The tool can be used by other stakeholders within and beyond the health sector, including NGOs, academia and public institutions, to calculate and manage their carbon emissions in order to promote environmental sustainability and low-carbon operations. It is an all-in-one tool to capture all data sets and work with readily available data. It is simple to use without any prior technical knowledge. It does not require data transfer, but instead functions in a way that educates and empowers users, generating costing information and diagnostic dashboards to help identify hotspots and suggest climate actions for users to consider. Since mid-2020, all AKHS facilities have been using this tool to report quarterly data.

• Download the tool from the WHO-ATACH webpage in English or French, along with a manual. Following review and testing, the WHO endorsed the AKDN Carbon Management Tool, recommended its use, and made it freely available on the website of the WHO’s Alliance for Transformative Action on Climate and Health (ATACH). The tool is accompanied by training videos and a user manual, all packaged and available in both English and French.


• Access the training videos from the AKF Learning Hub. These are open to anyone after establishing a (free) account.


• Read a brief description of the tool.


• See how to use the tool: English written instructions / French written instructions.


• For further information or support, write to [email protected].

Using the AKDN Carbon Management Tool to Evaluate AKHS’s Carbon Footprint

All operations have plans in place to reduce their carbon footprint based on:

• improving energy, fuel and water efficiency;


• transitioning to renewable energy;


• reducing consumption and waste;


• greening the supply chain;


• shifting to environmentally friendly inhalers and anaesthetic gases; and


• instilling behaviour change.

We monitor our carbon footprint through quarterly calculations of emissions related to standard factors such as energy consumption and transport, as well as health-specific items such as anaesthetic gas and inhaler use. Importantly, AKHS also estimates emissions related to procurement, which accounts for between 70 and 90 percent of our total footprint. Using 2021 as the baseline year, we were able to reduce our Scope 1 and 2 emissions across AKHS by approximately 47 percent by the end of 2024.

To overcome barriers to specialised care in remote regions, AKHS, Afghanistan has leveraged eHealth, offering services like teleconsultations, telepathology, teleradiology, and eLearning to bring essential health care closer to underserved communities.

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The Aga Khan Provincial Hospital in Bamyan is designed using special low-impact, rammed earth architecture to be culturally sensitive to the surrounding area, and also climate-friendly, durable and seismic-resistant.

All new facilities are designed to meet the best of possible environmental standards. We are actively retrofitting older facilities, with an emphasis on reducing carbon emissions, air pollution, energy and water consumption. We are also considering preparation and adaptation for more severe weather extremes.

Our architects and engineers have a long-standing tradition of working together to build facilities that fend off the worst of the weather and make full use of natural light and ventilation. These features reduce energy needs for heating, cooling and lighting. New facilities aim to satisfy the requirements for Excellence in Design for Greater Efficiencies or “EDGE” certification.

Major equipment must be energy efficient, and we continually seek better energy solutions for fixtures and fittings, and energy and water consumption. Given our net-zero targets, AKHS hospitals now use LED and sensor-responsive lighting, water efficient taps and toilets, and Energy Star-rated equipment and appliances.

For newer projects, wherever space permits, engineers install rainwater harvesting mechanisms to make the most of rainfall. Treated water is also routinely used for flushing toilets and irrigating grounds. Some facilities have reverse osmosis plants to produce the highest quality drinking water on site – preventing the need to transport potable water, which comes at a high cost to the environment. Plans are in place to install these features at all locations gradually. Wherever possible, and generally for larger projects, heat from generators and other equipment is being considered for heating water and supplementing heating too.

4.2 Insulation of Buildings

We are investing in improved building insulation, particularly in countries with extreme seasonal climates such as harsh winters and hot summers. These measures aim to enhance energy efficiency by reducing the demand for heating and cooling, thereby lowering energy costs and associated emissions. Enhanced insulation also helps maintain comfortable, stable indoor conditions for patients and staff, supporting quality care. Ultimately, these efforts contribute to consistent, climate-resilient health care delivery throughout the year, regardless of external conditions.

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4.3 Renewable Energy

As part of our commitment to net zero targets, we are investing in renewable energy and improved insulation to reduce our environmental footprint and enhance energy efficiency across our facilities. Renewable energy and solar power projects were initiated including retrofitting:

• an old facility at the Aga Khan Comprehensive Health Centre in Singal, Northern Pakistan;


• Basic Health Centres in Gilgit-Baltistan, Pakistan;


• the Aga Khan Outreach Health Centre in Kuze, Mombasa;


• Aga Khan Medical Centres in Kisii, Kimilili and Bungoma in Kenya;


• the expanded Aga Khan Hospital Kisumu;


• the Aga Khan Medical Centre Mwanza in Tanzania; and


• the Aga Khan Medical Centre Salamieh in Syria.

Aga Khan Health Services, Afghanistan, has solarised over 120 of its facilities. Other current installations include a 1.1 megawatt-peak solar system at Aga Khan Hospital Dar es Salaam, Tanzania, a 620 kilowatt-peak solar power system at Aga Khan Hospital Mombasa, and more Basic Health Centres in Pakistan. The solarisation project is ongoing, with many more facilities across AKHS planned for inclusion.

For these projects, estimates for solar covering energy needs range from 30 to 90 percent, with cost recovery projections between five to eight years. In the future, we expect even better results as prices of solar installation continue to reduce and technology improves. We have an ongoing work agenda to increase the use of renewable energy and gain energy efficiencies in larger hospitals and field operations. In areas with less sunlight, such as Northern Pakistan, we are exploring geothermal energy prototypes too.

The Aga Khan Medical Centre in Salamieh, Syria, has transitioned from diesel generators to solar power. Initially reliant on 60 KVA and 200 KVA generators, the centre installed a 50 kWp solar panel system in 2022, which now powers most clinical operations, including VRF systems and mammograms, while generators are retained for occasional backup. The system yields significant financial savings and avoids approximately 72 tonnes of CO2e annually.

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A large part of the agenda focuses on reducing greenhouse gas emissions through innovations in resource use, waste management, and the procurement of environmentally-friendly items. This includes improvements in energy efficiency, low-emissions transport (shifting to electric vehicles (EVs) and motorbikes or hybrids), water conservation (including recycling, rainwater harvesting and conservative use), and air pollution reduction. It also involves minimising waste through more prudent use of materials and better waste management practices. In addition, a carbon lens is applied to guide purchasing decisions for pharmaceuticals (including anaesthetics and inhalers), medical devices, food, air conditioners (with specific refrigerants and energy efficiency requirements) and other products. Efforts are underway to work with suppliers to identify and address hotspot emissions, while also fostering a culture of environmental sustainability among staff and other stakeholders.

5.1 Anaesthetics

Many anaesthetics are known to contribute significantly to healthcare’s carbon footprint. As well as being powerful greenhouse gases, some anaesthetic gases are also ozone-depleting substances and as such, also have consequences for skin cancer. Consequently, efforts are underway to reduce emissions from these products.

As part of our net zero plans, we started identifying the types and volumes of gases we were using and making better substitutions wherever possible. As a result, most AKHS health facilities have either stopped or significantly reduced the use of the most potent greenhouse gas ozone-depleting agents, including desflurane and nitrous oxide. We prioritise the use of oxygen/medical air, sevoflurane, intravenous anaesthesia, and regional or local anaesthesia instead of general anaesthesia where clinically appropriate.

We are actively working to reduce the impact of anaesthetic gases by increasing the use of low-flow anaesthesia to minimise gas volumes and, where possible, capturing and reusing these gases.

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We are examining ways to use these gases prudently and experimenting with novel techniques which reduce consumption without compromising safety. Often, making such changes also reduces costs.

A group of AKHS anaesthetists are working on implementing changes and sharing lessons learnt across the network. We are also seeking opportunities to share information on the carbon footprint and ozone depletion qualities of anaesthetic gases with anaesthetists in private and public sectors to influence best practice more broadly.

5.2 Inhalers

It is well known that air pollution is a problem in many low and middle-income countries where AKHS works, but what is not known is the fact that some treatments for respiratory illness can contribute to climate change.

In particular, pressurised Metered Dose Inhalers (pMDI) use gases to deliver medications which are potent greenhouse gases. The propellant gases used in pMDI are up to 3,350 times more potent than carbon dioxide as greenhouse gases. A single pMDI, if fully used, can release as much greenhouse gas emissions as a small car driven for 180 miles; a single patient may use more than 12 inhalers a year.

Fortunately, there are alternatives. Some propellant inhalers are better than others for delivering the same type of drug; either they use less propellant or a less damaging propellant. In most cases, dry powder-based inhalers can be just as clinically effective and have a small fraction of the environmental impact. For these reasons, dry powder inhalers are predominantly (90 percent) prescribed in Sweden.

We are committed to reducing our own contributions to air pollution and the carbon impacts of respiratory care including:

• reducing the contribution of all our operations to air pollution (eg through smart choices of fuels used and incineration practices in health facilities);


• reviewing how inhalers are prescribed, dispensed, and used (often inhalers are not fully or properly used, reducing their health benefits and creating unnecessary waste);


• favouring lower-carbon or propellant-free inhaler alternatives where clinically appropriate; and


• disposing of inhalers in an environmentally safe way.

We have started examining the inhalers we were purchasing as part of our net zero plans, and begun an education programme to alert physicians and pharmacists to the relative impacts of different inhalers.

5.3 Waste Management

Waste management begins with conservative usage and segregating waste. Where possible, we use options such as sterilisation / chemically treating or burying waste in preference to incineration. Additionally, kitchen waste is either used for animal feed or composting, while paper, metallic material, used cooking oil and containers are recycled with certified companies.

When we embarked on the journey to reduce our negative impact on the environment, we reviewed waste management practices to examine room for improvement. Many facilities adopted tactics to reduce the waste burden on landfills or incineration by optimising minimisation at the source, composting, reusing, and partnering with recyclers.

Hospitals and health facilities use incinerators to burn hazardous waste. We ensure that we conduct incineration in the most energy-efficient and environmentally friendly way. This starts with training. Without training and support, operators tend to burn more waste than they should.

For waste that has to be burned, we ensure that each incineration cycle uses the full capacity of the incinerator, limiting wasted space. This practice maximises the use of energy and greatly reduces the amount that is burnt.

We offer freed-up incinerator space to other health facilities and provide training for other hospitals. Gilgit Medical Centre in Northern Pakistan offers incineration services to private health operations as well as the regional government hospital. In the process of these collaborations, better waste management by all partners has been the result. We have calculated that the environmental benefits far outweigh the cost of transporting waste to this central facility. We hope to continue to expand best practices in waste management and incineration within our countries of operation.

As technology improves, we replace old incinerator units with those that are better designed in terms of energy use and air pollution. Our latest installation at Dar es Salaam is one of the very highest of fuel-efficient, minimised pollution designs rated for medical, municipal and animal waste incineration.

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