NIHR Group on Environmentally Sustainable Hospitals in Low and Middle Income Countries

RESEARCH QUESTION

To co-develop and test interventions to decarbonise operating theatres and hospitals in low and middle income countries. BACKGROUND

Climate change is an emergency with communities worried about effects on their health. World leaders have pledged to introduce Net Zero healthcare and the NIHR has identified carbon reduction as a research priority. This Group will explore how to reduce the carbon footprint of operating theatres in low and middle income countries and apply these lessons to the wider hospital.

We will provide a sustainable approach to addressing the current research deficient, addressing 7 Sustainable Development Goals, with direct impact on SDG3 (Good Health) and 13 (Climate Action). WORK TO DATE

We conducted systematic reviews, a global Delphi exercise, gathered pilot data, conducted two global community engagement workshops and submitted our first research plan for ethics. We have prioritised three areas for testing: 1. Reusable drapes and gowns in theatre 2. Reducing use of harmful anaesthetic gases

3. Improving waste management SETTINGS

We will deliver this research across Ghana, India, Nigeria, Pakistan, and Rwanda, where we have established research pathways, allowing rapid starts. RESEARCH FRAMEWORKS 1. Behaviour Change Wheel (COM-B) 2. Consolidated Framework for Implementation Research 3. MRC/NIHR framework for developing and evaluating complex interventions

RESEARCH WORKSTREAMS

1. Perform needs analyses for anaesthetic gases and waste management, to design protocols for Quality Improvement Projects (QIP) in workstream 4 2. Co-develop modelling processes to deliver policy changing health economics and carbon reduction outputs

3. Multicentre, cluster randomised trial testing reusable versus disposable drapes and gowns in theatre (14,400 patients, 72 hospitals)

4. Deliver two QIPs across four central hospitals, focussing on sustainability over time, before expanding waste management across the wider hospital COMMUNITY ENGAGEMENT AND INVOLVEMENT

Our overarching aim is to learn how to communicate with community members around concepts of Net Zero healthcare, and then bridge communication gaps to policymakers. To accomplish this, we have built senior leadership in each country and created four CEI strands 1) identify community members’ training needs, 2) build context specific training toolkits, using suitable non-specialist language, 3) co-design relevant aspects of our research studies, 4) use our large trial as a learning platform to test CEI-led dissemination.

CAPACITY BUILDING

This Group will build capacity for researchers, clinicians, and managers on how to decarbonise healthcare. We will disseminate our outcome measures, quality improvement methodology, and Policy Influence Process to underpin a new generation of environmentally sustainable healthcare research. NEW LEADERSHIP

This Group will bring a new LMIC Co-Director (Ghaffar, Health Services Academy, Pakistan, and immediate ex-Director of World Health Organisation Alliance on Health Policy and Services Research). It will build UK capacity by allowing a new Co-Director (Bhangu, University of Birmingham) to transition into an independent research leader. This Group is separate to the NIHR Global Surgery Research Unit but will leverage its infrastructure.

POLICY INFLUENCE

We have created a Policy Influence Process to create engagement at the very start of this Group, through a senior Policy Committee with members from each country.