This paper presents a proposed framework for action and a description of a joint project to be implemented in seven countries. The project has been approved by the Global Environmental Facility (GEF) and involves the World Health Organization, United Nations Development Program, and Health Care Without Harm. The framework for action is geared towards the promotion and implementation of best environmental practices and best available techniques for the management of health care waste. The key elements of the framework are: development of model facilities with the goal of replicating the program at other facilities; building institutional capacity including management systems and structures; awareness-raising, training, and education at the local and national levels; sustainability; and regional information dissemination. This paper describes the framework and how the GEF project will be carried out. The relevance of evolving international agreements and programs is also examined. Two major environmental pollutants of concern (dioxins and mercury), the role of health care facilities in their production or release into the environment, and some global trends are reviewed in the Appendix.