Green hospitals for a healthier future

Written by Indah Deviyanti, National Professional Officer (Environment) and Irma Syahriar, Communication Officer.

Protecting and restoring human health, saving lives, and strengthening health services – albeit for a good cause – may come at a price if we are not careful.

Imagine public health institutions, such as hospitals, operating 24 hours a day and 7 days a week, offering a range of services that comprises the entire spectrum of health and well-being. Not only do these resource-intensive institutions consume massive energy, but they also generate a large amount of waste that can be harmful to humans and the environment.

Unsafe waste management can even drive climate change. Open burning of medical waste releases many hazardous gases, compounds, including dioxins, furans, as well as toxic metals such as lead, cadmium, and mercury. It also releases large amounts of carbon dioxide, thus worsening climate change. The disposal of biodegradable waste produces greenhouse gas emissions, including methane, which has a bigger impact on the climate than any other gas. The unsafe disposal of waste that pollutes land and sea is one of the consequences when health care facilities (HCFs) have no recycling and disposal facility.

Fig. 01 A waste officer disinfecting jerrycans before processing them in the shredding equipment. Photo credit: RSUP Dr Sarjito/Agung Sapto Budi Nugroho.

Hospitals and other facilities in the health sector shall undertake efforts to integrate environmental sustainability and to mitigate the impact of waste resulting from their daily operations and related activities. This is especially true in the face of a pandemic. According to a WHO report released in 2021, tons of additional medical waste from the COVID-19 pandemic response has shown the urgent need to improve waste management practices in HCFs. This means that the health care sector should take steps to ensure safe waste management and improve their waste management systems and techniques.

An ensured sustainable and safe environment in HCFs is pivotal to achieving universal health coverage. Patient safety can only be achieved when the proficiency of water, sanitation, hygiene, and waste are provided, and resilient to the changing environment due to climate change and disaster.

Green transformation in RSUP Dr Sardjito

In the Yogyakarta Province, one hospital has taken an active role in ensuring the safe and environmentally sound management as part of their adoption of the green hospital concept. The hospital, RSUP Dr Sardjito, began this initiative in 2016. It has been a member of the Global Green and Healthy Hospital (GGHH) Asia Pacific, which allows them to implement learnings from the organisation and develop the green initiative. In the same year, RSUP Dr Sardjito management decided to participate in a green hospital competition held by the Ministry of Health (MoH) and was awarded first prize.

For waste management, RSUP Dr Sardjito initiated a reuse-reduce-recycle (3R) programme for domestic waste – both organic and inorganic– and medical waste such as used dialysed jerry cans and intravenous fluid containers. Specific attention was directed towards environmental and occupational safety aspects, operational costs, institutional policy, and government regulations.

With an integrated budget built in their programme, the hospital carefully planned their initiative. They established a partnership with Koperasi (co-operative) and a third party to implement the 3R programme through Waste Bank, applying the standard in the Ministry of Environment Regulation no. 13/2012, Ministry of Environment and Forestry no. P.56/2015, and internal regulations.

Fig. 02 WHO and UNDP-funded autoclave in RSUP Dr Sardjito. Photo credit: RSUP Dr Sarjito/Agung Sapto Budi Nugroho.

The 3R process is carefully monitored by the hospital’s environmental health staff, starting from collecting, disinfecting, shredding, and transporting to the third party. In 2016-2021, the hospital managed to recycle 8.08-14.61% of 900 kg of medical waste each day and 34.35-62.2% of 9,606 kg of domestic waste every month through the Waste Bank. The composting of organic waste further adds to the hospital’s efficiency. This enables RSUP Dr Sardjito to save around US$ 24 000 in 2022.

The hospital’s commitment to creating a healthier environment for patients, staff, and the public goes beyond waste management. Its green hospital programme is implemented throughout all operational aspects and infrastructures – from creating green facilities such as a pedestrian walk, a bike lane, and a healing garden for patients to promoting energy efficiency and building integrated facilities for waste reduction and handling.

“When people talk about green hospital in Indonesia, they always refer to RSUP Dr Sardjito. It’s now part of our branding. Although we do know there are still some areas that need improvements, we always try to make progress and innovate,” said Agung Sapto Budi Nugroho, Head of Environmental Health Sub-Installation of RSUP Dr Sardjito.

 “It helps that our management, upon seeing the results and scientific evidence, believes in the programme. They acknowledge that environmental health is an important aspect that we just can’t ignore,” he added.

Paving the way to real green actions

The hospital continually takes steps to go greener. In 2021, the hospital installed a WHO and UNDP-funded autoclave, a steam-based waste treatment technology that is used to treat infectious waste and disinfect waste ready for recycling. The autoclave uses less energy than incinerators and does not present a health risk due to the release of toxic pollutants to the air. The management is also looking to further develop their programme from the technology and safety aspects.

To date, RSUP Dr Sardjito has collected several awards for its outstanding achievements in the green hospital programme. The hospital management has high hopes in the implementation of this programme in the country, wishing that more would tread in their footsteps.

So far, their success has helped to inspire and pave the way for others. They have been responding to multiple requests coming from the MoH, Ministry of Environment and Forestry, universities, professional associations and healthcare institutions asking them to share their expertise and best practices.

When asked about the World Health Day 2022 theme “Our planet, our health” and what we can do to protect environment and the planet, Agung responded with a firm answer, “This planet needs real actions.”

“Pollutions from industry-related activities, damages done to the environment, illegal loggings, and other serious environmental issues should be addressed by the government and multisectoral partners, including the health sector,” he added.

A paper published by WHO and Health Care Without Harm suggests that it is possible for the health sector to play a major role in improving the health of the population, while also making efforts in reducing their climate footprint to protect the environment. From building green infrastructures to maximising efforts in waste management activities like RSUP Dr Sardjito, the health sector can take a leadership role in mitigating climate change and advocating for a healthier future.

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