We must invest in resilient, low-emission healthcare systems that deliver high-quality care
The National Hospital Energy Consumption Survey, conceptualised and conducted by the National Centre for Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India under the aegis of the National Programme on Climate Change and Human Health (NPCCHH), with technical support from Alliance for an Energy Efficient Economy and Centre for Chronic Disease Control, was launched recently. Akash Goenka, Associate Fellow, Alliance for an Energy Efficient Economy and Dr Poornima Prabhakaran, Senior Research Scientist, Centre for Chronic Disease Control in an interaction with Kalyani Sharma discuss about this survey
The survey revealed that Indian hospitals consumed 9 per cent of the country’s commercial electricity in FY 2019-20. Could you explain the significance of these findings for India’s healthcare sector and its energy consumption patterns?
Goenka: Recently, there’s been a growing emphasis on constructing sustainable, energy-efficient buildings, driven by increasing expectations regarding environmental, social, and governance (ESG) performance in both the private and public sectors. India has also committed to ambitious goals, including reducing the emissions intensity of its GDP by 45 per cent by 2030 (compared to the 2005 baseline) and achieving 50 per cent of its cumulative electric power capacity from non-fossil fuel sources by 2030, on its journey to attain net-zero emissions by 2070. The Long-Term Low Emissions Development Strategy (LT-LEDS), unveiled during COP27, has highlighted the substantial potential to diminish national power demand by enhancing energy efficiency in the building sector, encompassing design, construction, and operations. Consequently, improving energy efficiency in commercial buildings, including hospitals, is integral to India’s national energy policy framework.
Indian hospitals display diversity in energy needs, attributed to ownership (public, private, municipal, etc.) and size (ranging from small clinics to large multi-specialty hospitals with varying amenities). To advance energy efficiency and incorporate renewable energy effectively, precise data on energy consumption in various healthcare facilities across different regions is indispensable. This survey’s significance lies in bridging the data gap and setting the stage for a data-driven policy framework to reduce carbon emissions within India’s building sector.
How was the survey conducted, and what were the key entities involved in this research?
Dr Prabhakaran: The survey spanned 18 states and encompassed 10 different types of public and private hospitals. It operated through a partnership between two survey entities with differing technical expertise. Initially, a market research firm was chosen for the entire survey, with a parallel effort involving energy engineers and auditors to ensure data quality. Comprehensive training was provided to all surveyors.
However, the generalist surveyors from the market research firm struggled with the survey’s technical demands, leading to inconsistent data quality. Consequently, specialists took over, albeit at a higher cost, focusing on data precision rather than quantity.
Hospital identification and onboarding followed a top-down approach for public hospitals, supported by the National Program for Climate Change and Human Health. Private hospitals were enlisted from insurance providers’ extensive lists, offering participation incentives such as energy performance summaries.
Data collection methods included web-based surveys, telephonic interviews, and face-to-face interactions, with in-person visits providing valuable qualitative insights.
Goenka: Data quality control measures comprised regular check-ins, reviews, and back-checks. Dubious data was filtered using a multi-level approach, considering consent forms, critical data points, and outlier ranges. Despite these efforts, some data inaccuracies may persist due to the survey’s complexity and the challenges encountered during data collection.
The study highlighted that hospitals released 7.7 million tonnes of carbon dioxide (CO2) in the financial year 2019-2020. How do these emissions contribute to India’s overall greenhouse gas emissions, and what impact does this have on the environment?
Dr Prabhakaran: In the broader context, these hospital emissions are a part of India’s total greenhouse gas emissions. While they may not be the largest contributor, they certainly matter, especially considering the nation’s commitment to reducing emissions. Greenhouse gases like CO2 contribute to climate change, resulting in warming temperatures and more frequent and severe heatwaves. This poses a significant challenge for healthcare facilities, especially those lacking adequate air conditioning.
The COVID-19 pandemic has underscored the importance of resilient healthcare systems capable of handling crises. India’s Ayushman Bharat program is actively upgrading healthcare infrastructure, but these upgrades will affect hospitals’ energy consumption and emissions.
The National Programme on Climate Change and Human Health is already working to enhance our healthcare system’s capacity to cope with climate-related challenges. The survey’s findings and recommendations can guide us toward a more sustainable and climate-friendly healthcare model. This shift involves moving from one-off energy efficiency interventions to a long-term strategy based on reliable data, making our hospitals more resilient to climate change.
Moreover, climate change is expected to trigger more health emergencies, including infectious diseases and natural disasters. This places additional strain on healthcare systems. Therefore, prioritising climate-resilient healthcare systems and low-carbon, sustainable practices is crucial. We must invest in resilient, low-emission healthcare systems that deliver high-quality care while collaborating to address these pressing challenges.
Can you elaborate on the key recommendations derived from the survey? How do they aim to improve energy efficiency in healthcare facilities?
Dr Prabhakaran: The survey serves as a starting point for formulating data-driven policies and programmes and setting aspirational goals for hospitals. For example, state health departments should be empowered to convene State Development Agencies for energy efficiency, Renewable Energy Development Agencies, and other relevant stakeholders to create and implement a coordinated approach for the clean energy transition in the healthcare sector, including developing green procurement guidelines and ensuring proper operations of clean energy systems. At the central level, the Bureau of Energy Efficiency (BEE), the Ministry of New and Renewable Energy, and the Ministry of Health and Family Welfare can facilitate and promote inter-ministerial programmes, particularly enhancing awareness about the over-arching need for climate-friendly healthcare and building capacities for hospital energy management among hospital administrators, facility managers, and other staff.
Goenka: At the level of individual hospitals should track their energy consumption regularly and calculate energy intensity metrics such as energy used per bed. Hospitals can identify patterns and areas for improvement by comparing energy intensities and energy costs quarterly or yearly. A policy push for disclosing energy use can help policy researchers benchmark the energy performance of different hospital typologies and establish aspirational building performance standards. Hospitals can then compare their performance with their peers and the best-in-class and identify areas for further improvement in energy efficiency. Other programmes, such as BEE’s star rating of hospital buildings and the Perform, Achieve and Trade (PAT) scheme, can also utilise the benchmarking data.
Can you share any specific examples or case studies that highlight the impact of the survey’s findings on healthcare facilities or sustainability initiatives?
Goenka: In Telangana, Andhra Pradesh, and Maharashtra, a leading private hospital chain with over 4000 beds initiated an energy efficiency project in July 2018 at one of its 1000-bed super-speciality hospitals. Collaborating with a prominent energy services company, this hospital achieved a remarkable 22 per cent improvement in energy efficiency, resulting in Rs 10.8 crores in savings. Key interventions included design improvements for systems like air-conditioning, hot water, and steam, HVAC, lighting, and fans upgrades, and enhanced energy consumption tracking and maintenance practices. These efforts exemplify the effectiveness of monitoring energy use and implementing conservation measures, setting a notable precedent for sustainable healthcare practices in the region.
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