Measuring the greenhouse gas footprint of the health system in the Philippines

Context

The Philippines is among countries most at risk from extreme natural events and negative climate change impacts, and recognizes the urgent need to reduce emissions, increase resilience, and improve access to healthcare. To meet this challenge, the Department of Health (DOH) has placed sustainability and resilience at the core of its national health agenda.

The Department of Health is leading efforts to green the Philippine health system. The Health and Climate Change Office (HCCO), established in 2025, is the focal office of the Philippines for ATACH. The Health Facility Development Bureau (HFDB) introduced the Green & Safe Health Facilities Manual to guide public and private health providers towards resilience, sustainability, and improved health outcomes. This effort is supported by the Green Viability Assessment (GVA) tool, which is an annual survey conducted by DOH which enables hospitals, clinics, and other health facilities to self-assess and track performance in key areas, including resource consumption, operational efficiency, and climate resilience. Results are submitted to the Department each year, providing an overview of national progress towards developing green and safe health facilities.

Building on these foundations, the Department of Health is undertaking the country’s first base year assessment of health system greenhouse gas emissions, in collaboration with national government agencies, regional health offices, and healthcare providers. The project is being delivered through Technical Assistance from the Asian Development Bank, with analytical support from the Centre for Sustainable Medicine at the National University of Singapore.

Implementation process

The Philippine Health System Integrated National Accounting of GHGs (PH-SINAG) model quantifies the emissions generated from all private and public hospitals, infirmaries, primary care facilities, pharmacies, healthcare retailers, health administration, and other health-related service providers in the Philippines for the base year 2023.

This model boundary is fully aligned with the WHO guidance on GHG measurement in health systems developed under ATACH, covering all of the ‘must’ include organizations and activities:

The organizational boundary is defined using the Philippine National Health Accounts which cover all healthcare providers and administrators in the country, providing a broad and comprehensive definition of the health system boundary.
The operational boundary includes all GHGs under the Kyoto Protocol, volatile anaesthetic gases, and international and domestic supply chain emissions.
The base year is set as 2023, which is the most recent year for which comprehensive data were available.

In total, the PH-SINAG model integrates over 30,000 individual calculations using Philippines-specific data points and emission factors to calculate the total healthcare footprint. It applies a hybrid approach, combining both spend- and activity-based datasets to balance comprehensive coverage with high accuracy. This well-established methodology is consistent with the global examples of best practice from other health systems, as well as WHO guidance on GHG measurement in health systems.

The model consists of four interconnected modules focusing on different aspects of the footprint:

Figure 1. Geographic locations of barangay centres (green) and hospitals (blue) in the Philippines used to calculate patient travel emissions — Figure 1: Geographic locations of barangay centres (green) and hospitals (blue) in the Philippines used to calculate patient travel emissions (Credit: Department of Health, Republic of the Philippines, in collaboration with the Asian Development Bank and the Centre for Sustainable Medicine at the National University of Singapore)

Expenditure Module: This module establishes the overall boundary of the health system. Expenditure is mapped to emissions factors derived from the EMERGING MRIO model (Huo et al., 2022). This model was selected for its open-access availability, recency of data, symmetrical sector classification, and comprehensive coverage of the Philippines and neighbouring countries in South-East Asia where much of the Philippines’ health-related purchasing occurs. Data from the DOH Financial Management Service expenditure dataset is used as a sample to add detail to National Health Accounts data, enabling an accurate mapping to MRIO economic sectors. Expenditure on non-emissions-generating items like salaries, pensions, and taxation is excluded. Where emissions are calculated from the other three modules (e.g., electricity use in secondary care), spend is eliminated from the expenditure module to avoid the double-counting of emissions.
GVA Consumption Module: This module uses detailed hospital-level data submitted in the annual GVA tool data collection. Weighted stratified sampling by facility type is used to scale up submitted data to reflect the entire secondary care footprint across electricity, fuel, and water consumption, as well as waste treatment.
High-Carbon Medicines Module: This module is used to estimate emissions associated with anaesthetic gases and metered-dose inhalers. This module utilizes DOH prescription and procurement datasets, academic papers, and population statistics to estimate the usage and GHG footprint of the high-carbon sources of emissions.
Personal Travel Module: This module uses population distribution data in each of the Philippines’ 40,000 barangays (the smallest administrative division in the Philippines); census and survey data on common modes of transportation in the Philippines (e.g., private car, jeepney, motorcycle taxi, or ferry); and DOH geospatial datasets of health facility locations. In combination, these are used to calculate the average distance, mode of travel, and emissions associated with staff and patient journeys to healthcare centres, accounting for different travel patterns for commuting, as well as for Accident & Emergency (A&E), inpatient, outpatient, and primary care attendances. The model accounts for differences in rural and urban modes of travel, with populations in rural barangays typically travelling further to receive treatment and being more reliant on public transport.

Figure 2 below summarizes the structure of the Philippine Health System Integrated National Accounting of GHGs (PH-SINAG) model.

Figure 2: Structure of the Philippine Health System Integrated National Accounting of GHGs (PH-SINAG) model (Credit: Department of Health, Republic of the Philippines, in collaboration with the Asian Development Bank and the Centre for Sustainable Medicine at the National University of Singapore)

Lessons learned

Several factors enabled the successful development of the PH-SINAG model. Building a comprehensive national emissions model requires not only robust data and analytical methods, but also sustained collaboration across institutions.

Cross-system collaboration: The level of detail achieved in the PH-SINAG model was made possible by contributions from multiple data owners and technical partners. Data is integrated from sources inside and outside of the health system, including public and private hospitals, DOH datasets, the Philippine Statistics Authority, the Department of Energy, the Climate Change Commission, and academic literature. Early and sustained engagement with data owners, focusing on the value of the study and explaining why each dataset is important, was crucial in the model development process.
Comprehensive hybrid model coverage: While hospital-based activity data from GVA and other sources added valuable detail to our model, full coverage of emissions could not have been achieved without the use of national-level expenditure data from the Philippine National Health Accounts.
Targeted data collection and leveraging existing data: By using information already collected for other purposes, such as procurement, energy monitoring, and budget management, the DOH was able to generate emissions estimates without placing additional reporting burdens on the system. This was supplemented by longstanding GVA data collections, which added high-value insight into hospital-level emissions hotspots.
Regional input: The strong collaboration between the Philippines’ regional Centers for Health Development helped collect actionable data from all 18 administrative regions of the Philippines, enabling the model to account for regional differences and context, which will inform the design of more targeted decarbonization strategies.

Challenges

Data quality presented an occasional challenge, with some sources of data only being available in non-machine-readable formats and variable levels of completeness. Processing the data to ensure that all consumption activity was included was a time-consuming and manual process.

Success factors

To address data quality challenges, the Department conducts a rigorous data validation exercise for GVA submissions for completeness and consistency, flagging anomalies for review. Moving forward, the Department will enhance its GVA data collection process to further standardize submissions and provide additional GHG insights to users, while maintaining familiar data submission templates. This will improve the quality of reporting and enhance the ability of users across the health system to understand and apply data for emissions measurement and tracking.

Recommendations

Based on the experience of developing the PH-SINAG model, several overarching recommendations can guide other countries seeking to measure and report their health system’s greenhouse gas (GHG) emissions more effectively.

Use locally appropriate emission factors: Prioritize emission factors that reflect national or regional production contexts, electricity grids, and supply chains. One-size-fits-all emissions factors may misrepresent local conditions and distort results, especially if they are originally designed for use in different global regions or income settings.
Ensure model ownership and continuity: When developing a model with external support, retain control of the model within government, so that future calculations, updates, and scenario analyses can be carried out internally. This builds long-term institutional capacity to measure emissions efficiently.
Build multidisciplinary teams: The model was developed with a multidisciplinary team of experts that includes clinicians, public health specialists, engineers, economists, policy specialists, and data analysts. Diverse expertise helps to ensure both technical rigour and real-world relevance.
Act now: Do not wait for perfect data or a comprehensive baseline before taking action. Beyond being a valuable source of consumption data, the GVA tool has had an even greater impact by providing hospitals with a clear set of actions to reduce emissions and improve climate resilience that are already being implemented at pace.

Key resources

More information

This case study was led by the Department of Health, Republic of the Philippines, in collaboration with the Asian Development Bank and the Centre for Sustainable Medicine at the National University of Singapore. For more information on this study, please contact hcco@doh.gov.ph

This case study is part of the work of the ATACH Task Team for health systems GHG emissions measurement, complementing the WHO guidance for measuring greenhouse gas emissions in health systems.