Enabled by the power of digital technology and data, Global Surgical Initiatives' (GSI) flagship centre, the Kyabirwa Surgical Centre (KSC) in eastern Uganda, is demonstrating the feasibility of adapting to, and mitigating, the impact of climate change while filling 80% of the local surgical care gap. Established in 2019 by members of the Mount Sinai healthcare system (USA), KSC is a woman-led center of excellence for research, training and care providing safe, quality, and affordable ambulatory general surgery, laparoscopic and endoscopic procedures, fully powered by renewable energy (solar and collected rainwater). Leveraging the power of fiber optic and mixed reality technology such as Microsoft's HoloLens, KSC builds local surgical workforce capacity through remote telementoring, including telesurgery, teleradiology, and telepathology, effectively connecting surgeons at Mount Sinai hospital in New York to those in the operating room at KSC. The use of cloud-based technology further enables the management and use of electronic health records to capture, track, and report on clinical and energy outcomes. Health and energy data are used to improve care quality and efficiency, and track energy usage and savings. In 2023, linked health-energy outcomes were sold on the financial market as a health distributed Renewable Energy Certificates (d-REC) bundle, creating a mechanism for KSC and other Uganda-based solar healthcare facilities to sustainably support their operation and maintenance costs. Since its inception in 2019, KSC has completed over 4000 surgeries, trained 11 surgeons, reached over 3,800 individuals across 124 villages through its community outreach program, and resulted in a net impact of over $USD 3 million (calculated as the saved productivity from averted Disability-Adjusted Life Years minus the operating cost of the surgical center). KSC has, and is, developing supporting mobile apps to (i) track and address post-operative outcomes at community-level and (ii) optimize surgical healthcare workflow.

https://www.kyabirwasc.org/

• Kyabirwa, Jinja, Uganda

• Youth
• Older persons
• Women
• People with disabilities
• The unemployed
• The poor
• Remote and rural communities
• Adolescent
• Adult
• Children between 5 and 12
• Children under 5
• Elderly
• New born
• Pregnant women

The KSC model is replicable to any public or private healthcare facility in low- and middle-income countries, or resource-limited settings in high-income countries, operating primarily off-grid. Additional replication requirements include digitally accessible and auditable health and energy data (powered by connection to fiber optic, minimum 4G), a fit-for-purpose operation and maintenance (O&M) structure, and funding directly accessible by the healthcare facility and O&M providers. It is also worth noting that this model could be replicated across health (not limited to surgical care) and social areas (e.g., education, employment).

This project is operationally, financially, environmentally, and socially sustainable. As indicated in the Description section of this submission, linked health and energy outcomes are sold on the financial market through the issuance of (health) distributed Renewable Energy Certificates (d-REC). d-RECs can be sold as either health or energy outcomes alone, or as health d-RECs when linked. Funds secured through (health) d-REC transactions are directly and fully re-invested into the healthcare facility (in this case KSC and other Uganda-based solar healthcare facilities), supporting all healthcare facility operation and maintenance costs, and directly contributing to re-orienting global capital to climate and health action. d-REC transactions can support healthcare facilities at subnational, national and/or potentially regional levels. It is also worth noting that 95% of all voluntary RECs are currently purchased in the USA and Europe. Through its Uganda health d-REC bundle, GSI has taken a step towards opening up the REC market in LMICs and effectively providing a sustainable mechanism for public and private actors (including governments) to mobilize funding.
Finally, KSC is both environmentally and socially sustainable; it is woman-led and was built in close partnership with the local community, government, and the public healthcare sector, using only local materials and locally procurable supplies, and exclusively employing a local workforce. Its green architecture is fully powered by renewable energy (solar and collected rainwater).

As a fully renewable energy powered healthcare facility, KSC provides a solution to both adapt to, and mitigate, the deleterious effect of climate change on health. Its completely green architecture and use of solar power and collected rainwater directly align with WSIS' respect for nature. By offering access to affordable, quality, and safe surgical care in rural and remote communities, including to the most vulnerable (e.g., the most poor, women, children and adolescents, those living with a disability, the elderly), KSC supports financial and social freedom by preventing years lost due to disability and enabling individuals to return to work or school. KSC is a community-driven healthcare facility - it engages community members to understand their needs and develops services, programs (e.g., women's surgical health programs) and payment structure accordingly, directly supporting gender and social equality. KSC is the result of a multi-cultural, inter-jurisdictional, transdisciplinary, and intersectoral collaboration. Surgical, health, and non-healthcare personnel collaborate, dialogue, and solve problems across countries, professions, and functions to achieve the common goal of providing access to affordable, safe, quality care for all in the communities KSC serves. From the janitor to the chief surgeon, KSC is the demonstration of commitment to excellence through true human solidarity, tolerance and shared responsibility.