Iphendule Ndzipho, Sustainability Consultant - Built Environment, WSP in Africa

One of the biggest challenges for healthcare facilities is how to reduce their carbon emissions and transition to net zero, especially as the demand for health services grows. Healthcare buildings perform a critical role in communities around the world. But they are also among the most carbon intensive facilities, directly and indirectly. Overall, healthcare is responsible for almost 5% of global carbon emissions.

As we grapple with the impacts of a climate emergency, different healthcare systems around the world are responding to their unique circumstances with a variety of strategies and design solutions to decarbonise their facilities. Decarbonisation has the potential to improve health outcomes in the short and longer term, making it crucial for the future viability of health systems. By focusing attention on the hospital environment and transitioning to cleaner forms of energy, for example, it is possible to realise better conditions for patients, staff and wider communities.

The primacy of clinical need and infection control standards is universal. Meeting these requirements is often viewed as diametrically opposed to decarbonisation, which requires drastic reductions of energy and water use. But these two priorities can, in fact, work together symbiotically – considering aspects such as air change rates and recirculation, heat recovery, alternatives to fossil fuels for sterilisation, and how digital modelling and occupant-sensing controls might be used to improve both healthcare environments and energy performance.

A good example of this symbiosis in action is Roha Health Inc's multimillion-dollar Roha Advanced Multi-Speciality Hospital project in Addis Ababa, Ethiopia. Due for completion in 2026 and supported by WSP's comprehensive engineering and sustainability services, the facility aims to meet critical healthcare needs on the continent. The hospital will span 40,000m² and feature 350 beds with 8 operating theatres.

It will also offer advanced specialties and cutting-edge technology, including oncology, dialysis, neurosurgery, spine surgery, cardiac surgery, as well as a dedicated Mother & Child floor offering maternal and child health services. It aims to become Ethiopia’s first JCI (Joint Commission International) accredited hospital – robustly assessed for patient safety and quality of care. Careful planning has also gone into integrating sustainable building principles centred around patient care and targeting EDGE certification; including energy-efficient lighting, water-saving measures, plans for renewable energy and a forest and park to provide a natural healing environment.

Other healthcare systems on the continent should also be examined. In South Africa, healthcare contributes 2.5% of national emissions or 15.93 MtCO2e (2015). South Africa’s healthcare sector is primed at turning the country’s infrastructure challenges into a catalyst for innovation, as it works to expand access across this large, geographically diverse country, and address historically entrenched inequality.

Energy demand drives change

South Africa’s ongoing energy crisis is prompting healthcare operators to seek alternative sources that reduce their reliance on the grid, with installations of photovoltaics becoming an increasingly popular strategy. To encourage investment in renewables, the government has removed both the requirement for independent power producers to hold generation licences, and a cap on the amount that they can generate. This enables healthcare providers to meet a higher proportion of their own needs on-site, with benefits both for resilience and decarbonisation.

Healthcare operators are also reducing demand for electricity by installing energy efficient LED light fittings, occupancy sensors, and water aerators in non-clinical settings that reduce the flow rate and, therefore, the amount of energy required for water heating without compromising pressure. Sensor taps with timers also reduce the quantity of water used.

Heat pumps are often used to provide cooling and heating and although gas or oil powered boilers are typically favoured for supplying hot water and steam for sterilisation the business case may be made for a hybrid solar hot water/heat pump system to reduce energy linked carbon while still promoting reliability. Developing heat pump technologies that can deliver water at higher temperatures is a major opportunity to drive more widespread adoption. In existing facilities, owners are taking the first, essential step of improving the measurement and monitoring of energy and water consumption, as a fact-finding exercise to inform decarbonisation strategies. This involves the installation of building management systems and smart metering, to identify the areas or systems within a building where energy and water use is greatest.

Investors make sustainability a prerequisite

Investment is a driver for decarbonisation across the continent. This is partly because international hospital groups are bringing their own decarbonisation policies and targets with them. WSP is part of the design-build team applying the US standard LEED on the African Medical Centre of Excellence in Abuja, Nigeria, which is being developed in partnership with King’s College Hospital in the UK with funding from the African Export-Import Bank.

Development banks also drive decarbonisation by making sustainability measures a prerequisite for funding, or by tying more favourable terms to carbon savings. The EDGE rating tool was developed by the International Finance Corporation (IFC) for use in emerging markets. It focuses on energy consumption, water consumption and embodied energy, in the form of construction materials. Local versions are tailored to each market, and for various sectors including healthcare. The target is a 20% reduction in each of these three parameters, against a country-specific baseline building.

There is a palpable enthusiasm for decarbonisation through collaboration among healthcare providers, policymakers and green building councils across the continent. All these stakeholders recognise that sustainability in African healthcare provision is a balancing act between sustainable, leading-edge engineering, and providing basic access.

In the pursuit of a prosperous future of inclusive and sustainable growth, where all African people have a high standard of living, quality of life, sound health and well-being, learning from global trends and adapting these to suit African conditions is the key to building successful networks of healthcare infrastructure and medical facilities. And always, it’s about working towards net zero, on a continent with limited infrastructure but an abundance of resilience and optimism.