FM Sustainability Program

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"Building healthy sustainability together"
"Optimal care, sustainable for everyone"

To maintain a balance between nature, culture, and economy (Blue Destination) also for future generations on Bonaire. Fundashon Mariadal (FM) strives to reduce the burden on the environment and the dependence on fossil energy and scarce raw materials.

Fundashon Mariadal is aware that not only the climate and environment have an impact on people’s health, but that FM itself also has an impact on the climate and environment of Bonaire.

Fundashon Mariadal is a healthcare institution on Bonaire that covers the following areas of focus: Acute care, Short-term care, Long-term care, Diagnostics and Medicines supply. Bonaire has become a special municipality of the Netherlands since 2010. In addition to this change, population growth is expected to increase significantly in the coming years. The result of this is that Fundashon Mariadal will grow along with it. FM will make efforts to offer this growth in a sustainable way on Bonaire.


“Fundashon Mariadal will provide everyone on Bonaire with professional and optimal medical and transmural care, aiming for coordinated care facilities through integrated collaboration between general and specialist care. This cooperation focuses mainly on the surrounding (island) countries to which Bonaire is forced to fall back. International standards for healthcare, adapted to the situation of Bonaire, are paramount and will determine the direction.”


“Everyone is entitled to the maximum integrated quality of care that is achievable on Bonaire and tailored to the needs and wishes of the patient and those of his or her family. As Fundashon Mariadal is the largest healthcare service company on the island, it is its job to continuously guarantee well-being on Bonaire and to ensure that its staff can provide the necessary knowledge, skills and resources required for this, to have.”

FM to organize the growth of the coming years sustainably and optimize existing care. FM uses (international) policy frameworks for the composition of its multi-year program:

  • WHO Sustainability goals1
  • GREENDEAL Zorg 3.0
  • Blue Destination – Openbaar Lichaam Bonaire
  • International Civil Aviation Athourity (ICAO)
  • Airport Council International (ACI)

Sustainability and resilience are part of the FM – Corporate Strategic Plan (CSP). The RvB mandates employees in the organization to implement the multi-year program through an internal working group.

FM seeks strategic partnerships with the ministries of the Kingdom of the Netherlands. FM pursues an active policy in initiating collaborations and building alliances with (international) industry (chain) organizations. ANNEX 1 provides an overview of used knowledge sources. ANNEX 2 provides an overview of the stakeholders involved. The ambitions have been captured in a Letter of Intent (LoI) with several key stakeholders.

1. By (re)sustainable care FM means: focusing on care with the lowest possible impact on the climate, environment and living environment, taking into account legislation and regulations. This requires ‘green and climate neutral care’ with minimal greenhouse gas emissions and impact on the living environment, delivered with an eye for economical and circular use of raw materials and materials.

2. FM has developed concrete, quantifiable and time-bound (interim) goals, so that sustainability is achieved towards care with minimal impact on the climate and the environment in 2050.

  • 55% CO2 reduction in 2030 and climate neutrality in 2050, as included in the Coalition Agreement Rutte-IV;
  • 50% less use of primary abiotic raw materials in 2030 and 100% circular working in 2050.

3. FM institutionalizes a measurable method and scope to achieve sustainability. This method and scope consists of:

  1. Demarcation; This policy statement provides an opportunity to demonstrate commitment at executive level, increase the importance of sustainability and energy efficiency and
    develop the framework to meet the requirements of the program. The policy statement must be formulated in such a way that it best meets the general needs of Fundashon Mariadal.
  2. Reduction: The target relates to overall emissions and includes the emissions improvement measure (i.e. absolute or intensity target). FM selects a base year for the target. FM demonstrates meaningful efforts to reduce its emissions in accordance with its stated goal and policy statement. FM provides evidence to demonstrate that the Plan is being implemented effectively.
  3. Optimization: The goal includes specific emissions for healthcare and all forms of mobility, ground and air. The plan must demonstrate that FM maintains an ongoing dialogue, shares best practices, provides training, develops joint projects and promotes collaboration with key stakeholders on Bonaire.
  4. Neutrality: FM-purchases offset and submit evidence to cover both residual emissions and emissions from employee business travel that cannot be reduced by other means.

FM determines operational limits of direct and indirect emissions for activities based on FM established organizational boundaries.

Scope 1: Direct emissions arising from sources owned and/or controlled by FM, for example emissions from combustion in owned or controlled aircraft, vehicles, etc.

Scope 2: Indirect emissions from the generation of purchased electricity, steam, heat or cooling consumed by FM. Scope 2 emissions physically occur in the facility where purchased electricity is generated.

Scope 3: All other indirect emissions, which are a consequence of FM’s activities, but originate from sources not owned and/or controlled by FM (e.g. air ambulance aircraft movements, vehicles and equipment operated by third parties, external waste management, etc.).

2 Multi-year program

It is important for the entire healthcare chain to ensure that people are and remain healthy as much as possible. Because the most sustainable form of care is care that does not have to be provided. More focus on preventing disease, on promoting health and a healthy lifestyle, on a healthy care and living environment and more on disease control will lead to more healthy years of life and a decrease in healthcare use. This saves costs, time and the deployment of people and materials, and is therefore also good for the environment. That is why the parties aim to:

  • FM is demonstrably committed to promoting the physical and mental health of the population, patients/clients and their employees, based on existing insights and concepts (The HR department has developed a policy in the context of sustainable employability) and actively contributes to programs and awareness of it.
  • A healthy, varied and sustainable diet for clients/patients and (where applicable, such as in company canteens) for employees. Healthcare providers make ‘sustainable and healthy food’ part of their purchasing policy.
  • Food with more plant and less animal proteins is often more sustainable. For the nutritional offering for staff and visitors, healthcare providers aim for a 40/60 ratio of animal/vegetable proteins by 2030 at the latest, with a 50/50 ratio as an interim result in 2026. A nutritional policy has been developed for patients and residents.
  • Healthcare providers apply existing and new knowledge and experience regarding a health-promoting living and working environment in and around their healthcare locations, especially in (re)new construction. They also further expand this knowledge and share good examples among themselves.

Sustainable anchoring and realization require awareness, knowledge, skills, research and cooperation. It is necessary that all employees in FM are informed about the relationship between human actions, climate, environment and health.

  • FM actively contributes to the social debate about the relationship between human actions, climate change and environmental pollution, a healthy living environment and health.
  • FM include (the importance of) prevention, sustainable care and the relationship between climate, environment and health integrally and visibly in their strategy and vision documents. FM is forming a team that focuses on raising employee awareness about sustainability and the relationship between climate change and health.
  • FM develops a clear communication strategy to highlight the goals and agreements, with special attention to the information for the patient/client and employees.
  • FM promotes the integral embedding of sustainable care in the curriculum of all healthcare training courses within the FMA. Agreements will be made with the FMA on how these themes will be structurally (better) included in healthcare training courses.

Making buildings, energy and mobility more sustainable, FM aims to achieve a 55% reduction in direct CO2 emissions by 2030 and climate neutrality by 2050.

  • Aim for an average of 30% CO2 reduction for real estate and energy by the end of 2026 based on the sectoral monitoring roadmaps.
  • By 2023, FM will map the CO2 emissions from transport movements of personnel, commercial vehicles, air ambulance missions and draw up a mobility plan with goals and measures for reducing these CO2 emissions and making these transport movements more sustainable. Where possible, FM involves the transport movements of patients/visitors.
  • FM includes climate neutral and/or ‘low CO2’ as a starting point in policy for new construction and renovation and when purchasing energy and mobility resources. It works here together with the Water and Energy Company and car leasing companies.
  • FM takes initiatives towards IT and application suppliers to configure as energy efficient and CO2 neutral, future oriented as possible. FM thinks about:
    • Energy efficient IT infrastructure including monitoring and reporting, provide dashboards where you can see what impact the application has on energy.
    • Placing applications in green data centers, requesting evidence and intentions from the data centers as to what actions are being taken or will be taken.
    • Server consolidation and virtualization.
    • Optimize software, minimize system resources, adjust processing power during off-peak hours.
    • Data compression and data deduplication, reducing storage needs.
    • Remote working, improve access, collaboration and communication.
    • Supplier support for green initiatives (paperless working, recycling, digital invoicing.

FM would like to use raw materials responsibly to achieve a cleaner and healthier world for the current generation and future generations. It is also important in the light of continuity of care. A turn from ‘disposable’ to ‘reuse’ and preferably a reduction in consumption is therefore necessary. FM sets the goal of 50% less primary raw material consumption in 2030 and maximum circular care in 2050.

  • FM applies existing knowledge, experience and possibilities to work circularly and use raw materials sparingly. FM increases insight into available knowledge about this and promotes the development of new knowledge.
  • Where possible, FM chooses ‘reusable’ over ‘disposable’ and the ambition is that by 2026 at least 20% of (medical) devices will be reusable. To this end, parties promote dialogue between users, producers and buyers. Health insurers and healthcare offices are looking at how they can positively encourage healthcare providers to reuse through contract agreements.
  • FM and its suppliers establish ‘sustainable and circular purchasing’ as a starting point in their purchasing policy regarding (construction) materials, (medical) devices and food, and purchase jointly where possible to stimulate market demand for this and thus the development of to promote sustainable alternatives for Bonaire.
  • FM aims for an average of 25% of all waste to be ‘unsorted residual waste’ by 2030. The aim is also to have an average of 25% less unsorted residual waste by 2026. To this end, FM promotes waste policy with attention to waste separation and ‘zero waste’, encourages knowledge about this among employees and focuses on better chain cooperation to achieve an optimal situation.
  • FM structurally maps existing food waste within healthcare and makes every effort to reduce it.

Medicines make a valuable contribution to the daily functioning of many people, to quality of life and to the prevention and cure of diseases. However, due to the use of medication, drug residues also end up in the ground and surface water through urine and feces, resulting in damage to the environment and living environment. In addition, it can still happen that unused (liquid) medication is flushed down the sink or toilet and thus ends up in the ground and surface water. The production of medicines also has a climate and environmental impact. FM’s goal is to reduce the environmental impact of medication (use).

  • FM promotes health, preventing unnecessary use and combating waste, by 1) appropriately prescribing and dispensing necessary medications and 2) promoting patient compliance and correct use.
  • FM is developing an approach with measures to prevent wastage of medicines, for example as a result of unnecessary prescribing, excessive dispensing or unnecessarily high dosage.


Below is a summary of consulted knowledge platforms:

  • Milieu Platform Zorg3
  • Landelijk netwerk de groene Operatie Kamer4
  • Expertisecentrum verduurzaming zorg5
  • Good Travel accreditatie programma6
  • Mobiliteitsplatform7
  • Airport Carbon Accreditation program


Stakeholders involved within the sustainability strategy:

  • Stinapa
  • Water en Energie Bedrijf
  • Bonaire International Airport
  • Kamer van Koophandel
  • Dutch Caribbean Cooperation Airports