Delivering on Commitments to Sustainable Healthcare in Kenya: the role of the healthcare system in mitigating and adapting to climate change

Climate change poses significant threats to human health through direct impacts, such as extreme weather events, and indirect pathways, including shifting disease patterns, exacerbated mental health challenges, and undernutrition. Healthcare systems, essential for addressing these challenges, paradoxically contribute approximately 5% of global greenhouse gas emissions. This dual role necessitates urgent action to reduce healthcare’s environmental footprint while enhancing its resilience to climate-related risks. Integrating mitigation and adaptation strategies within healthcare systems presents opportunities to improve health outcomes, strengthen resilience, and achieve co-benefits such as enhanced energy security and cost savings. The disproportionate impact of climate change on low- and middle-income countries (LMICs) underscores the need for contextually appropriate approaches. Kenya exemplifies ambitious climate leadership with its commitment to achieving a net-zero, resilient healthcare system by 2030.

This thesis explores pathways to transform healthcare systems into sustainable, resilient systems, using Kenya as a case study. It investigates the interactions between mitigation and adaptation strategies, focusing on synergies, co-benefits, conflicts, and trade-offs to inform actionable transformation pathways. The research evaluates global commitments to healthcare system sustainability, synthesises evidence on mitigation interventions in LMICs, and develops policy recommendations tailored to Kenya. It also examines the role of education in empowering health workers as agents of change. Employing a multi-method approach, the study integrates a global policy analysis, a systematic review, stakeholder interviews, a Delphi process, a questionnaire, and a focus group. These methods collectively identify barriers, opportunities, and priorities for action, considering alignment with Kenya’s healthcare needs and offering insights applicable to broader contexts.

Unexpected findings from this research challenge prevailing assumptions about climate action in LMICs. In particular, political will and cautious optimism among diverse stakeholders including Kenyan healthcare workers regarding the 2030 net-zero target demonstrate a strong foundation for transformation. These insights suggest that LMICs may offer greater opportunities for climate-health leadership than often recognised by international funders and policymakers. Evaluation of progress of global commitments to sustainable, resilient healthcare systems reveals inconsistent outcomes, with significant gaps in accountability and data transparency. The policy analysis highlights the risks of greenwashing and emphasises the need for robust, outcome-oriented indicators to track tangible health system transformations. In Kenya’s context, the lack of appropriate indicators for healthcare emissions and resilience highlights a critical barrier that must be addressed to sustain momentum and evidence tangible progress over time. Lessons from global efforts, particularly the integration of healthcare into national climate strategies, provide critical insights for Kenya. By addressing governance, financing, and data challenges, Kenya can lead in implementing sustainable healthcare practices while avoiding emission-intensive models.

The systematic review identifies evidence-based mitigation interventions in LMIC healthcare systems, highlighting potential reductions in emissions through energy solutions, waste management, and operational interventions. Renewable and hybrid energy systems show promise for rural areas, with the potential of addressing both adaptation and mitigation needs. However, gaps in evidence regarding supply chain emissions and long-term outcomes warrant further research. Stakeholder interviews and a Delphi process in Kenya reveal critical strategic themes, including infrastructure, competing priorities, financial constraints, awareness, and strategic coordination. Findings highlight the tension between immediate healthcare needs and long-term sustainability goals, emphasising the importance of aligning policies with near-term co-benefits, such as cost savings and improved health outcomes. Notably, the Delphi process revealed a conviction among participants regarding the importance of mitigation, indicating that support for climate action is deeply rooted and can be harnessed to accelerate progress. Nevertheless, bridging the gap between strategic ambitions and practical implementation remains an urgent task, particularly through strengthening accountability frameworks and operational planning. Prioritised actions include clean energy implementation, evidence-driven policy development, and local stakeholder engagement.

Health workers are identified as pivotal to achieving Kenya’s net-zero healthcare goals. A mixed-methods approach, including a questionnaire and focus group, identifies a broad awareness of climate change’s health impacts and the healthcare system’s role in emissions reduction. However, limited training, financial constraints, and a disconnect between national policies and local realities hinder their ability to act. Recommendations include co-created educational programs, peer-led workshops, and embedding sustainability modules in curricula. Despite widespread awareness, there is currently no systematic education on sustainable healthcare in Kenya’s health workforce training, representing both a critical gap and a major opportunity for embedding climate resilience and sustainability into health education at scale. Education emerges not just as a support tool but as a cornerstone for systemic change, empowering health workers to bridge structural barriers and lead in advancing sustainable practices.

This thesis concludes by emphasising the urgency of transforming healthcare systems to address the interconnected imperatives of health, climate mitigation, and adaptation. It underscores the importance of human agency, cross-sector collaboration, and international financial support in driving this transformation. It also argues that LMICs like Kenya are uniquely positioned to leapfrog high-carbon healthcare development pathways through strategic alignment of mitigation and adaptation, provided that education, data systems, governance structures, and financing mechanisms are strengthened in tandem. By aligning immediate healthcare needs with long-term climate goals, the research provides a roadmap for achieving sustainable and resilient healthcare systems, offering relevant insights for implementation and recommendations for future research.