Assessing greenhouse gas emissions in a primary care subdistrict in Cederberg, South Africa.

BACKGROUND: Climate change poses a significant threat to global health, risking decades of progress in public health gains and threatening the ability of developing countries to achieve universal health care goals. In response, healthcare systems worldwide are beginning to assess and mitigate their environmental impacts, ideally alongside building their resilience to climate change. Most of this work has centred on high-emitting health systems in high-income countries, yet a large number of developing countries are also committed to reducing the environmental impact of health care and in doing so pursuing a clean development trajectory. This study evaluates the emissions of a primary healthcare network in the Cederberg subdistrict, South Africa, using a standardized greenhouse gas accounting tool. The findings aim to inform mitigation strategies for Cederberg and may offer insights to other resource-constrained settings. METHODS: A hybrid approach, combining bottom-up and top-down calculations, was employed to quantify greenhouse gas emissions across Scopes 1, 2, and 3 of the Greenhouse Gas Protocol, using the Healthcare Without Harm Climate Impact Check-up Tool. Key operational areas included energy use, transportation, waste management, procurement, and water use. Activity data were collected for 2023 through an iterative process of reviewing facility records, interviewing staff, and direct observations involving facility visits. FINDINGS: The emissions for the Cederberg primary care subdistrict, including six clinics (two large and four small) totalled 1,228 tonnes of carbon dioxide equivalent (CO₂e) per annum, which equates to 10.5 kg CO₂e per consultation. Of these emissions, 51% were generated by the extra supply chain (mainly pharmaceuticals and medical instruments and equipment), inhalers (34%), purchased electricity (8%), transportation - employee commuting (4%), stationary combustion (1%), mobile combustion (1%), electricity transmission and distribution losses (0.5%) and waste incineration (0.5%). CONCLUSION: This study provides the first published GHG emissions assessment for primary care in South Africa. The findings emphasize the importance of reducing emissions while maintaining essential services and advancing universal health coverage, with decarbonization offering potential environmental, economic, health, and social co-benefits. This work supports global efforts to decouple health outcomes from environmental harm and lays the groundwork for climate-resilient, low-carbon healthcare in similar settings.