Chemicals are an integral part of everyday life, including for having heat, goods and clothing. While they are a significant contributor to our economies, their sound management is essential to avoid risks to human health and the environment, particularly regarding those that are highly toxic, such as persistent organic pollutants and mercury. These chemicals remain in the environment for a long time and can travel over large distances through air, migratory species and water currents. As a result, they contaminate ecosystems and are absorbed by both wildlife and humans. Despite growing concerns about their effects on people’s health and the global environment, the current chemical production capacity of 2.3 billion tonnes, valued at US$5 trillion annually, is projected to double by 2030.

As the world celebrates World Health Day today, the Global Environment Facility’s Small Grants Programme (SGP), implemented by the United Nations Development Programme, highlights the efforts of the Center for Public Health and Environmental Development (CEPHED) in Nepal, a civil society organization that has been working on reducing and controlling chemical use that is particularly harmful to human and environmental health. For the past ten years, CEPHED has been engaging in research, awareness-raising, capacity-building and advocacy to reduce, and eventually phase out completely, the use of harmful chemicals in Nepal’s health sector. Working in close collaboration with government agencies and with support from SGP, it recently won the WWF Nepal Conservation Awards for playing a key role in reducing chemical pollution through the elimination of persistent organic pollutants and mercury management in hospitals in the country.

Nepal’s first mercury-free city

Located by the Narayani River and north of Chitwan National Park, a renowned World Heritage Site and home of many endangered species, Bharatpur is a city in southern central Nepal known for its highly developed healthcare system. Without a proper waste management scheme in place for this sector, over 964 metric tons of medical waste produced every year were either burned or dumped on the riverbank. Both methods resulted in mercury and persistent organic pollutants contaminating the waters and fish of the Narayani river and, consequently, the local people.

“We started a campaign to make the health sector in Nepal mercury free”, recalls Ram Charitra Sah, CEPHED’s Executive Director. In 2017, the organization launched a project with support from SGP to address the medical waste management problem in Bharatpur by assisting in the creation of a central waste treatment facility and developing the capacity of over 1,700 local healthcare professionals to use it.

The initiative also supported the development of a model waste management system in Manakamana Hospital, located in the city. Dr. Usha Kharel, a dentist at the hospital, notes how doctors, nurses and other workers were all suffering effects from the unmanaged medical waste, which included mercury. “We have completely shifted to mercury-free dentistry practice in our hospital, and also suggest all other dental doctors and hospitals to follow suit and use alternative restorative materials”, she says. For the manager of Green Nepal City Waste Management, Uttam Aryal, the results of this experience are clear: instead of mixing all waste together, hospitals in Bharatpur now have an onsite system to separate and contain different kinds of waste, which makes the waste management done by his organization much easier and safer.

To scale up the successful model and have larger impacts beyond the city, CEPHED also succeeded in influencing several related national policies. In 2019, Nepal banned the use of mercury dental amalgam, a liquid applied to fill cavities, in children, pregnant and breast-feeding women. It was also agreed that its use would be phased out for other groups of people within five years. Meanwhile, all hospitals in Bharatpur decided to stop using mercury, making it the first mercury-free medical city in Nepal. The model waste management system developed at Manakamana Hospital has been replicated by other institutions, while mercury-free healthcare facilities and dental clinics are multiplying spontaneously throughout the country.

“Hospitals are providing their invaluable service in curing sick people. By managing their waste, they are also preventing people from being sick”, says SGP’s National Coordinator in Nepal, Gopal Sherchan. Another significant improvement achieved in the country is a requirement for universities to revise their dental curriculum to reduce and eventually ban the use of mercury, promoting a shift to alternative materials.

Local actions, global impacts

There are two main multilateral environmental agreements that have been adopted by world leaders to address the global challenge of chemicals and waste management: the Stockholm Convention on Persistent Organic Pollutants and the Minamata Convention on Mercury. In coordination with SGP, CEPHED has highlighted its work on chemical management, particularly on this successful initiative in establishing a mercury-free city in Nepal, at the first Conference of the Parties of the Minamata Convention on Mercury held in 2017. Since the Global Environment Facility serves as the financial mechanism for both of these Conventions, SGP has been piloting innovative community-based projects in this area to help reduce the use of harmful chemicals and minimize their adverse effects on human health and the global environment. As of today, SGP has supported a total of 800 chemical and waste management projects all over the world. For more information on SGP’s chemicals and waste portfolio, see the publication Community-based Chemicals and Waste Management.