Establishing environmental sustainability in a resource-limited surgical setting: the design of Kyabirwa surgical center

Background: The healthcare industry is a leading contributor to climate change and resource depletion and its footprint is growing given efforts to improve healthcare access worldwide. Low- and middle-income countries (LMICs) are most vulnerable to this environmental degradation due to their relatively weaker infrastructure and lack of resources. This case study describes the infrastructure and procedures that drive environmental sustainability at Kyabirwa Surgical Center (KSC), an ambulatory surgery facility in rural Uganda that has cared for over 25,000 patients since its 2019 inception. Methods: KSC was architecturally designed with the goal of zero carbon footprint, exemplifying how environmental sustainability can be achieved in low-resource settings. In collaboration with a New York-based institution, Ugandan stakeholders constructed the original 8500 ft² center with local materials, leveraging natural resources such as sunlight and natural ventilation to minimize energy required. The center also prioritized operational independence from the local power grid and water supply, nearly exclusively using solar power and rainwater. Specific treatment and storage protocols, like environmentally conscious anesthesia regimens, were also implemented to minimize environmental footprint. Results: From 2021 to 2023, KSC obtained only 0.4% of its power and 25% of its water from the town. Excluding installation, this saves KSC an estimated $6,121 in annual operating costs—greater than annual maintenance costs estimated at $5,040. KSC also conserved 11% of solar power produced and 93% of rainwater collected from 2021 to 2023 for future use. Lastly, 71% of procedures were completed under environmentally friendly alternatives to general anesthesia. Conclusion: Integrating sustainability into LMIC surgical care is essential for improving healthcare resilience and accessibility. KSC shows that sustainable surgical models are feasible with innovative design, renewable energy, and potentially cost-effective practices. Scaling these efforts requires global collaboration, particularly support from high-income countries (HICs), to build resilient health systems in the face of climate change and resource limitations.