A Systematic Review to Identify the Effectiveness of Greenhouse Gas Mitigation Interventions for Healthcare Systems in Low- and Middle-Income Countries

Background
Climate change poses serious risks to human health. At the time of writing, 81 nations pledged to sustainable healthcare systems, with the majority from Low- and Middle-Income Countries (LMICs). The healthcare sector accounts for 4.4% of global greenhouse gas (GHG) emissions, primarily from high-income countries. Without robust GHG mitigation, future increases are predicted in LMICs. This systematic review aims to identify interventions that reduce GHG emissions in healthcare systems in LMICs and explores synergies between interventions that aid adaptation while mitigating emissions.
Methods
A systematic review protocol was published on Wellcome Open Research following the PRISMA-P checklist. Relevant search terms were used to retrieve all primary research published in peer-reviewed journals between 1990 and March 2023. We assessed the risk of bias and quality of evidence. The final synthesis was performed with identified existing evidence around GHG mitigation interventions across all scopes of emissions, including scope 1 (healthcare operations), scope 2 (energy), and scope 3 (supply chains).
Findings
After screening 19,292 unique records, we included a total of 22 studies from 11 different countries across the globe. The articles spanned energy, waste, heating and cooling, operations and logistics, building design, and anaesthetic gases. All interventions demonstrated potential for GHG reductions, cost savings, and positive health impacts. Due to variations in measuring and reporting, the overall quality of evidence following the GRADE evaluation tool is low.
Interpretation
This systematic review provides the first comprehensive overview of existing evidence in peer-reviewed literature on greenhouse gas mitigation interventions for healthcare systems in LMICs. Gaps were identified across areas of emissions, such as the supply chain, as well as a lack of consideration of interactions with adaptation. It is vital that increasing GHG mitigation efforts are robustly monitored, evaluated, and reported to contribute to a strong evidence base to inform policymakers across contexts.