Thai Hospitals Emissions Management System (THEMS)

During COP26, Thailand solidified its commitment to addressing the issue of climate change by announcing its ambitions to reach carbon neutrality by 2050 and net zero by 2065. As such, the Department of Climate Change and Environment (DCCE) was established under the Ministry of Natural Resources & Environment and tasked with tracking GHG emissions at both national and provincial levels. 

In 2021, Thailand emitted approximately 270 MtCO2eq and abated approximately 60 MtCO2eq against the national emission budget of approximately 380 MtCO2eq. The energy sector accounted for 65.8%, agriculture for 18.1%, industrial 10.8%, and waste for 5.3%. However, annual emissions from the health sector remained unknown. 

In 2022, the Health Intervention and Technology Assessment Program Foundation (HITAP), in collaboration with Chulalongkorn University, conducted the first baseline of GHG emissions from public healthcare facilities in Thailand. The study estimates suggested that the healthcare sector may account for up to 9.5% of Thailand’s total emissions. However, this study had several limitations including a small sample size, data availability, absence of local emission factors, and low awareness among healthcare professionals. Hence, one of the recommendations of this study was to establish a system to routinely report emissions from healthcare facilities.

In 2023, the Ministry of Public Health (MOPH) introduced the Smart Energy Climate Action (SECA) policy to accelerate healthcare decarbonization efforts. As part of this initiative, MOPH commissioned HITAP and the Health Administration Division (HAD) to develop the Thai Hospitals Emissions Management System (THEMS) – a national web database requiring all 904 public healthcare facilities under HAD to routinely report and monitor their quarterly emissions. THEMS will allow baseline assessment of all individual healthcare facilities and of the overall health system in Thailand. Information from THEMS will be used to:

1. Identify emission hotspots;
2. Implement interventions as well as measure their cost-effectiveness in reducing those emission hotpsots;
3. Recognize and reward healthcare facilities for their decarbonizing efforts; and
4. Support national baselining and emissions reduction plan set by the DCCE.

THEMS Dashboard (Credit: HITAP and HAD, Office of the Permanent Secretary, Ministry of Public Health, Thailand)

THEMS is a hybrid system with most of the emissions data being estimated using the bottom-up approach, relying on actual activity data from healthcare facilities. Only the emissions from extra supply-chain activities are estimated using the top-down approach, leveraging hospital expenditure data. It covers key emissions including scope 1 such as fuel, refrigerant, anesthetic gases, waste, etc., scope 2 such as electricity consumption, and scope 3 supply chain, waste, travel, etc. Local emission factors are used provided by the Thailand Greenhouse Gases Management Organization (TGO). The development process of THEMS can be summarized as follows.

• Template development: First, a desk review of templates for baselining was conducted from the National Health Service (NHS) England, Health Care Without Harm (HCWH), and Practice Greenhealth, as well as general guidelines including the Kyoto Protocol and the Enhanced Transparency Framework (ETF) by the United Nations Framework Convention on Climate Change (UNFCC). Second, a survey among healthcare facilities was conducted to understand the availability of data, current emissions reporting practices, preferred functions and features for THEMS, and barriers to reporting. Based on the review of templates and survey responses, a locally relevant template was developed to capture emissions from healthcare facilities. Lastly, several consultations were held with stakeholders within MOPH including the Bureau of Environmental Health under the Department of Health as well as experts from HCWH.
• Web-database development: The template was then housed in a web-database with several features. All public healthcare facilities have private login to THEMS (linked to their pre-existing unique hospital codes). Once logged in, users can (i) record their quarterly scope 1-3 emissions and reductions and (ii) see their total and net emissions real-time. External users (for example, the public) can see aggregated emissions data on THEMS dashboard where results can be disaggregated by scope 1-3, calendar year, provinces, 13 Area Health regions, etc. These data will form the basis for hotspot identification, to intervene and reduce emissions, and generate performance reports.
• Pilot test and training: THEMS was introduced first introduced to healthcare facilities in January 2025 where basic training was delivered on how to measure and report facility-related emissions. THEMS was then piloted among 4 healthcare facilities to test its feasibility and reliability. Minor revisions were made based on feedback from users during the pilot phase. Furthermore, THEMS was subjected to penetration tests to ensure the system is robust from data breach before being implemented at the national level.
• Launch and next steps: THEMS was officially launched by the MOPH in October 2025 and all healthcare facilities under HAD will now be reporting and tracking their GHG emissions. First set of results is expected to be released by the end of 2025. Next steps for THEMS include: 
  • Delivering routine training to healthcare facilities to ensure timely and accurate reporting;
  • Linking THEMS with the Low Emission Support Scheme (LESS) program launched by the TGO which will recognize and reward healthcare facilities for reducing their emissions;
  • Expanding THEMS to healthcare facilities outside the mandate of HAD; and
  • Integrating THEMS with DCCE’s national GHG emissions tracking system with a common platform.

THEMS Data entry portal (Credit: HITAP and HAD, Office of the Permanent Secretary, Ministry of Public Health, Thailand)

The following challenges and success factors have been encountered in the THEMS development process.

• Frequent change in leadership: While a common phenomenon, frequent changes in leadership delayed project timelines. To ensure political buy-in remained intact, routine meetings were held to debrief new leaders about THEMS and how it aligned and contributed to SECA policy.

• Internal communication: Developing THEMS required a multidisciplinary team with expertise in health systems, carbon footprinting, and IT. Given this diversity and difference in nomenclature, ensuring effective communication within the team proved challenging.

• Integration: MOPH and healthcare facilities have several other databases for parallel sustainability-related initiatives. Without integrating THEMS into existing databases, the users expressed concerns about fragmented and potentially duplication of effort. To address this, THEMS has been designed to be interoperable with existing and future databases via a common API, enabling seamless data exchange between THEMS and other systems.

• Data: There is large variation in how healthcare facilities currently record their resource consumption data including the units in which they are measured. As THEMS uses common metrics, difference in practice across healthcare facilities means data have to be converted into the specified units before they can be entered into THEMS.

• Policy demand: THEMS has survived several leadership changes largely because (i) the objectives are aligned with national goals to decarbonize healthcare and the country as a whole and (ii) the initiative is being co-led by a government institution.

• Collaboration: Despite initial concerns, THEMS has received continued support from healthcare facilities in the development and pilot phase – largely owning to ongoing advocacy and collaboration with other relevant authorities such as DCCE and Thailand Greenhouse Gas Management Organization (TGO). Furthermore, support from international partners like HCWH and Centre for Sustainable Medicine (CoSM) has helped legitimize the system at the international level.

• Availability of funding: While this is a government driven initiative, development of THEMS and associated activities are being supported by Thailand Science Research and Innovation (TSRI) which has enabled HAD to receive technical support from HITAP and flexibility in operations.

The following overarching recommendations can be drawn from the THEMS experience in Thailand:

• Goal setting: Tracking emissions will be more effective if healthcare facilities are working towards a certain goal. In Thailand, the MOPH aims to cut health sector emissions by 80,000 tons CO₂-eq annually. Such targets may prompt urgent action, measure performance, and ensure accountability.

• Practical over perfection: While the adoption of a universal template for baselining enhances comparability, one size does not fit all. Each country differs in terms of data availability, health system functionality, technical capabilities, etc. Hence, internationally recognized templates should be tailored to local settings such that they are fit-for-purpose.

• Stakeholder engagement: Early engagement with relevant institutions to map existing foot printing or sustainability related initiatives can help avoid fragmentation, reduce duplication of efforts, and help integration with ongoing initiatives. Therefore, building networks, communicating, and exchanging information between departments or agencies is crucial.

• Capacity building: While decarbonization is gaining momentum, it remains a relatively new concept in the healthcare sector. Therefore, ongoing advocacy among healthcare policymakers and facility executives, along with continuous training for healthcare staff, is essential to ensure sustained progress.

• Thai Hospitals Emissions Management System (THEMS):
• Press release on THEMS
• Policy brief on THEMS (TH)
• Policy brief on the first baseline study in Thailand (TH)
• 4.5. Full report for the first baseline study in Thailand (TH)
• 5.6. About the Low Emission Support Scheme (LESS)

For more information or collaboration, please contact the Environmental Economics Unit (HITAP) at envecon@hitap.net. 

This case study was developed by:

• Health Intervention and Technology Assessment Program Foundation (HITAP): Wilasinee Samniang, Thanakorn Jalearnkittiwut and Sarin K C
• Health Administration Division (HAD), Office of the Permanent Secretary, Ministry of Public Health, Thailand: Phimpha Phasawang, Virawan Muangpratab

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.