Considering growing health needs, increased climate impacts and higher energy prices, reducing the carbon footprint of health assistance is an opportunity to increase access to quality care for populations and improve their resilience to shocks.

The Climate Resilient and Environmentally Sustainable Health Facilities (CRESH)¹⁰² is designed to address the changing needs caused by current and anticipated climate change impacts, and to make optimal use of ‘climate smart’ and low carbon technologies and approaches. Applying a CRESH approach at primary and secondary care levels allows the transition towards environmentally sustainable health in a realistic timeframe.

A first step is identifying a Climate Vulnerability and Capacity Assessment (VCA) methodology that includes infrastructure and service delivery. Climate Action Accelerator has developed a field-tested Climate VCA methodology adapted to health facilities in LMICs that includes five stages: 1) a desk review of regional climate hazards and vulnerabilities; 2) a quantitative audit of health facility vulnerabilities and capacities; 3) qualitative (scenario-based) data collection from health workers and the local population to identify climate risks and potential solutions; 4) data analysis and solution generation; and 5) prioritization of solutions and development of a facility adaptation plan.¹⁰³

In partnership with Alerte Santé and the Chadian Ministry of Health (ALIMA), Climate Action Accelerator is supporting the Ngouri Hospital (Chad) for the transition of its malnutrition and paediatrics services into CRESH services. This will be one of the first documented CRESH transition projects in a low-income setting with high climate risk.

Other interventions to improve the way climate and environmental strategies are integrated into health programme design are currently being explored. Several diseases can be aggravated by climate change thereby creating a significant additional burden on already fragile health care systems. Adopting climate smart approaches therefore allows for significant health co-benefits in addition to emissions reduction. As such, investing in cross-cutting and disease-specific approaches, and exploring climate smart approaches in immunization, surgery, and nutrition should be considered a priority.

Humanitarian medical organisations are looking for ways to achieve a ‘virtuous’ circle, e.g. being more climate and nature smart, reducing quantities, and adapting technical protocols and guidelines. The question of reducing the number of products used for medical activities (and the related risk of pollution) needs to be weighed against the ability to maintain quality of care.

Reduce the overconsumption or unjustified use of consumables:

• Ensure the selection, ordering, and dispensing of drugs, the use of consumables, the use of medical devices, are in line with medical protocols and with what is necessary from a medical perspective. Train staff on reducing overprescriptions.
• Optimise the ordering, use and maintenance of medical equipment.

Switch to medical protocols with less environmental impact:

• Switch to longer-lasting medical equipment and alternative products, like recycled plastic items or anaesthetic gases and inhalers with lower ‘global warming potential’.
• Train and support medical practitioners on updated protocols and their environmental impact.

Increase the percentage of sea and road freight through better planning of medical orders:

• Only use air freight in situations and contexts where it is unavoidable.
• Reduce field stock-outs that need to be urgently re-supplied.

Purchases of medical and paramedical goods and equipment represent one of the most important sources of emissions for medical humanitarian organisations.¹⁰⁹ Suppliers can make meaningful contributions to emissions reduction by reducing the lifecycle footprints of products, developing innovative programming and increasing the availability of more medical products with reduced climate and environmental impact.

In health programmes, buyer-specific and supplier-specific challenges are particularly delicate, due to the global regulatory environment, national legislative frameworks, and the overall complexity of drug production processes (small molecule and biologic drugs). While a significant proportion of pharmaceutical companies, notably some well-known brands, have already committed to emissions reduction targets, their results have yet to be substantiated.¹¹⁰

Key levers for organisations:

• Engaging with existing and potential suppliers to explore the availability of alternative, low-carbon, sustainable products and/or packaging options.
• Requesting that suppliers have robust decarbonisation plans in place, which, ideally, are independently verified.
• Mapping WHO qualified regional or local production and distribution sources, especially for heavy items, to reduce emissions from freight (e.g. anaesthetic gas, inhalers, etc.).

Sustainable markets initiative’s health systems task force¹¹¹

Seven of the world’s largest pharmaceutical companies have partnered with the WHO to introduce a new set of requirements for suppliers to abide by. This initiative will help these organisations, and, in turn, healthcare organisations, to reduce their scope 3 emissions. Private sector members of the Sustainable Markets Initiative Health Systems Task Force have signed an open letter calling on suppliers to commit to joint, minimum climate and sustainability targets to play their part in decarbonising the healthcare value chain.