- A hospital’s sustainability begins before construction: planning and design decisions determine its costs, efficiency, and performance for decades, and investments in efficiency measures can pay for themselves in less than seven years.
- Managing infrastructure as an asset throughout its life cycle helps reduce operating costs, optimize maintenance, and plan the investments needed to ensure long-term performance.
- Efficient, resilient hospitals are better prepared to maintain services during emergencies and adapt to demographic, epidemiological, and technological changes.
In Latin America and the Caribbean, hospitals are around 60 years old on average, and many facilities providing highly complex care are more than 100 years old. Their age increases operating and maintenance costs and limits hospitals’ ability to respond to new health needs.
The sustainability of hospital infrastructure begins with planning and design, and encompasses decisions that determine how a hospital is built, operated, maintained, and adapted throughout its useful life.
To advance toward sustainable hospitals, countries must act across three dimensions: reducing energy and water consumption, managing infrastructure throughout its life cycle, and strengthening its resilience to emergencies and future changes. Studies by the Inter-American Development Bank (IDB) show that these decisions can reduce costs and improve the continuity of health services.
Hospitals consume large amounts of energy and water. They operate continuously and must meet strict requirements for temperature control, ventilation, and the operation of equipment and specialized systems. Although health care buildings account for around 4% of the floor space in nonresidential buildings, they consume nearly 9% of the total energy used by these types of buildings. This consumption presents both an environmental challenge and an opportunity to improve health system efficiency.
In this context, small efficiency improvements can generate significant cumulative savings, especially when incorporated into the early stages of planning and design. Passive measures, such as building orientation, protection from solar radiation, thermal insulation in walls or roofs, and the use of vegetation for shade, reduce energy demand.
Active measures, such as optimizing heating, ventilation, and air conditioning systems, using efficient lighting, and reusing water, help reduce resource consumption and operating costs over time. Certification systems such as LEED or EDGE provide objective criteria for assessing energy efficiency, resource use, and the environmental quality of infrastructure.
These savings have a direct impact on public budgets, as the resources freed up can be allocated to improving patient care or expanding coverage. This is especially relevant in a region facing significant and growing fiscal constraints.
An IDB study that assessed health infrastructure in eight cities in the region estimated that the additional investment in energy and water efficiency measures could be recovered within periods of up to 6.2 years, depending on the climate, facility type, and solutions selected. For existing hospitals, the most cost-effective package of measures achieved payback periods of around 4.3 years.
One of the most significant challenges is moving from a short-term perspective focused on construction to a long-term perspective of 30 to 50 years that considers the entire life cycle of a hospital’s assets. In fact, the initial investment is only part of the costs that infrastructure generates during this period, which also include operations, maintenance, replacements, and future adaptations.
Early design decisions directly shape future performance. Factors such as the building’s thermal performance, the selection of heating, ventilation, and air conditioning systems, the flexibility of spaces, and accessibility for maintenance purposes can significantly reduce operating costs and improve the hospital’s ability to adapt over time.
In this context, digital tools such as BIM (Building Information Modeling) make it possible to integrate all information about an infrastructure asset and manage it from design and construction through operations and maintenance. These models bring together data on architecture, structure, building systems, and materials in a single platform. This improves coordination among teams, reduces errors and clashes during design, facilitates estimates of materials and costs, and enables planning for preventive maintenance and future investments.
Under this approach, the hospital is managed as an asset over time, extending the project’s scope beyond the handover of the completed building. This improves operational efficiency and reduces the risk of failures in critical systems, both of which are essential factors in ensuring service continuity.
Resilience is an essential requirement for hospitals, which must continue operating during natural disasters, health emergencies, and other critical events. But resilience also involves the ability to adapt to demographic, epidemiological, and technological changes.
Population aging, the rise in chronic noncommunicable diseases, and the emergence of new health threats are changing care needs. Investments must therefore consider long-term scenarios from the outset. This requires flexible spaces that can be repurposed as demand changes. It also requires planning hospital capacity based on long-term projections and using construction systems that facilitate future expansions or modifications without disproportionate costs.
Infrastructure designed solely to meet current needs can quickly become a constraint on health systems. The lessons of the pandemic reinforced this need: an IDB regional analysis identified flexibility and adaptability in health facilities as central attributes for responding to future health crises.
Achieving this change requires strong institutional frameworks and updated regulations and standards that incorporate criteria for performance, sustainability, and asset management throughout the infrastructure life cycle.
To advance toward sustainable hospital infrastructure, countries can incorporate efficiency criteria from the preinvestment stage, assess costs throughout the entire life cycle, and require designs to address operational continuity, flexibility, and adaptation.
These decisions are interconnected. A hospital that consumes fewer resources reduces its operating costs. Life cycle management makes it possible to anticipate maintenance and replacements. A resilient, flexible design helps maintain services during emergencies and respond to new needs.
The evidence shows that some efficiency measures can pay for themselves in less than seven years, while inefficient design, operations, and maintenance decisions generate costs for decades.
At the IDB, we work with countries in the region to strengthen hospital infrastructure planning and management. Our approach recognizes hospital infrastructure design, planning, and management as strategic decisions that determine the sustainability of the health system as a whole.
The following resources and courses offer tools to put these approaches into practice (available in Spanish):
- Project Management for Innovation in Social Infrastructure
- Hospital Preinvestment Studies
- Health Investment Master Plans with a Network Approach
- Public-Private Partnerships in the Health Sector
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