Bongani Regional Hospital, South Africa

Sustainable Health in Procurement Project (SHiPP) case study.

Location: Lejweleputswa District, Free State, South Africa

Work areas: Policy, Products, Process.

Summary: The hospital is a leader in implementing Integrated Pest Management (IPM) - reducing the use of hazardous pesticides by substituting more sustainable choices. The facility drafted and implemented an IPM policy which led to the adoption of a province-wide policy (Free State), ensuring that the practice became a required practice.


Initial situation

Before the implementation of the Integrated Pest Management program, the hospital’s pest control program was centred on the use of pesticides that belong to chemical families including pyrethroids, neonicotinoids and coumarins with active ingredients that were Class 1A (extremely hazardous) and Class II (moderately hazardous) pesticides that are harmful to the employees, patients and the environment.  The hospital was experiencing problems with use of pesticides due to: 

  • Short and long term exposure of harmful pesticides to patients and staff through fumigation (spraying and aerosolization of chemicals.)
  • The use of fumigation was costly and not effective as it only lasted for a few weeks.
  • Offensive odour to patients and staff during fumigation service as a result of chemicals being used for pest control.
  • No policy on IPM in the province of Free State. 
  • A need for a uniform approach to pest management in the Province was identified.


Proposed alternatives

  • Develop IPM policy as a guiding document for all the health facilities in the province
    • Policy clarifies the roles and responsibilities of all relevant stakeholders from the Province for pest control including: CEO-District Director, Infection Prevention and Control Coordinator, Environmental Health Practitioner, Procurement officer, Supervisor, Pest Control Service Provider.
  • Introduce sound management of pests through resource mobilization, and the procurement of alternative devices and methods to make the health institution safe for the public and employees.


Progress and benefits

Financial Benefits: IPM has both financial and environmental benefits to the health care facility. By introducing IPM the health care facility stopped buying harmful pesticides which resulted in a drastic cost reduction. The cost of pest control by the hospital was reduced by over 50%.  IPM was introduced in a phased manner The four implementation phases of the IPM process are: 

  1. Pest repellents.
  2. Sterilisation of natural predators.
  3. Installation of insect light traps.
  4. Bird control.

The cost for each phase is detailed in the table below: 

Costs of integrated oest management in phases
Table 1: Costs of integrated pest management in phases.

Environmental benefits:

  • The use of pesticides has been reduced by 80% in all health care settings in the Free State.
  • Promotion of sustainable and environmentally friendly pest control methods such as ultrasonic pest repellents, use of natural predators, and bird control-based approaches have also been deployed in all health facilities.

Human health benefits: Reduced exposure to harmful chemicals in the form of pesticides, to employees, patients, and community members.

Other quantitative results: After successful implementation of IPM strategy phases, the health care facilities have seen significant reduction of pest infestations over the past 3 to 4 years of implementation along with cost savings.


Implementation process

IPM implementation was introduced to the supply chain unit using the green procurement principle preferencing procurement of environmentally sound services for pest control, and also an IPM policy was drafted to ensure that this green initiative is legislated.

  • Upscaling the IPM policy for the hospital as well as the province (Free State) was critical to ensure that the system becomes a binding strategy 
  • Challenges faced during the implementation of the IPM approach related to approval to procure IPM devices. This resulted in the development of an IPM policy that was used as a binding document to enforce this initiative to be implemented in the hospital.


Next steps

The next steps of the project are:

  1. Policy: The hospital policy on Integrated Pest Management was adapted for the region and is in the process of being upscaled to all regional health care settings. Other health systems and hospitals in the region are learning from the case study and will apply it to their facilities. The hospital policy led to the development of a legal framework for IPM for the province of Free State.
  2. Process: The hospital will continue to expand and scale up the IPM program and implement other planned IPM activities to procure more environmentally friendly options. 


Information about the organization

Bongani Regional Hospital is a level 2 hospital offering specialised health care service to the community of Lejweleputswa district (DC 18). The bed capacity of the hospital is 450 beds with 1,000 regular staff. The hospital uses a referral system to admit patients from 5 district hospitals namely Nala, Mohau, Thusanong, Katleho and Winburg all of which are located in the vicinity of Lejweleputswa district.