Heading towards zero emissions in South Africa

When Netcare Environmental Sustainability Manager André Nortjé talks about the key message of the Hippocratic Oath, “first do no harm”, he applies it to hospitals and healthcare systems, as well as physicians. “Healthcare and hospitals worldwide are responsible for more than four percent of global [carbon] emissions," he said on a recent visit to Netcare Montana Hospital in Tshwane, South Africa. Netcare believes healthcare has a responsibility to become sustainable and move away from practices that harm the environment and its people. If pursued successfully, the quest for zero emissions can free up resources and contribute to a healthier environment. As Netcare asserts, “There can be no care for people without care for the environment – the two are inextricably intertwined”.

Netcare’s move to sustainability was sparked long before it became a “buzz word,” says Nortjé. In 2013, the country was hit by energy supply shortages and rolling blackouts. Electricity prices spiked. “We realized that if we didn’t act, the sustainability of healthcare could be threatened,” Nortje explains. By 2015, Netcare’s first solar PV plant was being installed. Now, 72 solar installations countrywide produce some 10 percent of Netcare’s total energy requirements.

At noon on a 33°C spring day, the solar photovoltaic panels that cover the roof of Netcare Montana Hospital were working in optimal conditions. This rooftop plant provides 683 MWh of energy annually. Like all Netcare hospitals, Netcare Montana Hospital uses smart metering to monitor energy use, and to keep systems such as the energy-reliant HVAC systems working optimally.

Heat pumps and heat reclaiming systems are now standard design requirements, as are up-to-date LED lights and motion sensors. Water recycling and saving mechanisms are in place. New technology makes savings too; the autoclaves, for example, contain technology that sterilizes theater tools using two thirds less water than before. Macerators pulp recyclable bedpans, saving 80 percent of the water once needed to wash and sterilize them.

Although these measures put a dent in the hospital’s energy bill, the solar systems alone can’t provide the stable supply needed by, for example, Netcare Montana Hospital’s theaters. Rolling blackouts, or “loadshedding” mean there is still considerable reliance on dirty, diesel-powered generators during power outages. Netcare Montana Hospital alone has four. The healthcare group had already spent over R100m on diesel in the first six months of 2023. This key challenge threatens sustainability targets, and may necessitate investing in batteries in the future, despite the expense. Insulating fire-fighting water storage tanks for hot and cold water can also play a role in storing energy. But buying renewable power is essential.

Netcare has committed to using 100 percent of its purchased energy from renewable energy sources by 2030. Its commitments don’t stop at its own doorstep – it has just signed a major private partnership deal with an independent renewable energy producer to supply six hospitals with up to 100% of their energy needs from green energy by 2026. As Africa’s first healthcare organization to join the United Nations’ Race to Zero Challenge 2050, it aims to produce zero emissions not only from operations on site, but all through the supply chain.

“We want all of our suppliers to start reducing their Scope 1 and Scope 2 emissions,” says Nortjé. Green procurement requirements in tender processes will encourage the 4,000 companies Netcare deals with to act on sustainability.

“Suppliers that walk the same journey and become more sustainable will ultimately benefit. It’s important that we maintain our relationships and take everyone along. Sustainability is the one area where we should not be in competition with other companies, as this should be something each and every company prioritizes. We need to join hands, learn from each other, and enforce the same principles because we have the same suppliers. If 80 percent of the market requires change, then all suppliers will move with the trends.

The move towards greater sustainability involves embracing the circular economy. “Waste is a commodity now; it’s the new oil,” says Nortje. 

Sorting and separating materials at the source helps Netcare Montana Hospital and other hospitals dispose of “pretty much everything” responsibly. One program they are proud of is the MyWalk initiative where they are making school shoes out of recycled PVC drip bags – over 100,000 pairs have gone to children who previously had none and it has prevented over 75 252kgs of healthcare waste going to landfill.

In the same vein, medical equipment needs to be designed to allow for reuse or up-cycling of parts. “As a professional engineer, I believe products need a shelf life, so that the world moves with technology as it advances,” says Nortjé, “but parts should easily be replaceable with updated and more efficient alternatives.” He also advocates for locally manufactured spare parts, as this helps with transportation carbon costs. “We have to start putting a price on CO2 [emissions].” Nortjé believes this will help decide what equipment is, in fact, more expensive in the long-term.

Netcare Montana Hospital’s technical services manager, Herman Esterhuizen, relies on intelligent systems for all sorts of equipment, which is critical in a hospital setting. He is alerted when the hot water or energy systems, for example, are not working optimally, and tracks expenses and problems with equipment. “This means you can see when it’s most viable to replace the equipment [without wastage], because you have a track record,” says Esterhuizen. Remote diagnostics help monitor the complex heating, ventilation, and air conditioning system (which in a typical hospital can consume up to 50 percent of energy).

At Netcare Montana Hospital, time-saving apps also help managers plan the best utilization of the technical team. Digital data collection and a secure platform allow for accessible electronic patient records, long-distance diagnosis and care, as well as efficiency in dispensing medicine – all of which save resources and valuable care team time. Netcare, like all South African healthcare facilities, is in a position where they will need to do more with less. By optimizing operations and deploying the best technology and innovations available, they can supply quality care to greater numbers of patients – in a more sustainable way. 

As Nortjé points out, “Digitalization is important in the hospital context from a patient and a systems point of view. It provides real time insights into performance.” The technology of the future could help patient outcomes even further. “I think we’re moving towards being able to provide the exact air quality or lighting levels a patient needs to make them heal faster or provide exactly what is needed for treating a condition in terms of environment,” says Nortjé. This feeds in with patient information systems: Real data that is collected allows for valuable analysis.

“We believe whatever you do needs to be better for mankind and make a positive contribution to the earth,” says Nortjé. “In the healthcare industry, I can physically see the fruits of saving energy. By doing so, we are ultimately contributing to containing the cost of healthcare. If we can reduce operational expenses, this is directly translated into the pocket of the patient. One can provide better, safer healthcare at reduced cost, which makes access to healthcare a little easier. If we all cut down on losses and waste, there will be more to go around for everyone.”