Hospitals are large consumers of energy. This guide for the Tunisian hospital sector gives concrete recommendations to energy managers and architects. It covers areas such as the orientation of waiting areas and patient rooms, energy efficiency and management of different hospital installations, and the integration of renewable energy sources to provide a safe and secure power supply for its day-to-day functioning.
Healthcare facilities that are energy efficient are important for patient comfort and can save costs that can be reallocated to patient care. Still this is not a priority for architects or engineers involved in construction and rehabilitation of healthcare facilities. PEEB therefore developed an energy efficiency guide for healthcare facilities in Tunisia, together with the Tunisian Ministry of Health and the Tunisian Energy Management Agency (ANME). This guide complements the PEEB financing for two hospitals.
This detailed guide gives concrete recommendations to energy managers and architects working in the health sector. It covers areas such as the orientation of waiting areas and patient rooms, energy efficiency and management of different hospital installations, and the integration of renewable energy sources to provide a safe and secure power supply for its day-to-day functioning. The guide also contains an overview of the current state of public and private sector health buildings in Tunisia. An accompanying quick checklist for integrating energy efficiency in health buildings is under development.
Awareness raising and trainings sessions on the guide for energy managers and architects in Tunisia’s regions are planned for the summer of 2021.
The health sector contributes to and is affected by climate change. On the one hand, the health sector generates between 4 and 5% of the world''s greenhouse gas emissions, and, on the other hand, these same infrastructures must become more resilient to the effects of the climate crisis, particularly heat. Furthermore, health buildings should be designed to improve the well-being of patients and the working conditions of medical staff, as well as maintain the continuity of cold chains, essential to ensure our health security.
The energy performance of essential health infrastructures such as hospitals must improve massively to address the pressing climate issues.
The Programme for Energy Efficiency in Buildings (PEEB) organised a webinar with several experts to present best practices in sustainable construction and renovation in the health sector, tools to stimulate their financing, as well as the highlights of a technical guide developed for the hospital sector in partnership with the Tunisian Ministry of Health and the Tunisian National Agency for Energy Management (ANME).
"Technical solutions for a more resource-efficient design exist," said Jérémy Bourgault of the Agence Française du Développement (AFD) and member of the PEEB secretariat. "These solutions can both increase energy security and climate resilience of communities, especially in hot climates, while reducing greenhouse gas emissions and operating costs."
This comes against a backdrop of great attention from international organisations such as the World Health Organisation (WHO), which has launched numerous programmes and initiatives in this area, including engaging all countries in promoting sustainable, climate-resilient and low-carbon health systems.
Elena Villalobos Prats, Technical Officer for Health and Climate Change at WHO, highlighted the usefulness of the work developed by PEEB in regard to the ambitions set at COP26 in Glasgow. There, countries committed to transitioning to sustainable, low-carbon health systems for the first time.
"Today, 58 countries have already committed to this initiative, and now they will need financial and technical support to implement these commitments," she added.
The example of Tunisia fuelled the experts'' discussions, as the Tunisian government has put in place a national energy transition strategy for 2030, which aims to increase the share of renewable energy to 30%, reduce primary energy demand by 30% and cut its carbon intensity by 40% by 2030. At the heart of this strategy are the many new health infrastructures that the country needs.
Rym Nafti, Head of PEEB in Tunisia, explained that with more than 5,000 health facilities, the sector accounts for 5% of building-related energy consumption in the country, with an energy intensity of 464 kW/h consumption per square meter per year. The estimated potential for reducing energy consumption in health buildings is 50%.
To ease this drastic reduction in energy consumption, ANME, the Ministry of Health and PEEB have developed a guide. The Guide for Energy Management in Health Facilities provides recommendations for the construction, equipment and operation of hospitals to promote energy efficiency and renewable energy.
Amira Gader Jaziri, Chief Architect of the Tunisian Ministry of Health, said that "the collaborative work made possible by the guide is bearing fruit, as it will be the basis for new hospital construction here in Tunisia."
She explained that 44 hospital infrastructure projects are being assessed for a total budget of 7 billion EUR (2400 billion dinars), financed by several international lenders in loans and grants. Within the framework of the PEEB, AFD is already funding the renovation and extension of two regional hospitals in Gafsa and Sidi Bouzid to the tune of 156 million euros, in accordance with the recommendations of the technical guide.
The guide describes how to reduce energy consumption in different areas such as heating, lighting, air conditioning, technical installations and equipment.
The main lines of action for building and managing a sustainable, more energy-efficient hospital with lower greenhouse gas emissions are described there, from the planning phase to the energy management system and the use of renewable energy for electricity production, including the eco-construction of the building.
The construction site of the Sbeitla hospital, 95% completed, presented by engineer Mohamed Ali Reghini and architect Nejib Krid from Bureau Asselec, is a perfect example of the application of these principles: harmonious architecture, use of local materials, low-nuisance construction site, energy management (favouring photovoltaic and natural lighting), water and waste management, and centralised technical management.
For example, the designers worked with patios, which provided a double benefit by letting in more natural light while helping to control temperatures. This is an essential stake because in Tunisia, particularly in Sbeitla, the variations in temperature between summer and winter are very significant. This system of patios, combined with insulation, also makes it possible to avoid mechanical air conditioning.
In general, a better commitment of the health sector to the energy transition is essential. It relies on three dimensions: political, by providing the impetus, the legal framework and good practice guides for building professionals; technical, by strengthening the building professionals'' technical skills required to construct or rehabilitate buildings integrating energy efficiency measures; and health-related, by establishing a link with health issues such as the well-being of patients and health professionals.
Nicolas Valour, project manager for health sector investments at Agence Française du Développement (AFD), identified the obstacles to a faster and more thorough development of sustainable hospitals, "including political ownership and drive – which still lacks – so that projects can integrate energy performance concerns. He also underlined the need to give more consideration to the point of view of the medical staff while in the planning phase.
"As we can see, the task is colossal," he added, welcoming that Tunisia is leading the way with its strategy for sustainable health buildings.
Nora Steurer, Policy Officer at the Global Alliance for Buildings and Construction, GlobalABC, reminded the audience that the success of this initiative had been grounded on collaboration between the different players in a very fragmented sector, such as ministries contractors, architects, engineers and health care staff.
As such, the work in Tunisia highlighted in this webinar is a highly encouraging and relevant case study in preparation for COP27 in Egypt. This year''s climate conference will be held on the African continent, which is facing immense needs in terms of health infrastructure and challenges due to climate change.
This webinar on hospitals is the first in a series of dialogues exploring solutions for making health, hotel and residential buildings more sustainable.
This article was originally published on the PEEB website.
Read more about the series here. Watch the webinar here.
Hospitals are hives of activity, with large numbers of staff, patients and visitors, and machinery and equipment requiring two to five times the energy requirement per square meter than a typical structure. Producing bright light and large amounts of heat and cold air, the energy intensity of hospital buildings is increasingly scrutinized with an eye to reducing their environmental impact and increasing efficiency.
"When it comes to renovating and constructing healthcare buildings, energy efficiency is a real challenge," says José Lopez, energy efficiency lead for the Energy division for AFD.
"This is especially true in developing countries, where until recently, it has remained a secondary consideration, as the priority was providing care to patients."
Ignoring healthcare buildings'' energy efficiency takes a heavy toll on the environment. And it proves costly in the long term, with a hospital''s energy bill representing as much as 10% of its operating costs in developing countries, versus 2% to 5% in Europe or North America.
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