1. 1 |1 | Module 8 Environmental Management including Energy WASH FIT Module 8 Environmental Management including Energy WASH FIT

2. 2 |2 | Overview What makes a health care facility safe What does environmental management mean Required interventions towards a safer health care facility environment Energy efficiency practices Resources required to ensure environmental management

3. 3 |3 | What is a safe healthcare facility environment? A safe healthcare facility environment is free from: Vectors (including mosquitoes, rats, etc) and other animals that transmit disease and pose a risk to humans Smoke, dust or other types of air pollution Inappropriate chemical use and disposal Unsafely managed wastewater and storm water Accumulated garbage or inappropriate disposed of health care waste A safe healthcare facility should have sufficient power to ensure adequate lighting and operation of water pumps, refrigeration and sterilization equipment. In addition, there should be enough fuel/energy to support treatment of healthcare waste.

4. 4 |4 | Examples of pests & animals in HCFs

5. 5 |5 | Integrated pest &vector control management A combination of approaches for excluding and reducing vector numbers including: –Keep health care facility environment clean and free from feces, wastewater and stagnant water –Improving food hygiene standards by safely storing and disposing of food –Removing pests manually by using hands, setting traps –Habitat manipulation, cultural control or pest/animal proofing including mosquito nets, solid fence, window screens, close fitting doors, etc. –Using biological control products

6. 6 |6 | Water leakages and overflows must be immediately reported and repaired

7. 7 |7 | Environmental management at facility level Environmental management is a key part of WASH FIT Ensure environmental management by implementing the following: Assign a member of the WASH FIT team to oversee environmental management Conduct regular assessments and implement pollution prevention and control measures Ensure environmental compliance Ensure training and awareness among health workers Incorporate environmental planning and decision-making into facility plans Keep records and documentation of measures Continual program evaluation and improvement Involvement of patients, their families, and community in environmental management

8. 8 |8 | Key environmental management interventions Implement pollution prevention and control measures. Key interventions are: –Ensure proper functioning & maintenance of incinerators to reduce air pollution from black smoke and toxic materials (Dioxins and furans/POPs) –Ensure proper collection, storage and disposal of used oil resulting from generator maintenance to prevent water and soil contamination by hydrocarbons –Ensure proper fueling of various equipment to prevent fuel spills –Prevent soil erosion by planting grass (vegetation cover) –Ensure safe disposal of laboratory reagents and chemical waste

9. 9 |9 | Petroleum, Oil and Lubricants (POL) products MUST be collected and disposed of in environmental friendly way to avoid ground water contamination. Examples of POL products: –Oil –Gasoline –Hydraulic fluids –Kerosene –Diesel, etc.

10. 10 | Effects of POL contamination Pollution of water sources: percolates easily to reach ground water sources Air pollution Health effects in human beings Affects ecosystem Can be persistent

11. 11 | Preventing spills and proper storage of fuel and used oil

12. 12 | Management of Spills Take steps to prevent spills from the generator Keep clean-up materials such as rags, saw dust and oil sponge readily available. Stop the oil from flowing at the source to reduce contamination. If a leak from a container/tank or generator cannot be stopped, catch the oil in another holding container. Contain spilled oil by isolating the contaminated area, closing the effluent, or spread oil sponge or other clean-up materials over the oil and surrounding area. Implement bioremediation of POL contaminated sites

13. 13 | Importance of energy Energy is necessary to ensures adequate lighting for safe provision of healthcare, use of toilets and safe waiting areas including at night. Energy is critical for treatment of health care waste, sterilization of equipment, water pumping, refrigeration, machine-laundry activities, etc. Efficient use of green energy in healthcare facilities mitigates climate change effects.

14. 14 | Renewable energy Renewable energy is the energy generated from resources which are naturally replenished such as sunlight, wind, rain, tides, waves, and geothermal heat.

15. 15 | Energy efficiency practices Only turn on air conditioners when required and establish a minimum temperature (24°C=75°F). Turn off lights, computers and other equipment at the end of the day. Unplug equipment that uses energy even when they are not in use. Use solar power for lighting, pumping water supply, refrigeration, etc. Use energy efficient bulbs

16. 16 | Examples of solar energy use Use solar power for pumping and heating water supply, refrigeration, light etc.

17. 17 | References WHO. (2008). Essential environmental health standards in health care. http://www.who.int/water_sanitation_health/hygiene/settings/ehs_hc/en/ http://www.who.int/water_sanitation_health/hygiene/settings/ehs_hc/en/ WHO/World Bank (2014). Access to modern energy services for health facilities in resource- constrained settings. http://apps.who.int/iris/bitstream/10665/156847/1/9789241507646_eng.pdf http://apps.who.int/iris/bitstream/10665/156847/1/9789241507646_eng.pdf WHO. (2011). Technical notes on drinking water, sanitation and hygiene in emergencies. Retrieved from http://www.who.int/water_sanitation_health/publications/2011/tn9_how_much_water_en.p df http://www.who.int/water_sanitation_health/publications/2011/tn9_how_much_water_en.p df WHO/UNICEF (2015). Water, sanitation and hygiene in healthcare facilities: Status in low-and middle-income countries. http://www.who.int/water_sanitation_health/publications/wash- health-care-facilities/en/

18. 18 | Questions?