Building climate-resilient and low-carbon hospitals—why regional learning matters

Introduction

Increasing climate hazards threaten not only public health but also health systems, particularly those in disaster-prone areas.

In Southeast Asia, one of the world’s most climate-vulnerable regions, critical health care infrastructures, such as hospitals, are increasingly exposed to a range of risks that could disrupt operations or impair their capacity to ensure the safety of patients, provide life-saving treatment, and respond to emergencies. In recent years, typhoons, storm surges, floods, heat waves, and droughts have increased in intensity and frequency. Extreme weather events often result in a surge in patient demand, which stretches hospitals’ resources, and could also damage facilities or equipment and cause power failures or water shortages.

At the same time, the health care sector accounts for up to 5% of net global emissions . Unless the sector is decarbonized, total greenhouse gas (GHG) emissions from health care could triple by 2050.

These challenges underscore the importance of building climate-resilient and low-carbon hospitals .

A project supported by the Asian Development Bank (ADB) seeks to support efforts of the Brunei Darussalam–Indonesia–Malaysia–Philippines East ASEAN Growth Area (BIMP-EAGA) in strengthening the resilience and sustainability of health systems . Regional cooperation is a key component of the initiative, which will establish a common framework for assessing climate risks, identify shared operational challenges, and develop locally appropriate adaptation and decarbonization pathways.

What is a climate-resilient and low-carbon hospital?

Rather than treating climate adaptation and decarbonization as separate goals, a climate-resilient and low-carbon hospital integrates resilient infrastructure, efficient energy systems, sustainable operations, and emergency preparedness into routine planning. This enables continuous delivery of safe health care services even during climate-related disruptions while reducing environmental impacts of hospital operations.

Climate adaptation and decarbonization are often planned separately. However, hospitals increasingly recognize that there are interventions that can strengthen climate resilience, improve service continuity, and reduce greenhouse gas emissions at the same time.

Evidence from the Philippines shows how these co-benefits can be translated into investment priorities. The Philippine Health System Integrated National Accounting of Greenhouse Gases (PH-SINAG) , the country's first comprehensive, system-wide assessment of health system emissions, found that the health care sector accounts for about 5.6% of national emissions. The findings provide an evidence base for identifying emissions sources and guiding strategic investments in sustainable and resilient health care, while integrating climate considerations into planning, budgeting, procurement, infrastructure decisions, and facility operations.

How can regional cooperation enhance the resilience and sustainability of health care systems?

Regional cooperation goes beyond exchanging experiences. It enables countries to apply common assessment approaches, compare findings across different contexts, identify shared priorities, and develop scalable technical and investment solutions.

Hospitals across the BIMP-EAGA subregion may face different climate hazards, but they share operational challenges. A common assessment framework allows these differences and similarities to be understood systematically, supporting locally appropriate yet regionally comparable solutions.

Regional cooperation can support the following initiatives:

• develop common assessment methodologies,
• establish comparable baselines,
• conduct joint technical assistance,
• pilot demonstration hospitals,
• undertake regional investment planning,
• align and harmonize policies, and
• facilitate peer learning.

Experience from other countries in Asia and the Pacific illustrates how these forms of cooperation can generate practical action. In Fiji, for example, climate hazard and vulnerability assessments were undertaken across more than 200 health facilities to identify those most at risk and prioritize investments . Under the subsequent Strengthening Health Adaptation Project, five health facilities were strengthened, solar power was installed in 18 facilities, and more than 600 health workers were trained to manage climate-related health risks. The experience shows how a common assessment approach can guide facility improvements and generate lessons that can be shared and scaled across health systems.

In Thailand, ADB’s Climate-smart Health Services System Enhancement project will upgrade five public hospitals while creating opportunities for regional learning and knowledge exchange on building climate-resilient, low-carbon health systems. Lessons from integrating climate-resilient features into hospital design, construction, and operations can provide practical guidance for other countries on how to incorporate measures such as heat resilience, improved air quality, energy efficiency, and climate-smart infrastructure into hospital planning and design.

What challenges are hospitals in BIMP-EAGA facing, and how can these be addressed?

The ADB technical assistance project selected three areas in the subregion—West Kalimantan province in Indonesia, Sarawak state in Malaysia, and Zamboanga City in the Philippines—for piloting approaches to climate-resilient and low-carbon health care. The three countries face increasing climate hazards and rising rates of noncommunicable diseases, a resurgence of infectious diseases, and health issues associated with aging and poor air quality (e.g., asthma, headaches, nausea).

Preliminary climate risk assessments of three public hospitals in these areas show problems include poor and under-resourced facilities, high exposure to climate hazards (e.g., flooding, heat stress, haze), lack of 24-hour access to electricity and clean water particularly during extreme weather events, inadequate drainage, and shortage of health workers.

The hospitals were assessed using the same climate risk assessment methodology, which was based on the Intergovernmental Panel on Climate Change (IPCC) framework and common risk concepts, and a common roadmap structure, which enabled meaningful comparison across countries. Procurement- and supplier-related emissions within the hospitals’ supply chain system were also tracked.

The findings highlight the need for integrated resilience planning, energy efficiency, and system optimization to achieve low-carbon operations while maintaining high quality of health care services. Interventions can include green retrofits, smart building automation, water or heat recovery solutions, shifting to renewable energy, training climate-informed health workers, and adoption of circular procurement principles and standards.

What can similar initiatives learn from this project?

Building climate-resilient and low-carbon hospitals begins with understanding climate risks and identifying priorities for action through a structured assessment process. Evidence from different health systems shows how such assessments can help identify priorities and translate climate objectives into practical investments.

Regional cooperation can accelerate this transition by enabling countries to share assessment approaches, technical experience, practical implementation lessons, and investment planning strategies—while adapting solutions to their own climate risks, health system needs, and local contexts.

Note: This piece draws on lessons from ADB’s Regional Cooperation and Integration (RCI) initiatives. Its findings contribute to ongoing efforts to decarbonize health care under BIMP-EAGA’s Environment Pillar. The authors gratefully acknowledge ADB consultants Liza Solano and Ramon San Pascual for their valuable inputs.