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Senegal, Health center, hospitals, energy
Healthcare infrastructure is designed differently from other buildings, requiring enormous amounts of energy. From hospitals to health clinics, construction projects must better address questions of energy efficiency. Tunisia and Senegal provide examples of the work being done to make these buildings greener, so the health sector contributes less to global warming.

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.

“In optimal, efficient infrastructure, energy savings more than offset the additional 5 to 10% cost of building an energy-efficient hospital and free up marginal budget funding,” says Lopez.

With this in mind, AFD is taking concrete action, as demonstrated in two flagship programs.


As a partner to the Programme for Energy Efficiency in Buildings (PEEB), AFD prioritizes efficiency in the healthcare construction projects it supports. 

“Our role is to persuade our partners and contracting authorities to opt for low energy consumption solutions,” says Camille Perreand, manager of the Tunisian hospital projects for AFD’s Health division. “In Tunisia, long before the two regional hospitals in Sidi Bouzid and Gafsa were established, a technical audit concluded that we could hope for a 20% reduction in energy consumption.” 

Savings can actually be as high as 40 to 50% compared with an existing building of the same type in the country.

With financial backing from the European Union and technical support from the PEEB, the two Tunisian hospital facilities were designed to be greener and more sustainable. Armed with PEEB’s expert advice, project managers launched the projects with a total area of 33,000 m² for a capacity of 420 beds, with an eye to achieving high energy performance, with low environmental impact. 

Insulation Provides Protection

“The buildings’ shape, location, and wall and roof insulation affect their ability to deal with exposure and external temperatures,” says Mitchell Schouchana, PEEB project coordinator at AFD. Sun shades for instance, on the windows, protect the glass surfaces, blocking excessive heat. 

“Indoors, areas that are air conditioned, or simply well ventilated, are grouped together to prevent thermal loss.” 

Solar power is also used to produce part of the electricity and hot water consumed in the buildings. Once construction is complete, PEEB specialists remain on hand for some time to monitor the building’s operation, and to provide training.

Ultimately, the new Sidi Bouzid hospital complex will reduce carbon dioxide emissions per square meter by nearly 46% as compared with the former hospital, even with the same facilities, occupancy, and comfort level. 

Over 25 years, that represents a savings of 61,700 tons of CO2.  As Camille Perreand puts it, “AFD’s 100% climate commitments are a driver to energy efficiency. We would like to be even more ambitious, but the countries where we work don’t always offer sufficient maintenance to ensure that such measures and equipment will continue to operate.”


Far from the urban projects in Tunisia, energy efficiency also plays a role in the construction of rural clinics in Senegal.  AFD’s Health division also supports green design for rural healthcare centers –  single-story buildings designed to provide healthcare to a local population.

Although their lack of operating rooms means that they consume less energy, these buildings can still be sustainably designed. “Our main contribution involves providing the facilities with thermal comfort,” says Mitchell Schouchana. 

“Making a point of insulating roofs also helps keep temperatures down inside the building.” The same goes for coating walls with a high-intensity glare protection, which prevents sunlight from being absorbed, and planting trees to provide shade. 

Growing Green Demand, Limited Supplies

Although the ideal is to use traditional, local materials in the building of healthcare infrastructure, there are limitations.  “Local production industries remain relatively undeveloped,” says Lopez. 

“As a result, the scope of our construction and renovation projects that can use these green materials is limited. Even when these kinds of materials are available, builders used to working with cement, concrete blocks, and corrugated sheets must be willing to use them.” 

Gradually, however, decision-makers are being won over, and buildings are becoming more energy efficient. In health, as in other sectors, simple construction schemes at a reasonable cost are driving the development of sustainable buildings, as part of the campaign against global warming.