A ONE-DAY DIALOGUE ON GOOD PRACTICESIN SUSTAINABLE PROCUREMENT IN THEGLOBAL HEALTH SECTOR

MEETING REPORT

W W W . S A V I N G L I V E S U S T A I N A B L Y . O R G

FOSTERING SUSTAINABLEHEALTH PROCUREMENTH O W P R O C U R E R S C A N C H A N G E T H E G L O B A L H E A L T H S E C T O R

M A Y 1 1 , 2 0 1 6

U N C I T Y , C O P E N H A G E N

S U P P O R T E D B Y

O R G A N I Z E D B Y

Introduction

24% of the global burdenof disease is due toenvironmental factors

23% of all deaths can beattributed toenvironmental factors

US$2-4b per year = theestimated direct costs tohealth from climatechange by 2030

250,000 additionaldeaths per year areexpected between 2030and 2050 from climatechange

The meeting will not end today – sharing good practices will help us to learnmore about sustainable procurement, intensify collaboration, and make thehealth sector more sustainable through our practices. – Camilla Brückner, Director, UNDP Nordic Representation Office

On May 11, 2016, more than 40 health procurement expertsand practitioners came together at UN City in Copenhagen toexplore the latest sustainable procurement initiatives, sharegood practice examples, and advance the dialogue on howsustainable procurement practices can be harmonized andscaled up across the global health sector.

Organized by UNDP and UNFPA, and supported by LeaderLaband the Sustainable Procurement in the Health Sector (SPHS)

Secretariat, the meeting was a milestone in the work of theSPHS, which was established at UN City in 2012. It also kickedoff a broader engagement with public procurers, who jointlyexplored how sustainable practices and policies in the publicand private spheres could be harmonized and scaled-upacross the global health sector.

SAVING LIVES SUSTAINABLYParticipants addressed the question of how to provide criticallife-saving medical products and services to individuals whilealso addressing environmental problems. This is a realchallenge for procurers, who know that environmentalhazards like climate change have an immediate impact onpeople’s health and well-being and that their work should notbe compromised by inaction which, in turn, may increase theenvironmental footprints of their collective endeavor.

By harnessing the normative, operational, and financial powerof the UN, the health industry, and public and privateorganizations throughout the international community, theorganizers expressed a commitment to tackle this challenge.

They left with a renewed commitment to engage theirnetworks, activate the group's purchasing power, and convertwhat they heard into action. This report captures thehighlights of the dialogue and discusses next steps.

OUR FOCUS: To provide critical, life-

saving medical products andservices to individuals whilealso addressing environmental

problems.

A DIALOGUE ON GOOD PRACTICES IN SUSTAINABLEPROCUREMENT IN THE GLOBAL HEALTH SECTOR

Sources:Annette Prüss­Üstün et al. (2016), "Preventing disease throughhealthy environments: A global assessment of the burden of

disease from environmental risks", World HealthOrganization, http://www.who.int/quantifying_ehimpacts/publicat

ions/preventingdiseasebegin.pdf

World Health Organization (September 2015), "Climatechange and health", Fact sheet no. 266,

http://www.who.int/mediacentre/factsheets/fs266/en/

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SNAPSHOT OF PARTICIPANTS

28 joined the dialogue in personTwenty-eight individuals participated in the dialogue at UN Cityin Copenhagen, representing organizations from the public andprivate sectors, NGOs, and the United Nations:

Central Denmark Region, Regional Development,and Department of Procurement & Clinical EngineeringConcept FoundationConfederation of Danish IndustryEPEA Aarhus ApS - Cradle to CradleFoundation TEM / CSR SkåneHealth Care Without HarmMarie Stopes International (MSI)Nordic Center for Sustainable HealthcareNovo Nordisk A/SSecretariat for Green Procurement - Plan MiljøSwedish County Councils and RegionsUnited Nations Development Programme (UNDP)United Nations Global CompactUnited Nations Population Fund (UNFPA) Universidad de Politecnica de MadridUnited States Agency for International Development (USAID)

The dialogue kicked off with conversations about participants' experiences with sustainable procurement, thechallenges they face, and what they would need to improve their practices and to have a bigger impact onintroducing sustainable procurement in the global health sector.

A "platform of platforms" — Procurers identified a need for an online space where they could connect with globalleaders and key stakeholders from the global health sector, to share knowledge and best practices related tosustainable health procurement. Officially launched at the dialogue, the new online engagement platform,www.savinglivesustainably.org, addresses that need and was named a "platform of platforms".

16 joined online

What did participants want to discuss?

Sixteen people connected online from:

Health Care Without Harm (United States)Health Care Without Harm EuropeKarexKfW German Development BankNational Agency for Public Procurement (Sweden)PfizerUnited Nations Development Programme (UNDP)UNDP BelarusUNEP DTU PartnershipUnited Nations Office for Project Services (UNOPS)

SNAPSHOT

44 individuals from 28 organizations

OUR DIGITAL PRESENCE

THE DIALOGUE TOOK PLACEON TWITTER THROUGH

#ACT4HEALTH

42,000 USERS WERE REACHED DURING

THE DIALOGUE

82% ENGAGEMENT CAMEFROM WOMEN!

MODERATORToke Falk Sabroe, LeaderLab

SPEAKERSCamilla Brückner, UNDP Nordic Representation OfficeEric Dupont, UNFPA Procurement Services Branch Rosemary Kumwenda, UNDP/SPHS SecretariatMirjana Milic, UNDP/SPHS SecretariatIgnacio Sanchez Diaz, UNDP/SPHS Secretariat Amelie Mahler, UNFPA Procurement Services BranchAlfonso Buxens, UNDPKarin Lonaeus, Swedish County Councils and RegionsAnne Gadegaard, Novo Nordisk and the Coalition forSustainable Pharmaceuticals and Medical Devices Anja Leetz, Health Care Without Harm EuropeGoh Miah Kiat, KarexLorea Coronado-Garcia, UNDP

Tracking impact and progress — Participants were interested in learning how tocapture data to track and monitor whether their procurement practices werebecoming more or less green, and identify the key hotspots and opportunities toimprove the environmental performance of their procurement.

Collaboration with suppliers and manufacturers — In the transition to sustainablehealth procurement, procurers acknowledged the importance of ensuring fair playfor their global base of suppliers and manufacturers. They recognized that securingfair play across a diverse range of suppliers and manufacturers requires a gradual,tailored approach that takes account of different circumstances and contexts.

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THE SPHS ONLINEENGAGEMENTPLATFORM

CUTTING EDGESUSTAINABLE HEALTHPROCUREMENT AT THE UN

Explore

ContributeKnowledge and practice isone of the most importantpages on the platform. Theknowledge poll of the SPHSnetwork is open forcontributions, and you canalso easily share your successstories, publications, projects,events or trainings related toany of the focus areas.

A new online engagement platformRecognizing how crucial it is to link both supply and demand andpublic and private organizations from the global health market, theSPHS Secretariat has launched an online knowledge hub andengagement platform: savinglivesustainably.org.

Much more than a website, the interactive online engagementplatform helps everyone to connect and share insights, activities,events, training opportunities, publications, and successes in ninefocus areas: chemicals, energy, medical products, packaging,procurement, resource efficiency, transportation, waste management,and water. The platform will expand and evolve over time as the SPHSSecretariat introduces other sophisticated features, such as aninteractive map to view and join events and activities. The Secretariatis also continually posting news and stories to expand the network,improve knowledge, and scale up sustainable health procurement.Remember: by linking the SDGs to your

contribution, you are taking action to connectyour work to the development objectives ofthe UN organizations. It will also help theSPHS understand what SDGs meanto different organizations, sectors, andgeographical areas.

Take action: Sign up to receive the SPHSNewsflash at: http://goo.gl/F37M6d

ConnectNetworking has never beeneasier. We provide you with alist of worldwide events,throughout the year. With aneasy overview of key eventsrelated to greening the globalhealth sector, you can nowmeet, network, and startexciting projects with expertsfrom diverse fields. Find outmore on our events page.

SAVINGLIVESUSTAINABLY.ORG

savinglivesustainably.org was madepossible by donor support from:

CUTTING EDGE PROCUREMENT

Presentation by Mirjana Milic, SPHS Associate Coordinator, UNDP

All you should know aboutgreening the health sector — inone place. Let your interests beyour guide and explore morethan 300 examples of the bestknowledge and practice thathave already been shared by theSPHS Task Team and its globalnetwork of experts.

Q: What other areas and regions will you focus on in the future?

The mandate of the SPHS is global, but the current focus is on Asia. Animportant upcoming event is the "Saving Lives Sustainably: Asia Forum 2016" inBangkok, Thailand, November 7-11. The event will bring together technicalexperts, suppliers, and manufacturers from across the global healthcareindustry. The Forum aims to facilitate a dialogue between all stakeholders whoare concerned about or involved in sustainable manufacturing.

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Gain an eco-innovative advantage

UNDP is thrilled about the SPHS development and themomentum in this room and across the health sector. We alsorecognize there is a lot of learning still to do. We want to makesure expertise is being transferred to manufacturers in everypart of the world that requires facilitation across the network.

Special Remarks by Lorea Coronado-Garcia, Sustainable ProcurementSpecialist, UNDP

Part of improving sustainable health procurement is supportingsuppliers and manufacturers to provide greener and more innovativeproducts. To do this, UNDP is inviting technical experts in the SPHSnetwork to link up with suppliers and manufacturers to share theirexpertise and provide technical support with scanning products andprocesses, technical and financial appraisals of opportunities, and theimplementation of eco-innovative projects. More information availableat: savinglivesustainably.org

UNFPA

Condom manufacturers go greenUNFPA is currently engaged with 12 condom manufacturers in different regions on green procurement and sustainableproduction, providing training opportunities, quarterly conference calls, and face-to-face meetings to share ideas on costand energy savings, such as reducing wastewater and insulating dipping tanks to minimize air conditioning. Beginning in2013, UNFPA tenders require suppliers to comply with five eco-requirements: IS0 14001 certification within 36 months, awastewater treatment plan, an air pollution reduction plan, a plan for saving energy and using renewable energy, andusing packaging that is FSC-certified (or equivalent). The financial and environmental savings are already impressive:

A research study on extending condom shelf life found thatcondoms that were six to nine years old were still incompliance with requirements for condoms that expiredat five years. A longer shelf life will mean less waste as fewercondoms are thrown away early. Another study onreducing condom pack size found that rectangular packages,which use less foil than square packs, were of comparablequality. Less foil means a smaller sized pack and ultimatelylower shipping costs.

In 2007, United Nations Secretary-General Ban Ki-Moon called for the UN become more climate-friendly andenvironmentally sustainable. As one of the biggest public procurers of condoms (USD 18 million purchased in2015), UNFPA's Procurement Services Branch (PSB) responded to this call by focusing on where it could have the biggestimpact. In 2013, PSB introduced a green procurement strategy based on collaboration with suppliers and stakeholderengagement. In this presentation, Amelie reported the positive results of an eco-condom pilot project and two researchstudies conducted under the new strategy.

We recognized we could not simply putstrict top-down requirements on suppliers— our supplier base is small and indeveloping countries. So instead we worktogether.

Next stepsExtending condom shelf life andsaving on shipping

Include environmental criteria in WHO/UNFPA pre-qualification guidance for male/female condoms Continuous monitoring of implementation Extend environmental criteria to other products Work on alternative packaging Establish a procurement tool that rewards theenvironmental achievements of suppliers ISO 14001 certification of PSB

GOODPRACTICES

GOOD PRACTICES INSUSTAINABLE PROCUREMENT

UNFPA is committed to working withmanufacturers to meet the new eco-requirementsover time so they are able to gradually adjustproduction, equipment, and find the greatestsavings.

Q: How did suppliers react to the new requirements and was there a tipping point when they became partners?At the beginning, we saw some skepticism that they could do it. But they were interested and knew that environmentalsustainability was in everyone’s interest, so they wanted to be on top of it. Engaging with the group and giving them a very clearroadmap with deadlines in our LTAs and bidding process helped give them a push.

Presentation by Amelie Mahler, United Nations Population Fund (UNFPA) Procurement Services Branch

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UNDP

CO2 emissions & shippingcosts drop dramatically

Two big wins

To reduce CO2 emissions, the PSM Team lookedto air freight as "low hanging fruit", since averageCO2 emissions from sea freight are significantlylower. To measure the potential cost and carbonsavings, PSM Team developed an emissionsreduction scenario for shipments betweenMumbai and Harare, which represents 95% oftotal procurement for Zambia andZimbabwe. The results were substantial:

81% decreasein CO2emissions

49% decreasein shippingcosts

Cost savings: 15%

Waste reduction: 12%

Shipping capacity:16.7% increase

CO2 emissions: 13% kgreduction per unit

Smaller leaflets save space,costs & materials

In an effort to reduce materials and saveshipping costs, the PSM Team conducted a pilotproject for the Mumbai-Harare shipping lanethat eliminated an outer shipping box andreplaced a large multilingual product leafletwith one written only in local languages. Theresults:

The first delivery willbe made to SouthSudan in May2016 and toZimbabwe thefollowing month.

Original packaging

New reduced packaging

A collaboration with four UNDP suppliershas resulted in two major successes:

The UNDP Global Fund Health Implementation Support Team(UNDP GF-HIST) manages $200-300m in procurement funds everyyear to meet the needs of global health-related projects in 24countries (listed below) and difficult contexts, such as South Sudan.Sometimes the Support Team develops framework/LTA for a supplyof ARV of TLE formulation to serve specific country offices. One ofthese framework agreements, with 4 manufacturers in India, has hadgreat success in terms of environmental impact and cost savings.

Sustainability Call-off Criteria: In 2016, UNDP PSM introducedrealistic sustainability criteria for suppliers to fulfill within 9 monthsof starting their LTA. All 4 suppliers have fulfilled the requirementswithout an impact on price. In 2016, ISO 14001-certification orequivalent, halt the use of PVC plastic, use chemicals in compliancewith the EU Reach List, and other requirements, have beenincorporated in the UNDP minimum sustainability qualificationcriteria, under the LTA for a supply of ARV of TLE formulation.

CO2 Emission Reporting for Logistics: Data and analytics for CO2emissions were collected from suppliers on a quarterly basis tocreate environmental performance metrics. A trade lane scenario forMumbai to Harare calculated the potential CO2 reduction ofswitching from air to sea freight, and this has resulted in dramaticcarbon and cost savings (see sidebar). Although making the switchwas not straightforward — sea freight requires more time andplanning and UNDP had to streamline its requirements, stockdeliveries and plan orders in collaboration with suppliers — pilot wasa success and sea freight now accounts for 84% of PSM's shipments.

Packaging Optimization and Innovation: Streamlining packaging isnever a straightforward process. Changes need to be brought in withcare and in collaboration with suppliers and regulatory authoritiessince packaging and information requirements are tied to bothWHO prequalification and national regulatory rules. A pilot project todo away with extra packaging and introduce a smaller productleaflet is already achieving positive results (see sidebar). The LTAholders are very supportive of this effort as it has simplifiedproduction and manufacturing and brought down costs and prices.However, these changes need to be introduced very carefully andseriously to ensure there are no ill effects down the road.

Presentation by Alfonso Buxens, Procurement & Supply Management(PSM) Advisor, UNDP

Sustainability Baseline Initiative: UNDPworks with its suppliers to develop andmonitor sustainability initiatives in thesupply chain. A questionnaire of the 4LTA holders gave a snapshot of theimprovements they had made so far andwhat they could do to improve theirenvironmental performance. Thisbaseline has been instrumental indeveloping minimum parameters forsuppliers.

UNDP's collaboration with suppliers involves four main activities:

"For UNDP to remove the leaflet and the externalpackaging from a pharmaceutical product is veryinnovative. It can be scary to those who might bechallenged on liability, but if the liability issue washandled, we would love to not include the bigleaflets. It is a very good sign, that this initiativecan open such conversations."- Anne Gadegaard, Novo Nordisk

GOODPRACTICES

The main goal of all of this is to treat more patients.Environmental improvement is not enough — without costsavings, we cannot serve more people, which is the reasonwhy we exist.

Countries where UNDP implements Global Fund grants (October 2015): Afghanistan, Belarus,Belize, Bolivia, Bosnia & Herzegovina, Chad, Cuba, Djibouti, Haiti, Guinea Bissau, Iran, Iraq,

Kyrgyzstan, Mali, Sao Tome & Principe, South Sudan, State Of Palestine, Sudan, Syria, Tajikistan,

Turkmenistan, Uzbekistan, Zambia, and Zimbabwe.

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SWEDISH COUNTY COUNCILS AND REGIONS

COALITION FOR SUSTAINABLE PHARMACEUTICALSAND MEDICAL DEVICES (CSPM)

Public procurement makes a difference, but challenges remain

Presentation by Karin Lonaues, Sustainability Strategist, Swedish County Councils and Regions

Sweden's 21 county councils are responsible for procurement for health care, dental care, andpublic transport. Since 2010, the councils have cooperated and coordinated their work,procuring 13 billion euro worth of goods. These products, from pharmaceuticals to gloves andsurgical instruments, come from developing countries where the risks of environmental,human rights, and labor rights violations are high. Through its code of conduct for suppliers,contract clauses, desktop follow-up, audits, and corrective action plans, the councils not onlytry to ensure the products they procure are manufactured in a sustainable and responsibleway but also try to create broader demand for sustainable products.

National procurement practices are having an impact globally. A 2015 SwedWatchreport showed improvements to working conditions in the surgical instrumentfactories in Pakistan where the councils procure from, and last year the councils wereable to detect trafficking and bonded labour in a Malaysian factory supplying surgicalgloves. But three major challenges remain: updating sustainability criteriafor procurement and harmonizing it with UN agencies; improving coordinationbetween the 21 county councils to avoid duplication of work, especially with follow-ups; and creating a more transparent supply chain to ensure compliance.

What has been one main lesson or takeaway? Address how you will follow up on therequirements you set and think of the whole evaluation process, especially socialresponsibility. Decide on these parts before you set your goals.

Presentation by Anne Gadegaard, Senior Global Advisor, Novo Nordisk

The Coalition for Sustainable Pharmaceuticals and Medical Devices (CSPM) is a consortium of suppliers set up by the NHSSustainable Development Unit (SDU) to examine the environmental impacts of NHS services and take action to reduceits carbon footprint. One discovery was that pharmaceuticals accounted for 11% of the NHS carbon footprint, whichprompted the Coalition to develop a priority list of 20 GHG-intensive pharmaceuticals it will use to work with suppliers toidentify carbon reduction opportunities. These product guidelines are available as a free download.

We cannot conducthealthcare in Swedento the detriment ofpeople in other parts ofthe world. But it is alsoa matter of creatingdemand forsustainable products.

GHG hotspots: where to target

Take action >To join CSPM, receive the newsletter, ordownload GHG guidance on products, visitwww.sduhealth.org.uk/cspm

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The carbon footprint of pharmaceuticals ormedical devices does not end with productionand distribution. How these products are used byhealthcare professionals and patients also burnsenergy, uses water, and generates waste.

The CSPM has also made guidelines to how youcan assess a patient carbon footprint. A case hasbeen prepared for the entire lifecycle of care fordiabetes – from GP consultations to patient travel,emergency department visits, in-patient bed days,survival procedures, and self-management – andidentified "hotspots" where savings and COreductions might be achieved (see chart).

GOODPRACTICES

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REFLECTING ONGOOD PRACTICES

Finding a niche"Whether it was UNFPA, UNDP, or theCoalition for SustainablePharmaceuticals, procurers werelooking at where to start. UNDP saidthey had to look internally and UNFPAdid the same as they saw the bulk oftheir purchases were condoms.Wherever we’re working, we need toask, "What is our niche?" We all need todo an internal baseline and see wherewe can have the biggest impact. Thiswill also help to keep UN organizationsfrom feeling overburdened."– Rosemary Kumwenda, SPHSCoordinator, UNDP

Following the presentations on goodpractices in sustainable healthprocurement, participants reflected onsome common themes, from identifyingareas with the biggest impact tocollaborating across sectors and sharingrisks and investments.

Sharing the investment, sharing the risk

Potential avenues to connect

"One challenge we face as procurers is that we are usually below what themarket can offer us. We end up looking for ways to fit suppliers into ourrequirements rather than learning from them what they can offer, and we findonly small cost savings. We need to get information about sustainable productsand solutions from the market much earlier than we do today so that we havethe time and resources to fit them into our procurements." – Christian LethChristensen, Central Denmark Region

"As a procurer it is easy to pass the risk to the supplier, but you may end uppaying higher prices. We are trying to do a couple of procurements where 10%of procurement is awarded to a corporation that is interested in doing aproject/innovation with us. We build in the risk and leave room for pricechange – but we share the risk, the profit, the savings. It is a model to get newproducts developed and get it delivered. The other way is to do a productinnovation at one hospital then see if it scales up and actually results in orders.Maybe this is a more innovative way to approach it. Sometimes we might losemoney, but usually, I think we will gain." – Dialogue participant

"We need action to increase the spend towards sustainable procurement. ForNovo Nordisk, it is clear that sustainable products are not just about saving theplanet but should become a part of core business and take on the risk ofpatenting them." – Anne Gadegaard, Novo Nordisk

Collaborating

Seeing low-hanging fruit

"We do not need to be repetitive withour quality assurance requirementswhen we go to suppliers. There areconfidentiality agreements betweensuppliers and procurers, but we shouldtry to share the evaluations to make ourlives easier and make it easier forsuppliers." – Dialogue participant

"What stood out for me were the bigfinancial savings on freight that UNDPrealized. I think it is a very good placeto start and a place where economyand sustainability can be gained. Thiscould be low-hanging fruit. But there isa worry that the UN will buy gold-plated solutions that developingcountry suppliers cannot offer. Itsounds like few suppliers are involvedso far, and I wonder about thepotential for scaling up and involvingsmall suppliers." – Dialogue participant

GOODPRACTICES

As an NGO, we are very interested in engaging with suppliers.Sometimes we refer to a paradox between supply and demand –if there’s demand we’ll invest / if there are green alternativeswe'll buy them. Events like this help to address this paradox, asdo SPHS, Global Green and Healthy Hospitals, and CleanMed.

Health Care Without Harm is a global non-profit organization thathas been working for 20 years to make the health sector moresustainable. Anja Leetz invited participants to connect to twosustainable health procurement initiatives:

Special Remarks by Anja Leetz, Director, Health Care Without HarmEurope

The annual CleanMed conference on environmental sustainabilityfor leaders in healthcare sustainability is a good opportunity forengagement: www.cleanmed.org and www.cleanmedeurope.org

Global Green and Healthy Hospitals, a global network of hospitalsand health centers committed to reducing their ecological footprintand promoting environmental health. Case studies and moreinformation available at: www.greenhospitals.net

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PRIVATE SECTOR INSIGHTSSustainable supply chains in the global health aid market: hotspots &opportunities

As condom manufacturing has shifted to Asia over the last 25 years, Karex has seen abig opportunity to change the landscape to greener production. In the hot tropicalclimates of Malaysia and Thailand where Karex operates, green manufacturingpractices make both environmental and financial sense. At its four facilities, Karexhas introduced water and energy-saving methods as drought and water shortagesbecome more common and global temperatures climb. Making these changes is notjust about going green, he says, but saving money to ensure the price of condomsremains stable and affordable for consumers.

Presentation by Goh Miah Kiat, CEO, Karex

NOVO NORDISK

PRIVATE SECTORINSIGHTS

Most of Novo Nordisk's products are related to managing diabetes. As part of itscommitment to financial, social, and environmental responsibility, the companyconducted a case study that looked at GHG emissions for total diabetes managementand per year, in order to measure the carbon footprint of products and patients. Itdiscovered that good diabetes management not only extends a patient's life, but mayalso lead to reduced carbon emissions, in part through less travel and energy spent onGP appointments, emergency room visits, and hospital stays.

Must-win battlesAnne Gadegaard pointed to three "must-win battles" for 2016-18: mapping supply chain risks cost-effectively,mitigating risk with key high-risk suppliers and increasing leverage through collaboration, such as through UN-sponsored dialogues like these. "I like working with the UN because you can create a platform that assists theconversation and takes away any potential tension. Let’s bring our lessons from managing quality and bring them tothe conversation - together with the procurers and other decision makers in the value chain."

Good diabetes management may reduce carbon emissions

The first green condom factory in the world

Presentation by Anne Gaadegard, Senior Global Advisor, Novo Nordisk

As one of the largest pharmaceutical companies in the world, Novo Nordisk has a bigimpact in terms of procurement. Using a triple bottom line approach, the companysees procurement as part of a broader effort to create a sustainable health system andbring benefits to the people they are helping to treat. A signatory to the UN GlobalCompact since 2002, Novo Nordisk uses a responsible sourcing model that does notlook at products in an isolated way, but rather looks at how they are produced, too.

Karex recently opened an ISO 14001, ISO 50001, and LEED-certified condom factory in Hat Yai, Thailand, a steel andglass structure with a multitude of green features:

Energy: 50% of the energy Karex uses is for heating and drying condoms, but introducing more efficient heaters tothe dipping lines, reduced electricity consumption by 25%. Passive cooling is also key architectural element thatreduces the need for air conditioning. Solar panels are planned to reduce reliance on energy from the grid.Water: Consumption of potable water is down significantly by collecting rainwater and condensation from AC units toflush toilets and clean. Karex is also exploring reusing treated wastewater from its cooling towers in production.Location: The factory is surrounded by rubber plantations within a planned rubber city set up by the Thai government,thereby reducing the carbon footprint of long-distance transportation of raw materials.

Donor pressure can drive greener manufacturing"A lot of the money that goes into buying condoms comes from donors, and donors are applying pressure to gogreen. This helped me make my decision to go green. Communication on where the donors are is very important."

KAREXWe don’t think goinggreen is about beingmore expensive – wethink the extra costs weput into insulation andother areas will be madeback in savings. It is avery long-term goal.

We can no longer justlook at the cost of aproduct. We need amindset change – whenyou are in a hospitaland deciding whatproduct to buy, youneed to look at howmuch hospital time apatient will need if youbuy that product. Howwe do things and whatthe product does bothneed to be considered.

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INTERNATIONALENVIRONMENTALCONVENTIONS ONCHEMICALS

HEALTHCAREPROCUREMENT& COMPLIANCEWITHINTERNATIONALENVIRONMENTALCONVENTIONSON CHEMICALS

Stockholm Convention onPersistent Organic Pollutants(POPs)

For procurers, three elements areimportant: substances that must beeliminated, restricted, and reduced. Thereare guidelines for some of thesesubstances. From UNDP's and a healthprocurement perspective, the importantsubstances are DDT and PVC.

Minamata Conventionon Mercury

Realizing there was not a tool to track UNDP's progress in greenprocurement and monitor its practices, the SPHS team aims to developa Green Procurement Index Health (GPIH) that defines greenprocurement criteria and captures supplier data on the products UNDPprocures. One of the first things the team decided to include in theindex was international environmental conventions on chemicals, whichare legally binding and well recognized by countries. It looked at 1,500products and conducted eight case studies, then developed checklists,indicators, and guidance on specific Conventions (see sidebar).

An innovative tool emerged from this work: a guide for procurementpractitioners, "Healthcare Procurement Compliance with InternationalEnvironmental Conventions on Chemicals". This guide will allowprocurers to measure and monitor product compliance with the fiveConventions. It will be published in June 2016 and shared with thenetwork on the SPHS platform. Internally, UNDP is in conversation to seehow it can begin implementing the tool and involve suppliers ingathering more product data. This will be an ongoing process, and willeventually involve setting standards for suppliers, conducting audits, andusing a scoring tool to reward companies that do more.

What kind of feedback are you looking for?"It will be useful to understand from each of the SPHS members howthe procurement process is done, how they process orders, control datafrom one agency to another, etc. The tool may not be 100% applicableto everyone, but you can take the checklist and use it in your day-to-dayprocurement processes." - Ignacio Sanchez Diaz, UNDP

"Monitoring compliance of the UNDP procurement with theinternational environmental conventions is a new approach, so we willneed to engage with companies to get them onboard. We are askingthem to provide information they have not provided before, thus, we willneed to engage with them and explain why we need the informationand how it will be used going forward. Based on the initial feedback weare confident that suppliers will be able to provide this information."Gregory Soneff, Team Leader, Global Procurement Unit, ProcurementSupport Office, UNDP

What's next? An Automated Report Dashboard (Excel sheet) that willallow procurers to assess whether products comply with theConventions and whether they are making progress with greenprocurement. We are also working on developing a Red List ofChemicals, and will begin by prioritizing 50 to 100 toxic chemicals.

Presentation by Ignacio Sanchez Diaz, Greening Health SystemsSpecialist, UNDP

Mercury is used in a variety of medicalproducts, like thermometers, vaccines,and laboratory chemicals. Researchshows there is no connection to diseasefrom mercury, but there is still a healthrisk. There are safe and cost-effectivemercury alternatives.

The disposal of hazardous healthcarewaste must be done at an approvedfacility authorized by a relevant nationalauthority. We need to start asking oursuppliers for third-party certification thatthe disposal is authorized.

The Convention does not apply topharmaceuticals, rather, the chemicalslisted in the Convention include pesticidessometimes procured by global healthorganizations as a disease control vector inregions at high risk of malaria transmission.

Vienna Convention for theProtection of the OzoneLayer and the MontrealProtocol on Substances thatDeplete the Ozone Layer

Ratified by all countries. Ozone-depletingsubstances (ODS) are still being producedand used in different sectors, in airconditioning, heating, etc. There are eco-labels that certify the use of non-ODS.

INNOVATIVETOOL

Basel Convention on theControl of TransboundaryMovements of HazardousWastes and their Disposal

Rotterdam Convention on thePrior Informed ConsentProcedure for CertainHazardous Chemicals andPesticides in InternationalTrade

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Wrapping up Rosemary Kumwenda, SPHS Global Coordinator and Senior Policy Advisor at UNDP, closed the day ofdialogue, thanking the moderator, presenters and participants for insightful and rich conversations,and the organizers, especially UNFPA and the SPHS Secretariat, for making the dialogue possible.

It is now clear, she said, that we all want to make the SPHS a front-running and far-reaching platformof global leaders and key stakeholders from the global health sector. "We have a hunger to knowmore and share more."

She closed with a passionate appeal for participants to participate at the Saving Lives Sustainably:Asia Forum in Bangkok in November 2016. She invited participants to get in touch with the SPHSSecretariat and UNFPA to indicate their interest in participating at the Forum.

CLOSING REMARKS

HOW CAN WE STAY CONNECTED AND MOVE THESUSTAINABLE HEALTH PROCUREMENT AGENDA FORWARD?

2. Attend the Saving Lives Sustainably: Asia Forum 2016

The Saving Lives Sustainably: Asia Forum 2016 will be held in Bangkok, Thailand, November 7-11, 2016.The Forum aims to facilitate a dialogue between all stakeholders concerned about or involved insustainable manufacturing, so that they can exchange knowledge and practice on the latestsustainable production techniques, share concrete examples of the benefits and savings brought bysustainable manufacturing, and develop a “Catalogue of good practices in sustainable healthcaremanufacturing” on how manufacturers can implement change that can simultaneously generatepositive social, environmental, and financial benefits. Each day of the Forum will focus on a particularthematic area and sessions will also be tailored for non-experts of environmental and social issues,therefore explicitly addressing participants with different kinds of professional backgrounds.

The SPHS Secretariat and UNFPA welcome proposals on keynote speakers, session topics, and otherways your organization can contribute.

1. Register, explore and collaborate at www.savinglivesustainably.org

"I really encourage you to come together and share your knowledge and practice through the SPHS.Communication is vital and the SPHS online engagement platform can bring all of our initiativestogether under one umbrella. For all the organizations that are questioning where to start, they cannow explore what others are doing. Some procurement agencies are more advanced than others, butthis is the beauty of the various initiatives – people are doing different things and have a diversity ofexperiences, and through our synergies we can have a true impact."– Special remarks from Ignacio Sanchez Diaz, SPHS

What's next?

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ResourcesUNFPA guide "Safe disposal and management of unused, unwantedcontraceptives" helps countries to develop or update waste disposal policies,and builds awareness and capacity in the management of contraceptive waste.

Download the guide at: http://www.unfpa.org/resources/safe-disposal-and-

management-unused-unwanted-contraceptives

UNDP guide for procurement practitioners "Healthcare Procurement and theCompliance with International Environmental Convention onChemicals", presents a practical guide aimed at assisting the procurementpractitioners to monitor compliance of healthcare procurement using therelevant International Conventions for environmental safeguarding.

Download the guide soon at: http://savinglivesustainably.org

Fostering Sustainable Health Procurement – Meeting ReportAll rights reserved © 2016 UNDPJune 2016SPHS Secretariat, UNDP Istanbul Regional Hub

Dr. Rosemary Kumwenda, SPHS Coordinator, UNDP

Mirjana Milić, SPHS Associate Coordinator, UNDP

Ignacio Sanchez Diaz, Greening Health Systems Specialist, UNDP

Nevra Gomdeniz, Communications Specialist, UNDPAmelie Mahler, Procurement Assistant, UNFPASandy Pederson, Rapporteur, Seed Edit

Contact: info@savinglivesustainably.orgWebsite: www.savinglivesustainably.org

The content, analysis, opinions and policy recommendations containedin this publication do not necessarily reflect the views of the UnitedNations Development Programme, United Nations Population Fund,

LeaderLab or any of the member organizations of the SPHS.

Leaderlab video "About us" gives information on how this transformation agencyhelps governments, cities and companies shape their strategies, leadership,

innovation and partnerships to help bring new game-changing innovations tothe market and drive sustainable growth.

Watch the video: at http://leaderlab.com/#section-about-leaderlab-frontpage