Pharmacists at TTSH turn medicine boxes green, saving $400k

SINGAPORE – Pharmacists from Tan Tock Seng Hospital (TTSH) have taken a green approach by redesigning pill packaging into a single-material paper box.

They removed the clear plastic window covering on the old box, replacing it with six perforated holes that still allow pharmacists and patients to identify the medicine, while ensuring the boxes remain durable and compatible with the automated pharmacy dispensing systems.

By doing so, and with the buy-in of the 16 public hospitals and polyclinics across the three public healthcare clusters in Singapore, TTSH unlocked the potential to recycle an estimated 4.36 million of the redesigned boxes a year.

This would reduce carbon emissions by 4,592kg, roughly equivalent to 24 round-trip flights between Singapore and Bangkok.

“We also look at cost savings across the clusters, about a 29 per cent reduction. So that’s about $400,000 in packaging cost over four years, with zero disruptions to pharmacy operations for patient safety or care… We have moved from a waste contributor to a sustainability champion,” said Ms Alicia Lin, a senior pharmacist at TTSH, who spearheaded the initiative.

“In healthcare, sustainability was never in the equation. Our focus is always on patient safety and workplace efficiency. So our director (Lim) Hong Yee and the head of pharmacy practice (Chong) Yi San created and provided support for an Eco-Pharmers team and got the pharmacy staff to think about sustainability, to think about how we can be green in our day-to-day practices,” she added.

Ms Lin said the spark was lit at the Healthcare Sustainability Innovation Challenge, organised by the Centre for Healthcare Innovation and the Singapore Institute of Technology in 2024.

“At the start, two of the 16 institutions rejected our design as they had some concerns (like whether the new paper boxes were sturdy enough, or if the pills might spill out of the earlier holes, which were round in shape),” she said.

“We kept going back to the drawing board. We actually went through five different versions and worked with our packaging vendor, Winson Press. They gave us the prototypes to test and put through our machines. Our breakthrough finally came about in October 2025.”

The initiative marks the first coordinated sustainability effort of its kind across all three clusters and reinforces NHG Health’s commitment to greener care and better health outcomes for the population.

The team swept the table at the inaugural TTSH Sustainability Awards, receiving both the Eco-impact and Sustainability in Everyday Practice prizes from Senior Minister of State for Sustainability and the Environment Janil Puthucheary at the hospital’s Earth Day 2026 on April 23.

Speaking at the event, Dr Janil praised TTSH for taking the lead in driving sustainability and circularity through innovative, practical solutions.

He cited the example of replacing desflurane – a well-established general anaesthetic gas that has a global warming potential more than 2,500 times greater than that of carbon dioxide – with the more environmentally friendly alternative, sevoflurane, and reducing desflurane usage by 66 per cent from 2022 to 2023, followed by an additional 20 per cent in 2024.

“TTSH’s commitment to sustainability has demonstrated how environmental responsibility can go hand in hand with high-quality care, operational excellence and innovation,” he said.

As Singapore develops its inaugural National Adaptation Plan over the coming year, Dr Janil said: “We will increase our engagement efforts across different sectors and communities, working together to explore how we can better prepare Singapore for climate change.”

This includes working closely with the public health sector to better understand the physiological effects of heat on population health and labour productivity.

“We will also need to build capabilities to ensure that quality healthcare continues to be delivered for various population segments amid the rising temperatures as well as other demographic and technological changes,” Dr Janil said in his speech.

“In line with this, to strengthen heat resilience, the Government has also set up the Heat Resilience Policy Office in March this year to oversee heat management efforts and coordinate across various sectors, including health and infrastructure.”

The National Adaptation Plan will serve as the nation’s long-term road map to outline actions that the Republic can take to enhance its resilience against climate impacts.

“We encourage Singaporeans, including all of you who are our key partners in healthcare, to share your concerns and ideas on how our nation can better prepare for the effects of climate change. This is more than planning ahead; it is our promise to future generations that we will not leave them to face these challenges alone,” Dr Janil said.

Beyond medication packaging, NHG Health is also enhancing sustainability through responsible medicine use in the community.

Its community health teams and TTSH have piloted a study called Project to Reduce the Impact of Medication Wastage on Environment in Community Care to safely redistribute eligible unused medicine to suitable recipients.

During home visits, the teams identify medicine no longer needed by patients and assess them against strict eligibility criteria such as intact original packaging, appropriate expiry dates and verified storage conditions, before they are considered for redistribution.

Common ones found suitable and frequently prescribed for chronic conditions include omeprazole, a medicine to treat heartburn and indigestion; senna, a laxative; and metformin for diabetes. These are then put through clinical review and documented before being matched to patients with the same prescriptions, in accordance with established governance protocols.

This ensures traceability and clinical oversight for better patient safety.

The study, conducted between March 2025 and February 2026, collected 44,104 unit doses across 124 types of medicine and successfully matched and redistributed them to patients with corresponding prescriptions, reducing wastage.

It also avoided about 89.5kg of carbon emissions, equivalent to one return flight between Singapore and Kuala Lumpur.

The pilot also identified medication categories with higher carbon impact and generated insights into reducing oversupply and stockpiling.

Pharmacy director Lim Hong Yee said the team managed to match and redistribute 30 per cent of the medication collected in the last six months, comprising mainly medicine to treat heartburn and indigestion and laxatives, with savings of about $1,400.

“Should the full amount of the donated drugs be given a second lease of life, then savings would have been around $17,000,” she said.

NHG Health is now exploring opportunities to scale the programme across the cluster, subject to further evaluation.