Systemic sustainability and resilience assessment of health systems, addressing global societal priorities: Learnings from a top nonprofit hospital in a bioclimatic building in Africa

Health services represent a cornerstone to ensure well-being and human rights, particularly in deprived areas. The resource cost and appropriate use for the implementation of a top-quality hospital in Sudan are here investigated. An emerging approach such as systems-based Emergy Accounting is applied to assess its sustainability and resilience, also relying on Life-Cycle Assessment data to calculate some new unit emergy values. Very few similar studies have addressed civil works so far, even less bioclimatic buildings, while the focus on health systems is an absolute novelty. Particular attention is paid to design in adverse climate and economic conditions, to the humanitarian nongovernmental organisation running the hospital, and to the cutting-edge medical staff and technologies imported from abroad, also letting local practitioners train in excellence medicine. The system's direct and indirect socio-ecological requirements are expressed as emergy (resource investment) per patient-day, per cardiac surgical operation, per outpatient visit, and per year. From a quantitative viewpoint, these indicators represent a benchmark for improvement scenarios, comparison with new studies in a deserving field, and future investments, driven by effective healthcare policies. They also provide an overview of the efforts required by nature and society to ensure a human right in conditions of scarcity. Besides the possibility to lower a hospital's environmental impact (sustainability-oriented) and to keep it functioning over time in changing climate, resource, societal, economic, and geo-political scenarios (resilience-oriented), this study leads to original remarks upon societal priorities and upon the challenges of guaranteeing high-quality health systems in an uncertain century.