Malaysia’s roadmap to carbon-neutral healthcare

Malaysia is firmly committed to advancing towards a carbon-neutral environment and is actively supported in this endeavour. Among the key public sectors leading this charge is the Ministry of Health (MoH), which aims to spearhead efforts to achieve carbon neutrality by 2050. It is widely acknowledged that the healthcare sector is a major contributor to carbon emissions, necessitating its active involvement in reducing greenhouse gases. The landmark Paris Agreement of 2015 underscores the urgency for global action to mitigate carbon emissions and address climate change. Central to this agreement are Nationally Determined Contributions (NDCs), which require all signatories to outline a framework of mitigation measures to achieve long-term goals. Malaysia’s NDCs framework encompasses all seven greenhouse gases, a significant expansion from the previous commitment which only covered three. This demonstrates Malaysia’s commitment to addressing climate change comprehensively and proactively.

As the urgency of climate change becomes increasingly apparent, governments and organisations worldwide are committing to ambitious targets aimed at reducing carbon emissions. In line with this global movement, MoH recognises the priority to mitigate its carbon footprint within healthcare facilities. The implementation of net zero carbon initiatives presents a unique set of challenges in the context of healthcare infrastructure, where energy-intensive operations are necessary for patient care, medical equipment, and maintaining optimal environmental conditions. Addressing these challenges requires a comprehensive approach that integrates sustainability into every aspect of healthcare facility management. To help accelerate the transition to carbon neutral healthcare facilities, the Carbon Neutral Healthcare Facilities Blueprint (CNHFB) was launched in 2023 serving as a framework for MoH to become sustainable and carbon neutral by 2050.

Carbon Neutral Healthcare Facilities

Blueprint (CNHFB)

Given the intricacies of healthcare infrastructure, particularly in hospitals where sophisticated engineering systems are necessary to maintain a conducive environment meeting stringent requirements consistently, hospitals have been identified as significant energy consumers in Malaysia. To tackle this issue, several initiatives have been implemented in selected facilities as trial locations to assist MoH in developing expertise and understanding the prerequisites for success. These initiatives were part of a Sustainability Program (SP) embedded within government hospital Facility Management Contract since 2015 that would spur carbon neutrality in healthcare facilities. The SP programme included Green Building initiatives, energy management, indoor air quality and 3R (reduce, reuse, recycle) programme. The achievements observed in these trial facilities have inspired the organisation to persist, broaden, and reinforce the transition. The promising outcomes from these initial endeavours led to establish a robust basis for expanding the intervention throughout the healthcare system, ultimately aiming to achieve carbon neutrality within healthcare facilities.

Achieving the vision of carbon-neutral healthcare facilities in the future demands a comprehensive strategy across all MoH healthcare facilities. Hence, the CNHFB is crafted with the overarching objective of determining the most effective and ideal mitigation plan for MoH healthcare facilities. It also aligns with the government’s ambition to transform into a carbon-neutral nation by 2050. The CNHFB outlines ideas on how the healthcare sector can reduce its carbon footprint and have identified key focus areas as well as green strategies of healthcare carbon emissions reductions. Table 1 outlines the six strategic actions approach towards Malaysian carbon neutral healthcare facilities.

CNHFB: Four focus areas

The MoH has outlined the pathways and actions necessary to accomplish a bold carbon reduction goal by 2050. These consist of four focal areas, each delineating main strategies and action plans.

The low carbon healthcare facility blueprint emphasises several key strategies aimed at reducing carbon emissions and promoting sustainability. These strategies, along with their associated action plans, play a crucial role in guiding the transformation of healthcare facilities towards low carbon and sustainable operations.

These strategies include:

• Government Green Procurement (GGP): Implementing procurement practices that prioritise environmentally friendly products and services.
• Green technology and smart system retrofits: Upgrading healthcare facilities with green technologies and smart systems to enhance energy efficiency and reduce carbon footprint.
• Zero waste management adoption: Implementing comprehensive waste management practices to minimise waste generation and maximise recycling and reuse.
• Embracing circular economy and bioproducts: Promoting the adoption of circular economy principles and utilising bioproducts to reduce resource consumption and waste generation.
• Adoption of waste-to-energy technology: Implementing technologies that convert waste into energy to reduce reliance on fossil fuels and mitigate environmental impact.
• Integration of energy recovery systems: Installing systems that recover and reuse energy from various processes to improve overall energy efficiency.
• Low carbon mobility: Promoting the use of electric vehicles and developing infrastructure to support their adoption in healthcare facilities.
• Application of biophilic design elements: Incorporating elements such as plants, green spaces, natural lighting, and green roofs into building designs to enhance indoor air quality and occupants’ wellbeing.
• Green building awareness, design, and application: Increasing awareness of green building practices and implementing sustainable design principles in healthcare facility construction and renovation projects.
• Sustainable facility management practices: Implementing sustainable practices in facility operations and maintenance to optimise resource use and minimise environmental impact.
• Shift to renewable energy sources: Transitioning to renewable energy sources such as solar photovoltaic (PV) and solar thermal systems to reduce reliance on fossil fuels and decrease carbon emissions.
• Green rainwater management: Implementing rainwater management practices to conserve water resources and reduce runoff pollution.
• Safeguarding biodiverse natural environment: Protecting and preserving natural ecosystems surrounding healthcare facilities to promote biodiversity and ecosystem resilience.

Challenges in going carbon neutral

In developing and gearing towards decarbonisation of Malaysia’s healthcare infrastructures, the challenge of establishing mechanisms to closely monitor and calculate public healthcare building emissions is critical. The MoH is currently developing a guideline for greenhouse gas (GHG) management specifically for Malaysian healthcare facilities, covering Scope 1 and Scope 2 emissions. This effort involves identifying emission sources within MoH facilities, calculating emissions, and managing a comprehensive GHG inventory. The guideline is set to be completed by the third quarter of this year. Setting targets and tracking GHG emissions towards specific goals is crucial, as it complements ongoing emission abatement efforts and ultimately moves towards carbon neutrality.

The importance of designing sustainable healthcare facilities cannot be overstated, particularly in minimising human impact on surrounding ecosystems. A resilient site, characterised by its ability to sustain natural ecological functions and serve as a carbon sink, is essential. Recognising the intrinsic value of biodiverse natural environments as health-promoting resources, it becomes imperative to preserve and protect them. This entails safeguarding green areas within hospital sites from development and construction activities, ensuring the undisturbed continuity of surrounding habitats and ecosystems.

The MoH has been a proactive advocate of green building initiatives, successfully certifying multiple hospitals to both local and international green building standards. Certifying a large number of healthcare facilities to green building standards across the country presents several challenges. First and foremost, it requires significant financial resources for the necessary upgrades and retrofits to meet stringent environmental criteria. Additionally, the process demands a strong commitment from all stakeholders, including facility managers, healthcare professionals, and government bodies, to prioritise sustainability amidst competing operational demands. Furthermore, the varying conditions and infrastructure across different regions add complexity to standardising green building practices nationwide, making it more difficult to achieve uniform certification across all facilities. Despite these challenges, MoH remains dedicated to expanding its green building certifications, recognising the long-term benefits for both the environment and public health.

At the same time, raising awareness among occupants of MoH buildings and the wider public emerges as another pivotal task. Despite the growing global emphasis on sustainability, many remain oblivious to the importance of green transformation and sustainable practices. Educating stakeholders about the environmental, health, and economic benefits of adopting green initiatives is paramount. Through comprehensive educational campaigns, workshops, and outreach programs, the significance of embracing sustainability can permeate MoH facilities and communities nationwide. By engaging staff, patients, visitors, and the broader community, Malaysia can foster a culture of sustainability and pave the way for widespread adoption of green practices.

In tandem with environmental conservation and awareness-building efforts, the challenge of creating safe and healthy built environments looms large. Striking a delicate balance between sustainability and occupant wellbeing is imperative. Improving indoor air quality, minimising noise pollution, optimising lighting, enhancing ventilation, and regulating thermal conditions are crucial aspects of this endeavour. By integrating green building practices with evidence-based design principles and cutting-edge technologies, Malaysia can achieve sustainable healthcare facilities that prioritise safety, health, and environmental stewardship. Through collaboration among architects, engineers, healthcare professionals, and stakeholders, Malaysia can chart a path toward a future where healthcare infrastructure serves as a beacon of sustainability, resilience, and holistic wellbeing for all.

Considering Malaysia’s healthcare infrastructures are scattered across varied regions and landforms in Malaysia, spanning rural, urban, and suburban areas, some facilities still do face some or more challenges as shown in Table 2 towards carbon neutral healthcare facility. The diverse landscape of Malaysia presents unique challenges for healthcare facilities in their journey towards carbon neutrality. In rural areas, healthcare facilities may encounter difficulties due to limited budgets and funding constraints, making it challenging to invest in green technologies or sustainable practices. Additionally, technological limitations may arise in remote regions, where access to certain green technologies or renewable energy sources may be limited.

Energy and environments

In urban and suburban areas, existing healthcare infrastructure may not be designed to accommodate renewable energy sources or energy-efficient systems, posing challenges for retrofitting and upgrading facilities. Furthermore, effort in implementing strategies and administering policies governing healthcare facilities may vary across regions, leading to inconsistencies in support for sustainability initiatives and carbon reduction efforts. Behavioural change is essential across all regions, as staff, patients, and visitors must adapt to new practices and embrace sustainability principles. However, in rural areas where awareness and education programmes may be less accessible, overcoming resistance to change and fostering a culture of sustainability may be particularly challenging. Supply chain challenges may also be more pronounced in remote or rural areas, where access to environmentally friendly products and sustainable suppliers may be limited. Lastly, data availability and monitoring infrastructure may vary across regions, making it difficult to accurately track progress towards carbon neutrality and identify areas for improvement.

Overall, the diverse geographic and socioeconomic landscape of Malaysia presents a complex set of challenges for healthcare facilities striving towards carbon neutrality. Addressing these challenges requires tailored approaches and collaborative efforts across regions to ensure that all healthcare facilities can transition towards sustainable, carbon-neutral practices.

Conclusion

The Malaysian Carbon Neutral Healthcare Facilities Blueprint serves as a promising framework for steering healthcare facilities towards sustainability and carbon neutrality. Despite the varied challenges posed by Malaysia’s diverse regions and landscapes, the 
blueprint offers strategic guidance for mitigating 
carbon emissions and fostering environmental stewardship within the healthcare sector. The upcoming comprehensive GHG management guideline is set to complement the blueprint’s strategies and further MoH efforts towards decarbonisation. The guideline will provide a clear roadmap for healthcare facilities to 
track their carbon emissions, set specific reduction 
targets, and measure progress over time. While 
financial constraints, technological limitations, and regulatory complexities present formidable hurdles, concerted efforts and innovative solutions can overcome these obstacles. By embracing the blueprint’s strategies and addressing the identified challenges, Malaysia can pave the way for a more sustainable healthcare system that not only reduces its carbon footprint but also promotes health and wellbeing for both people and the planet.

Acknowledgement

•  The authors would like to thank the Director General of Health Malaysia for his permission to publish this article.

Further reading

• Engineering Services Division (2023). Carbon Neutral Healthcare Facilities Blueprint: Towards A Future Proof Healthcare Facility. Putrajaya, Malaysia: Engineering Services Division, Ministry of Health Malaysia.
• Minister of Natural Resources, Environment and Climate Change (2022). Malaysia Fourth Biennial Update Report Under Nations Framework Convention on Climate Change, 324 pg. Report No.4.
• Imran MS, Abd Rahman NM, Mohamed R. Energy performance contracting initiative in Malaysian public hospitals. International Journal of Integrated Engineering 2020; 12 (9): 234-45.
• Kamaluddin KA, Imran MS, Yang SS. Development of energy benchmarking of Malaysian government hospitals and analysis of energy savings opportunities. Journal of Building Performance 2016; 7 (1).
• Muhammad Syukri Imran Abdullah MS, Noor Muhammad Abd Rahman, TZ Ahmad Zaidi, Khairul Azmy Kamaluddin (2019). Latest development on sustainability programme initiatives in Malaysian healthcare facility management. Proceedings of the 37th Conference of the ASEAN Federation of Engineering Organisations, Jakarta, Indonesia.
• Abdullah MS, Imran Kamaluddin K, Abd Rahman NM. Decarbonising facilities in Malaysian healthcare. IFHE Digest 2023; 26-9.
• Economic Planning Unit, Prime Minister’s Department (2021). Twelfth Malaysia Plan 2021-2025: A Prosperous, inclusive, Sustainable Malaysia; 2021. 532 p. Available online:
https://rmke12.epu.gov.my/en.
• Ministry of Environment and Water (2021). Low Carbon Mobility Blueprint 2021-2030. Available from: https://www.kasa.gov.my/resources/alam-sekitar/Low-Carbon-Mobility-Blueprint-2021-2030.pdf.
• Huovila P, Ala-Juusela M, Melchert L et al. Buildings and climate change: Summary for decision-makers. (2009).
• Directorate General for Communication, European Parliament (2023). What is carbon neutrality and how can it be achieved by 2050? Available online: https://www.europarl.europa.eu/pdfs/news/expert/2019/10/story/20190926STO62270/ 20190926STO62270_en.pdf.
• Rayer Q, Jenkins S, Walton P. (2022). Defining Net-Zero and Climate Recommendations for Carbon Offsetting. In Business and Policy Solutions to Climate Change: From Mitigation to Adaptation (pp. 13-35). Cham: Springer International Publishing.
• Rauland V, Newman P, Rauland V, Newman P. (2015). Certifying for carbon neutrality. Decarbonising Cities: Mainstreaming Low Carbon Urban Development, 149-159.
• SBTi (2024). SBTi Corporate Net-Zero Standard v1.2. Available online: https://sciencebasedtargets.org/resources/files/Net-Zero-Standard.pdf.