The Aga Khan Medical Centre, Kisii – a satellite of the Aga Khan Hospital, Kisumu, Kenya.

Achieving net zero

How our health operations are slashing carbon emissions while saving thousands

AKDN / Lucas Cuervo Moura

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The 400-KW solar plant of the Bamyan Provincial Hospital in Afghanistan provides for the majority of the …

AKDN / Sameer Dossa

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Inspiring via nature in the early years

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Children receive immunisations in northern Pakistan under the Hayat project which uses a mobile application that helps track health services delivered by field workers. Hayat is a mobile health application and web portal developed by Aga Khan University. AKU

Children receive immunisations in northern Pakistan under the Hayat project which uses a mobile application that helps track health services delivered by field workers. Hayat is a mobile health application and web portal developed by Aga Khan University. 

AKU

Health Service Delivery


AKHS's overall approach to climate-smart and environmentally-friendly health care is based on:



  • Emphasising health promotion, disease prevention and primary health care. The aim is to avoid people getting sick in the first place, which in turn, prevents the need for travel, diagnostic and medical interventions – all of which have high costs to patients as well as the environment.

  • Using technology to help patients receive information and care close to home. AKHS uses and plans to invest further in digital health solutions, telephone consultations and telemedicine to support remote diagnosis and consultations. This, in turn, limits travel needs but also allows for quicker detection and resolution of health problems – all of which are also good for the environment as well as patients. Find out about the AKDN Digital Health Resource Centre.

  • Using evidence-based approaches driven by population health needs. The philosophy of this approach is to minimise unnecessary consultations, interventions and treatment.


The Hospital’s special low-impact, rammed earth architecture is designed to be not only culturally sensitive to the surrounding area, but also climate-friendly, durable and seismic-resistant. AKHS

The hospital in Bamyan’s special low-impact, rammed earth architecture is designed to be not only culturally sensitive to the surrounding area, but also climate-friendly, durable and seismic-resistant.

AKHS

Greening Facilities


Eco Design


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


Our architects and engineers have a longstanding tradition of working together to build facilities that both fend off the worst of the weather and make full use of natural light and ventilation. In turn, all such 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.


Energy efficiency is a criterion for all major equipment. Better energy solutions for fixtures and fittings, and energy and water consumption are also continually being sought. Typically, AKHS hospitals use LED and sensor-responsive lighting, water efficient taps, 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.


Renewable Energy


In terms of solar power, our investment in this area really took off in 2016, when AKHS in Afghanistan with partners were constructing a new hospital in Bamyan. The site for this hospital was off the electric grid, requiring creative energy solutions. While solar looked promising in the long-term, the estimated costs for installation were very high. However, the projections seemed worth pursuing. Once funding was secured, a 400 KW solar energy system was installed, which at the time was the largest within AKDN. Fortunately, the experiment worked out far better than expected. In this region, summers provide up to 14 hours of sunlight a day. Through this experience, AKHS learned what is now obvious: hospitals consume most energy during the day (night use is restricted to lighting and emergency procedures); and as such, solar is a particularly good solution for health operations. From a financial perspective, it will take about six years to recoup the costs of the Bamyan investment, where solar currently provides 50-60 percent of all energy needs. As this installation generates more energy than can be saved, plans are underway to add more and better batteries which will reduce fossil fuel use even further.


The Aga Khan Medical Centre Gilgit, Pakistan. AKDN / Christopher Wilton-Steer

The Aga Khan Medical Centre Gilgit, Pakistan.

AKDN / Christopher Wilton-Steer

Since the Bamyan experience at Bamyan Provincial Hospital, every AKHS installation has aimed to explore and maximise the use of solar energy. Recent projects include retrofitting an old facility at the Aga Khan Comprehensive Health Centre in Singal, Northern Pakistan; five additional 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 123 out of its 235 facilities. Current plans also include installing a 1200 kWh solar system at Aga Khan Hospital Dar es Salaam, Tanzania, a 440-kWh solar power system at Aga Khan Hospital Mombasa, and 13 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 40 to 90 percent, with cost recovery projections between five to eight years. In the future, AKHS expects even better results as prices of solar installations continue to reduce and technology improves. In areas with less sunlight, such as Northern Pakistan, AKHS is exploring geothermal energy prototypes as well.


AKHS has won two awards for our solar projects, including from the Prince Sadruddin Aga Khan Fund for the Environment and the Access 2 Energy (A2E) award for the Health Centre in Singal in Northern Pakistan and the Medical Centre in Mwanza in Tanzania, respectively.


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In 2019, AKHS started identifying the types and volumes of anaesthetic gases it was using during surgeries. It stopped using the most potent greenhouse gas, Desflurane, and made better substitutions wherever it was possible. AKDN / Kamran Beyg

In 2019, AKHS started identifying the types and volumes of anaesthetic gases it was using during surgeries. It stopped using the most potent greenhouse gas, Desflurane, and made better substitutions wherever it was possible. 

AKDN / Kamran Beyg

Anaesthetics

Many anaesthetics are known to contribute significantly to health care’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, we are looking at ways to reduce emissions from these products.


In 2019, we started identifying the types and volumes of gases we were using and making better substitutions wherever possible. As a result, AKHS health facilities have stopped using the most potent greenhouse gas, desflurane. However, isoflurane, halothane, sevoflurane, and nitrous oxide which are also problematic from the perspective of global warming, and in some cases ozone depletion, are still being used.


AKHS staff are actively working on reducing the impacts of these gases by:



  • wherever possible, changing from high-carbon or ozone-depleting gases to lower carbon and more ozone friendly alternatives;

  • exploring the reduction of nitrous oxide and replacement in surgery with oxygen or medical air;

  • increasing the use of low-flow anaesthesia to reduce the volumes used of all gases;

  • using alternatives to fluorinated gases, such as intravenous anaesthesia; and

  • wherever possible, capturing and reusing anaesthetic gases.


In all instances, AKHS is examining ways to use these gases prudently and experimenting with novel techniques which reduce consumption – but without compromising safety. In many cases (but not all), making such changes also reduces costs.


A group of AKHS anaesthetists are working on implementing changes and sharing lessons learnt across the network. AKHS is 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.


The relative impacts of anaesthetic gases are shown in the table below. The Ozone Depleting Potential (ODP) of each gas is compared with the most common ozone depleting substance, CFC-11; whereas the Global Warming Potential (GWP) is shown relative to the most common greenhouse gas, carbon dioxide.