HIGH Horizons Consortium, 2023

Implementing Partners: HIGH Horizons Consortium represented for this activity by CeSHHAR (Zimbabwe), Burnet Institute (Australia), Wits RHI (South Africa), AKHS (Kenya)

Published In: COP28 Prospectus of Climate-Health Solutions, 2023

Developing a resource allocation tool for mitigation interventions at health facilities to cut carbon emissions and improve healthcare in East Africa.

Context

The healthcare sector has an important role to play in both carbon emissions and public health delivery. Sithole et al (2023) reported that without mitigation, Zimbabwe’s health emissions are projected to increase by 109% to 77 million tons CO2-equivalent, while Kenya’s emissions increased by 3.6% in 2016 alone. Therefore, healthcare organizations need to prioritize carbon mitigation actions alongside their normal functions.

Approach

CARBOMICA is an innovative financial resource allocation modelling tool developed by the HIGH Horizons consortium to inform the selection of a package of mitigation interventions to reduce carbon emissions specifically in healthcare facilities. CARBOMICA supports governments and healthcare organizations in low- and middle-income countries (LMICs) to allocate the limited resources and seeks to achieve equitable outcomes while addressing the intertwined climate and health challenges. CARBOMICA leverages ATOMICA, a tool designed to simulate disease epidemics, meaning that CARBOMICA caters to the unique challenges and opportunities of the healthcare sector.

The objective of CARBOMICA is to identify the optimal package of mitigation interventions given limited financial resources by evaluating carbon emissions, costs of interventions, and their impact, guiding decision-makers in the strategic distribution of scarce resources. Harnessing advanced data science methodologies, CARBOMICA considers the budget available, suggests mitigation measures and provides information on the carbon reduced under different scenarios within healthcare facilities. These comparative scenarios help users to understand the trade-offs in constrained circumstances.

Key stakeholders integral to CARBOMICA’s development included facility managers, mathematical modelers, data scientists, environmental consultants, researchers, economic modelers, and intervention providers. Stakeholder expertise ensured that the tool meets the nuanced needs of the healthcare sector. The diverse geographic footprints (Europe and sub-Saharan Africa) of the stakeholders, ensured that CARBOMICA was versatile and globally relevant.

To deploy CARBOMICA successfully, HIGH Horizons provides support in four areas:

  1. Initial implementation: Given the tool’s specialized nature, it may not be directly operated by health managers or facility managers initially. Instead, a dedicated research team will facilitate its initial implementation to ensure accuracy and efficiency.
  2. Data: The foundation of CARBOMICA is reliable data. This data encompasses carbon emission readings, details of carbon mitigation interventions, their potential impact sizes, and associated costs for both implementation and ongoing maintenance.
  3. Training: Sessions are organized for decision makers, sustainability managers, energy managers, and environmental consultants to ensure they understand the tool’s functionality.
  4. Ongoing support and transition: As the tool becomes more integrated into routine processes, the goal is to transition its operation to district health structures, particularly within their monitoring and evaluation functions.

Impact & Next steps

The return on investment for the CARBOMICA solution can be measured in multiple ways. From an environmental perspective, the tool’s impact includes reduced carbon emissions and improved environmental stewardship. The healthcare impact can be seen in enhanced public health outcomes, a more resilient healthcare system, and cost savings from energy efficiency measures which lead to a more resource efficient healthcare system. The solution also has a broader knowledge transfer impact.

At the Mt Darwin Hospital in Zimbabwe, CARBOMICA analyzed three different scenarios with different budgets and carbon-saving potential. Full coverage and fixed budget scenarios provided insights into intervention’s potential and practical impact. The optimization scenario identified priority interventions like solar systems, low global warming potential anesthetic gases, and water efficient fixtures, showcasing substantial greenhouse gas emission reductions across varying budget allocations.

The Aga Khan Hospital in Mombasa, Kenya offers primary, secondary and some tertiary level care health services. CARBOMICA is supporting efforts to invest in carbon emissions reduction. By considering patient volume data (average of 50 daily outpatient visits and 600 monthly admissions), the tool identified interventions that could effectively reduce carbon emissions while maintaining the quality of care.

Whilst the first case studies were successful, the ultimate objective of the tool is to scale and adapt to various healthcare facilities worldwide, specifically in LMICs. Adequate funding, human resources, and technical capacity will be necessary for successful scaling. Through its scalability and adaptability, CARBOMICA has the potential to drive systemic change by influencing healthcare systems and establishing new sustainability standards within the sector.