Reducing the Carbon Footprint of Health Care in Sub-Saharan Africa: An Equity-Centered Agenda for Action

Climate change is placing increasing pressure on health systems across sub-Saharan Africa (SSA) through extreme heat, floods, droughts, shifts in infectious diseases, food and water insecurity, displacement, and damage to essential infrastructure. Healthcare also contributes to the climate crisis, accounting for approximately 4–5% of global greenhouse gas emissions, largely through energy use, transport, pharmaceuticals, medical technologies, infrastructure, and supply chains. Although per-capita healthcare emissions remain lower in SSA than in high-income countries, the region should avoid reproducing carbon-intensive models as it expands services and pursues Universal Health Coverage. This Article argues that low-carbon healthcare should be integrated into health-system strengthening rather than treated as a separate environmental agenda. Priority actions include reliable renewable energy, strong primary healthcare, high-value clinical practice, sustainable procurement, climate-resilient infrastructure, safe waste management, workforce education, and locally relevant carbon accounting. Because direct empirical evidence from SSA remains limited, context-specific measurement and implementation research are essential. Integrating sustainability into health-system development could reduce avoidable emissions while improving resilience, efficiency, quality of care, and progress towards Universal Health Coverage.