Environmentally-friendly operations

AKHS has an ongoing work agenda to increase the use of renewable energy and gain energy efficiencies both within its larger hospitals and its field operations. We are also actively pursuing ways to minimise waste through more prudent use of items and better waste management.

A large part of the agenda focuses on reducing greenhouse gas emissions through innovations in transport, water consumption (recycling and conservative use) and air-pollution; as well as using a carbon lens to guide purchasing decisions for pharmaceuticals, medical devices, food and other products. Efforts are underway to work with suppliers to identify and address hotspots.

Read more (PDF):

• Afghanistan – Solar refrigerators
• Pakistan – Environmentally friendly air conditioners (AC)
• Syria – Greening the transport fleet

Waste Management

Waste management begins with being conservative with what one uses in the first place, but also 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 e-wastes are recycled with certified companies.

Incineration

Hospitals and health facilities use incinerators to burn hazardous waste. AKHS takes special care to 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, AKHS ensures 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.

Given the generally poor practices in this field, AKHS has started offering freed-up space in its incinerators to other health facilities. In the instance of Gilgit Medical Centre in Northern Pakistan, this facility 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. A further incinerator is being installed to expand the offer of these services to facilities in three districts within a hundred miles and to widen better practices in the process. 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, AKHS replaces older 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 designs rated for medical, municipal and animal waste incineration. It is expected to result in next to no direct pollution. For example, at a burn rate of 200kg/hr, the following emissions are expected: CO₂ 5 percent, O₂ 6 percent, SO₂ 6 percent, H₂O 29 percent, N₂ 54 percent, smoke 0 percent and odour 0 percent.

Waste minimisation

When AKHS embarked on the journey to reduce its negative impact on the environment, proper waste management was one of the low-hanging fruits. 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.

Read more (PDF):

• Kenya/Kisumu – Composting kitchen waste
• Tanzania – Minimising kitchen waste

While halothane is not a very potent greenhouse gas, it is nevertheless, a potent ozone-depleting substance. Ways to limit its use are being explored. Nitrous oxide is a fairly potent greenhouse gas and has some impact as an ozone depleting substance, too. Given the large amounts of nitrous oxide used, this is a significant contributor to both ozone depletion and climate change and therefore also a concern.

Read more (PDF):

Tanzania: Reducing carbon emissions from anaesthetic gases

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 (e.g. 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 started examining the inhalers we were purchasing in 2019, and began an education programme to alert physicians and pharmacists to the relative impacts of different inhalers. In 2020, a system was established to track procurement and prescription practices with the aim to make changes and reductions wherever possible. We intend to share information on the carbon footprint of pMDI and alternatives with health professionals in private and public sectors in the countries within which we work.

A range of estimated carbon impacts of several common inhalers can be seen below:

AKDN’s Carbon Management Tool

To reduce our carbon footprint, we must first measure it. But in 2019, existing tools, such as those available for calculating the carbon emissions from electricity and transport, were far from intuitive. Many used out-of-date carbon conversion factors or lacked data for countries where AKHS works. We therefore collaborated with the Aga Khan University to develop a tool that would work in low- and middle-income countries.

The tool can be used by other stakeholders within and beyond the health sector. 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 knowledge in the field. It functions in a way that educates users, generating costing information and diagnostic dashboards to help identify hotspots and inform users about corrective actions. Since mid-2020, all AKHS facilities have been using this tool to report quarterly data.

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

All operations have annual action plans to reduce their carbon footprint based on improving energy and water efficiency, 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 calculates the impact of procurement, which accounts for between 70 and 90 percent of our total footprint.

• Read a brief description of the tool.
• See how to use the tool: English written instructions / French written instructions.
• Download the tool in English or French, along with a manual.
• Access the training videos from the AKF Learning Hub. These are open to anyone after establishing a (free) account.
• For further information or support, write to [email protected].

Advocacy and Influence

As AKHS progresses, we learn from others and share our experience with others within and beyond the health sector. With this in view, we strategically collaborate to disseminate our expertise and tools, including to local governments, academia, partners, and the World Health Organization (WHO). This collaboration involves conducting online sessions and actively participating in various fora, such as the UNFCCC Conference of the Parties (COP) and the Alliance for Action on Climate Change and Health (ATACH). Through direct engagements and in partnership with WHO, representatives from Ministries of Health and Environment from various countries worldwide have received orientation training on using AKDN’s carbon management tool and on how to plan actions to align with the UNFCCC COP26 Health Programme commitments.

We engage with communities and health systems to support adaptations to and withstand the consequences of extreme weather events. As we implement actions, we will continue to use our voice as health advocates to increase attention to the climate agenda and influence policies and practice at local and global levels.

Read more (PDF):

• Kenya/Mombasa – Restoration of mangrove forests

Country case studies (PDF)

• Afghanistan – Solar power
• Afghanistan – Solar refrigerators
• Afghanistan – Transition from generators to hydropower
• Kenya/Kisumu – Composting kitchen waste
• Kenya/Mombasa – Restoration of mangrove forests
• Pakistan – Environmentally friendly air conditioners (AC)
• Syria – Solar power
• Syria – Greening the transport fleet
• Tanzania – Minimising kitchen waste
• Tanzania: Reducing carbon emissions from anaesthetic gases