The COVID-19 pandemic made one thing clear: poor indoor air quality in buildings can be dangerous. In many hospitals, inadequate ventilation became a fast track for the airborne spread of the virus.

Research shows the virus can survive in the air for several hours, with droplet transmission worsened by poorly designed air-conditioned spaces.

Yet despite these lessons, many hospitals in developing countries still depend on split-type air conditioning units. These systems lack advanced filtration, cannot manage positive or negative pressure in critical areas, and often fail to circulate fresh air. The result is higher risks of infection and lower levels of comfort for patients and staff, as well as higher electricity bills.

Hospitals are among the most energy-hungry buildings in any country. They operate around the clock and require controlled conditions for operating rooms, emergency units, and intensive care facilities.

Cooling, heating, and lighting all demand large amounts of energy. Rising global temperatures compound this challenge, as hospitals must prepare for more frequent and extreme heat events and poor outdoor air quality, particularly in South and Southeast Asia.

This creates a dilemma: the very systems needed to protect patients and staff from airborne diseases and heat (air conditioning units) are also a major driver of energy demand. This also presents an opportunity to solve both issues in one go.

Modern centralized cooling systems can dramatically improve both patient health and energy efficiency. Features such as variable refrigerant flow, smart controls, and proper zoning can reduce energy use while also providing the filtration and air quality hospitals require, in line with international health standards.

For existing hospitals, additional savings can be achieved through building retrofits such as better insulation and reflective roofs. Far from being competing goals, health protection and energy efficiency can be achieved together.

The Philippines offers useful insights into how developing countries can tackle this dual challenge. The Philippine government has recognized the importance of energy efficiency in hospitals, but progress has been slow without the necessary expertise and resources.

Programs such as the Green and Safe Hospitals initiative helped raise awareness, but bridging health sector needs with technical energy knowledge and investments required new approaches. A breakthrough came through collaboration across government departments.

The Department of Health partnered with the country’s Department of Energy to explore hospital air conditioning systems that were both disease-resilient and energy-efficient.

Modern centralized cooling systems can dramatically improve both patient health and energy efficiency.

This partnership revealed three important lessons:

Strong leadership spurs action. Institutional leadership matters. The Department of Health used its authority to embed energy efficiency into hospital standards and to convene discussions with the Department of Energy and other stakeholders.

These efforts led to an agreement between the agencies to expand energy efficiency and renewable energy technologies in health facilities. This shows how leadership from the health sector can drive cooperation across government.

Data turns awareness into policy. Detailed energy audits in four government hospitals exposed widespread inefficiencies. At one hospital, both split-type and central air conditioning units had to run at the same time just to cool the radiology department.

In other cases, simple issues such as open doors, poor space management, and neglected maintenance caused unnecessary energy waste.

The audits also revealed quick wins. At one facility, switching to an appropriate centralized system could produce significant energy savings. They also highlighted the importance of proper hospital zoning: operating rooms need positive pressure, isolation wards need negative pressure, and general areas require different levels of filtration. Split-type air conditioning systems cannot provide this, leaving hospitals vulnerable to infections.

By putting data on the table, the audits gave decision-makers the evidence they needed to prioritize investment and policy reform. Similar systematic approaches have been successfully implemented in Sri Lanka, demonstrating the regional applicability of these solutions.

Building capacity for the long term. Lasting change requires local expertise. The Department of Health requested training and accreditation for green building professionals to scale up technical assistance across hospitals. It also began working with theDepartment of Energy on training hospital managers and other staff.

Building in-house capacity ensures that energy-efficient and resilient hospitals can be sustained and replicated across the country.

The Philippine experience offers practical solutions that other developing countries can adapt. One approach is to embed energy efficiency and indoor air quality in hospital standards, such as making energy-efficient systems a requirement in health regulations.

Another is to use audits to guide investment, since systematic reviews of existing facilities highlight where energy is wasted and where savings can be achieved combined with improved filtration systems. Hospitals can also adopt centralized systems with smart controls, which provide both infection control and efficiency, addressing health and energy needs together.

For existing facilities, retrofits including improved insulation, better space management, and reflective roofing such as white coatings or light-colored materials can significantly reduce cooling loads.

Building technical expertise within the health sector through training ensures long-term sustainability, while collaboration, particularly between health and energy agencies, is essential for progress.

Hospitals are trusted institutions, present in many communities and staffed by professionals committed to public welfare. They should also be models of how buildings can protect health of their staff and users while reducing energy demand.

Safer and more efficient hospitals are possible when strong leadership, solid data, and long-term capacity building come together with investments which deliver both health and economic benefits.

For developing countries across Asia and the Pacific, investing in better air systems is not just about protecting patients and staff today, it is also about building resilient health systems for the future.