Sustainable public procurement at health care facility level

• City:  George
• State/province/region:  Western Cape
• Country:  South Africa
• Type of institution:   Public hospital 
• Number of full-time staff:  800
• Number of part-time staff:  80
• Patient population served annually: Inpatients (1,700), emergency (4,000), outpatient (5,400), extensive outreach programs to population of 713,225.
• Geographic area served:  Garden route and Central Karoo 62 185 km2 
• Number of beds 285

This strategic priority was initiated in response to environmental pollution and resource consumption concerns, which are being addressed through procurement strategies to manage water, electricity, waste (medical and organic), and cleaning products. In particular, waste generated by health care impacts air and water quality, which in turn impacts public health.

The goal of this initiative is to position George Hospital as a health system leader in Western Cape Rural Health Service in responding to climate change and providing more sustainable health care. Specific items include:

• Securing funds for staff or consultants to assist with the design of the action plan.
• Reducing energy costs.
• Reducing carbon dioxide emissions.
• Encouraging staff to carpool and cycle to work.
• Establishing an extreme heat emergency response plan with the local community.
• Making progress on health equity goals.
• Transitioning from conventional chemical products that have not been designed to prevent environmental and human health harm. 
• Advocating for more environmentally friendly practices within the broader health system network.

Hospital leaders aimed to leverage their goods and services budget, which in 2020 and 2021 amounted to R151 million (USD 8,161,097). Specifically the plan looked at: 

• Sustainable procurement strategies, policy, and plans.
• High-impact procurement opportunities considering which sustainability concerns are a priority for upcoming procurement/tender events.
• Training and communication.
• Revising standard operating procedures.
• Engaging with suppliers around sustainable procurement and alternatives.
• Promoting supplier leadership in innovation.
• Tracking and monitoring data, as well as preparing sustainability procurement reports.

Hospital leaders established key performance indicators that defined and tracked procurement and supply chain objectives, regularly reviewed progress and adjusted strategies as needed, and monitored supplier performance and cost savings.

Implementation began with a conversation between procurement officials and the team on sustainability, focused on why the changes matter and what can be done about it.

Western Cape Department of Health Procurement specialists brought knowledge and expertise on contract management, procurement, and interpretation of policies and prescripts. Procurement specialists received training on conducting market research, testing markets for sustainable products, and writing and compiling specifications inclusive of “environmentally friendly/biodegradable products.” The team reviewed best practices within the Department of Health and revised technical specifications to find environmental alternatives that met functionality criteria.  

This process also considered ethical sourcing, human rights, and child labor along with sustainability benefits. This included a lifecycle approach to chemical consumption, reduced use of hazardous chemicals for lower local environmental impact, local and environmentally responsive market development, and reduced aquatic system pollution.

The team fostered strategic supplier relationships to develop long-term partnerships to encourage collaboration and innovation. A successful supplier open day was held in January 2020 and the response was overwhelming, initiating a conversation about sustainable procurement. They provided inputs to specifications as specialists in their respective fields. 

The team also engaged the community by raising awareness, organizing, collaborating, and helping others as a fundamental component of their success. End users of the hospital such as clinicians, nurses, support staff, and facility management staff were educated to understand str they could use at work and at home. The strategies had to be reviewed every three months along with inventory levels to adjust as needed and minimize carrying costs and stockouts. By leveraging digital procurement tools, the facility is able to streamline processes and maximize cost savings.

No targets were set for this project, as this was a relatively new concept for public procurement. However, the organization was one of three institutions in South Africa identified to pilot the Global Green and Healthy Hospitals carbon footprint tool, which enabled the facility to measure its carbon footprint within supply chain management using expenditure costs.

The tool identified the top supply chain emission categories: 

1. Construction
2. Food and catering services
3. Business services 
4. Information and communication technologies

The results are ranked by their GHG emissions to easily identify hotspots in the supply chain. The following graphics include results within the supply chain compared with the whole GHG Inventory.