development Program (UNDP) to help policy makers, manufacturers, suppliers, procurers, and health care facilities monitor greenhouse gas emissions, resource depletion, chemical / toxic impact on human and environmental health, and human rights, labor rights and gender equality. 

2. Product specifications and criteria

A. Health Care Without Harm's quick guides

• Sustainable procurement criteria for examination and surgical gloves: Standardized tender criteria addressing priority sustainability issues for examination and surgical gloves [English] [Spanish] [Portuguese] [Chinese]
• Toolkit - Sustainability criteria for examination and surgical gloves provides additional resources to support the implementation of the standardized tender criteria for gloves [Englisht] [Spanish] [Portuguese]
• Surface disinfection: Procurement criteria for chemicals used to disinfect surfaces  [English] [Spanish] [Portuguese]
• Hand hygiene: Procurement criteria and safer alternatives for products used for routine hand hygiene [English] [Spanish] [Portuguese]
• Instrument disinfection: Evaluation of procedures, procurement criteria, and benefits of products used for high-level disinfection of instruments [English] [Spanish] [Portuguese]
• Sustainable procurement quick guide - Reducing PVC and DEHP in IV bags: Criteria, recommendations, and alternatives to PVC/DEHP products for IV bags, as well as links to case studies and references. [English] [Spanish]
• Sustainable procurement quick guide - Reducing PVC and DEHP in medical products: Criteria, recommendations, and alternatives to PVC/DEHP in medical products, as well as links to case studies and references. [English] [Spanish]
• Coronavirus update - Disinfection tunnels factsheet: A documento on the use of disinfection tunnels and disinfectant spraying of the general population. [English] [Spanish] [Portuguese]
• Coronavirus update - Health care waste management: A comprehensive document with the latest information and recommendations on how to address waste management in a coronavirus context [English] [Spanish] [Portuguese] [Bahasa] [Polish]
• Antimicrobials in hospital furnishings - Do they help combat COVID-19?: No current high-quality evidence indicates that adding antimicrobial agents to the surfaces of products adds significant value beyond the array of the CDC's recommended procedures for preventing SARSCoV-2 transmission or health care-associated infections. [English]

B. Protection without pollution: COVID-19 waste-reduction strategies

1. Guidance for sustainable glove purchasing: As health care facilities rethink their purchasing and supply chains in the wake of COVID-19, this guidance can serve as a roadmap for advancing sustainable options [English] [Spanish] [Portuguese]
2. Guidance for immunization waste management: The huge need for masks, gloves, and other personal protective equipment, millions of COVID-19 tests, and lifesaving hospital treatment for victims of the disease has, in many cases, led to an increase in health care waste. This guidance provides recommendations on how to better manage and safely dispose of waste associated with immunization. [English] [Spanish] [Portuguese]
3. Guidance for Personal Protective Equipment for immunizations practices: This document is for health professionals who are using PPE as they administer vaccinations. It will help vaccine administers ensure infection prevention while reducing unnecessary product use and waste. [English] [Spanish] [Portuguese]

3. Health Care Without Harm and Practice Greenhealth resources

A. Case studies on sustainable procurement

• Sustainable Health in Procurement Health Project (SHiPP) case studies: A collection of 15 sustainable procurement success stories from different parts of the world.
  • Aarhus University Hospital (Denmark)
  • Bongani Regional Hospital (South Africa)
  • Catalan Agency for Health Information, Assessment and Quality - AQuAS (Spain)
  • China Environmental United Certification Center (China)
  • Club Noel Children's Clinical Foundation (Colombia)
  • E.S.E. Hospital San Rafael de Pacho (Colombia)
  • National Centre for Disease Control - NCDC (India)
  • Quality and Accreditation Institute, Health and Environment Leadership Platform (India)
  • Region Västra Götaland (Sweden)
  • Regional General Hospital R. Syamsudin (Indonesia)
  • Santa Casa da Bahia (Brazil)
  • Sebokeng Hospital (South Africa)
  • Second Hospital of Jilin University (China)
  • Sociedade Beneficente de Senhoras Hospital Sírio Libanês (Brazil)
  • Talca's Communal Department of Health (Chile)
• SHiPP - Impact stories that inspire:: A collection of 14 stories of people working to build more sustainable health care systems [English] [Spanish].
• Global green and healthy hospitals case studies: Health care organizations around the world share their purchasing successes and learn from each other
• Sample of case studies (Practice Greenhealth):
  • Fluid management in the operating room: A case study on how one health care organization reduced waste and increased staff safety by switching to a fluid management system
  • Reusable textiles: A case study on the strategies and implementation process taken by one health care organization to move away from disposable to reusable textiles to save money and reduce waste
  • Reusable trocars: A case study of the process used by one health care organization to evaluate and compare total costs of reusable and disposable trocars to find significant cost savings
• Strategic Procurement in European Healthcare: Selection of best practice and case studies.

B. Purchasing goods and services

• Sustainable procurement digest: A central resource for environmental criteria for health care goods (medical and non-medical) and services
• Sustainable procurement directory: Lists more than 120 sustainable products and services for health care organizations to consider and summarizes environmental criteria
• Sample policies and purchasing resources

-- Food

• Sustainable food definitions criteria and checklist: A checklist of allowed third-party certifications for food
• Healthy food: Request for proposal questions for purchasing a variety of food types for hospitals and group purchasing organizations (GPOs) and other tools to develop sustainable food service operations.

-- Medical devices and supplies

• PVC/DEHP-free medical devices
  • Guidelines for the procurement of safer medical devices: Resources for eliminating PVC/DEHP from medical devices
  • Report on polyvinyl chloride (PVC) in health care: Summary of recent research about the human and environmental impacts of PVC from production to end-of-life, and provides a rationale for choosing alternatives.
  • PVC/DEHP elimination goal: Elimination goal for safer medical products and devices
• Anesthetic gas toolkit: Guidance for health systems to reduce GHG emissions linked to anesthetic gases
• Non-Toxic Health Care: Alternatives to Hazardous Chemicals in Medical Devices: Phthalates and Bisphenol A, 2019
• Mercury-free devices
  • Guidance on eliminating mercury from health care: Resources for purchasing non-mercury devices and links to other resources for a mercury elimination program. Health Care Without Harm mercury elimination guide for hospitals (in English, Spanish, Portuguese and Chinese).
  • Health Care Without Harm Asia mercury phase-out and mercury-free alternatives
• Reprocessed medical devices: Resources to guide implementation of reprocessing and buying back reprocessed devices
• Sterilization containers: Resources to guide the implementation and purchasing of rigid sterilization containers to reduce the use of disposable blue wrap.

-- Non-medical devices

• Green cleaners
  • Greener cleaners: Guidance for environmentally preferred cleaners
  • Green cleaners: Resources for purchasing green cleaners
• Hand hygiene: Procurement resources for sustainable hand hygiene products
• Freight, reducing impacts: Resource to reduce transportation emissions
• Sterilants and disinfectants: Resources on safer alternatives
• Waste treatment technologies
  • Alternative waste treatment technologies: A global inventory of alternative waste treatment technologies with vendor list of suppliers of alternative technologies around the globe
  • The health care waste treatment technologies database: A web tool, searchable by type of treatment and available location, to help staff responsible for procuring health care waste treatment technologies to identify alternatives to incineration
  • Global database of safe and sustainable healthcare waste treatment technologies: To aid in the procurement of appropriate technologies, Health Care Without Harm first published a database of non-incineration healthcare waste treatment technologies in 2007. The 2014 version has been fully updated and provides listings of suppliers from one hundred and six countries, from Albania to Zimbabwe. Many of the suppliers also ship globally.

-- Building materials and furnishings

• Flooring
  • Guide for healthy flooring: criteria for manufacturers: Guidance for manufacturers on meeting Health Care Without Harm’s healthy flooring criteria, which apply to all flooring except carpet, fluid applied floors, and concrete.
  • Healthy flooring: Identifies a purchasing goal, criteria, and supplier product lists
  • Healthy carpet: criteria for healthy carpet
• Furniture: Purchasing resources on healthy furniture for interiors of health care facilities
  • Report on the use of antimicrobials in hospital furnishings: Explores the benefits, risks, trade offs, and cost implications of adding antimicrobials to hospital furnishings.

C. Reducing health care impacts

• Green paper on climate footprint of the health sector: The most comprehensive global analysis of health care’s contribution to climate change to date, providing a global estimate of health care’s greenhouse gas emissions
• Chemicals of concern to health and environment: This document combines a list of 200 chemicals from various authoritative lists and environmental conventions that are carcinogenic, toxic, mutagenic and reproductive hazards. [English] [Spanish]
• Chemicals of concern for the health sector: This document is based on the report Chemicals of Concern to Health and Environment. It includes the list of chemicals used by the health care sector and/or included in health products. In addition, the document includes case examples that demonstrate how hospitals have successfully substituted chemicals and chemicals in products with more sustainable alternatives. [English] [Spanish]
• Factsheet on reducing the carbon footprint of health care through sustainable procurement: Provides a glance of the carbon footprint of the health sector and case studies from health care facilities to reduce their environmental footprint
• Recycled/reusable products: List of recycled product resources
• Safer chemicals: health care action kit: Guidance on choosing safer products and chemicals in health care institutions

D. Implementation strategies

• Plastics Toolkit for Hospitals | Mobilizing Healthcare to Prevent Plastic Pollution
• Substituting medical devices - Lessons from Europe and Morocco: A survey on medical device procurement practices in Morocco and the attitudes and behaviors of professionals using medical devices containing PVC plasticized with DEHP

E. Cost Analysis Tools

• Greenhealth cost of ownership calculator: A tool to provide a framework to compare product costs and calculate the total cost of ownership

F. Purchasing Cooperative

• Greenhealth Exchange: Purchasing cooperative that makes it easy to source products and services used in health care settings that are good for people and the planet.

G. Recognition programs

• Practice Greenhealth Environmental Excellence Awards: The United State’s premier recognition program for environmental performance in the health care sector.
• Global Green and Healthy Hospitals Green Health Challenges and Award Program.

4. Additional resources

You may also find helpful the following external resources on implementing sustainable procurement:

A. Sustainable public procurement, general guidance

• Buying Green Handbook: Guidance document to help public entities buy goods and services with a lower environmental impact.
• European Union’s Procura+ manual: It provides guidance for any European public authority on how to implement sustainable procurement.
• National Health Service, England, Southern Health NHS Foundation Trust, sustainable procurement procedure: A publication on the sustainable procurement process.
• Sustainable Purchasing Leadership Council: Nonprofit membership organization supporting leadership in sustainable procurement.

B. Social and ethical procurement

• Buy Social Canada: Resources to advance social procurement.
• Democracy Collaborative: A nonprofit organization working to transform our economy to build community wealth and create a next system anchored in democratic ownership. The Healthcare Anchor Network is an initiative of the Democracy Collaborative made up of 45 health care systems building more inclusive and sustainable local economies.
• Ethical Procurement for Health workbook: Provides guidance for organizations in health care and social care sectors to embed labor standards into procurement and supplier management activities.
• Fostering Sustainable Behavior - An Introduction to Community-based Social Marketing: Provides an introduction to community-based social marketing to foster sustainable behavior.

C. Sustainable procurement claims and labeling

• Federal Trade Commission green guides: Guidance to help marketers avoid misleading environmental claims and to help buyers understand them.
• ISO standard for sustainable procurement ISO 20400, 2017(E): A standard on sustainable procurement.
• Sins of Greenwashing, UL Environment: Identifies the different types of misleading marketing claims.

D. Identifying criteria

• Design, Procure, and Install the Energy System, published by the U.S. Agency for International Development: Facility owners who want to hire professionals to design and construct energy systems should know how to create a bid document and avoid common design and procurement problems.
• Ellen MacArthur Foundation: A foundation working to build a framework for an economy that is restorative and regenerative by design.
• European Union Green Public Procurement EU criteria - GPP - Environment: EU GPP criteria aim to reach a good balance between environmental performance, cost considerations, market availability and ease of verification, procuring authorities may choose, according to their needs and ambition level, to include all or only certain requirements in their tender documents.
• Green Electronics Council: A nonprofit that collaborates to achieve sustainable IT products, initially founded to manage the EPEAT standard and registration.
• Green Science Policy Institute’s six classes of chemicals: A nonprofit whose mission is to facilitate responsible use of chemicals to protect human and ecological health. Educational videos are available on six classes of chemicals known to cause harm to human health and the environment.
• Kaiser Permanente’s environmentally preferable purchasing principles (EPP) and standards: Vendor information on their environmental purchasing program.
• National Health Service - England Procurement for Carbon Reduction research, tools and resources.
• Trucost, environmental impacts in hospital supply chains and implications for green procurement programs: Trucost, part of S&P Global, prepared research briefing.

E. United Nations resources

• Saving Lives Sustainably: United Nations Sustainable Procurement in the Health Sector website for UN agencies and global health financing institutions committed to introducing sustainable procurement in the global health sector and beyond.
• Sustainable public procurement implementation guidelines
• UN Initiative on Greening Procurement in the Health Sector, from products to services: A report assessing the baseline of sustainable procurement activities in UN agencies and opportunities for advancement.
• UNDP Sustainable Procurement Guidance Note
• UNEP sustainable public procurement implementation guidelines: Tools and resources on sustainable procurement.
• United Nations Sustainable Development Goals: Call to action for countries to advance 17 development goals as a global partnership.