The Belgian National Environment and Health Action Plan (NEHAP) provides a global, coherent framework for action in environment and health at all institutional levels in Belgium.
The 1st NEHAP was adopted on 3rd April 2003, followed by a 2nd version and now a 3rd update (currently ongoing). NEHAP offers a reference framework and toolbox for action. Within its framework, the federal government and governments of the federated entities (through the National Environmental and Health Cell, set up to support implementation and monitoring) support related policies at national level.
Previous versions did not have a coordinated national level policy for the sustainability of the health system. The 3rd plan will map policies and projects related to decarbonisation of health systems in Belgium, in order to develop a roadmap and specific projects at national level for more sustainable health sector. Some policy developed at the regional level that feed into this are:
- Adoption of new sustainability and resilience norms for hospitals and Greening the Health care section (Brussels)
- The 2017 Climate Engagement; the 2023 Sustainable Care Green Deal (Flanders)
- Sustainable and energy efficiency norms for care institutions (Wallonia)
The roadmap will be designed following Healthcare Without Harm methodology and guidance and will include governance issues, baseline data, a trajectory towards reduction of GHG emissions from the healthcare sector and monitoring.

The Roadmap forms an integral part of the HSE Capital & Estates Property Strategy and Implementation Plan and the wider Climate Action and Sustainability Strategy.
The objective of the Roadmap is to set out how the HSE will deliver on its energy efficiency and emissions reduction targets. The Roadmap is the pathway by which the body will implement the Climate Action Mandate.
The Infrastructure Decarbonisation Roadmap identified seven key action areas to continue, enhance and expand on the work and progress made to date. Progression of these action areas provides a Roadmap for the HSE to achieve the targets set out in the Climate Action plan and to comply with its mandated obligations. The Roadmap builds on the approach to date to reduce the HSE’s existing energy usage load and shift the HSE’s use of energy away from fossil fuels and towards renewable and carbon zero energy sources.
Within DAPHNE, we address 3 out of the seven action areas, as follows:
• Action Area 2: Regional Energy Bureau, Energy Management Teams, Green Teams and Shallow Retrofit Programme
• Action Area 3: Energy Efficient Design (EED) Process and Towards Carbon Zero Design (TCZD)
• Action Area 4: Deep Energy and Carbon Retrofit Programme including Pilot Pathfinder Programme
The Roadmap includes detailed sub-actions (with timelines) outlining how the above action area will be addressed in the short to medium term. The Roadmap actions are funded through the HSE’s annual capital plan.

In continuity with the 2014-2020 programming and in coherence with the Regional Environmental and Energy Plan (PAER), the region intends to activate energy efficiency measures for public structures that can contribute to achievement of European targets.
The ERDF Tuscany Regional Programme 2021-2027 promotes measures that support energy efficiency interventions in public structures, including healthcare facilities, to reduce energy consumption.
Priority 2 - Ecological transition, resilience and biodiversity, with its “Specific Objective 2.1 - Promoting energy efficiency and reducing greenhouse gas emissions” supports the financing of energy efficiency measures for public buildings and the reduction of primary energy consumption in public buildings and facilities. Eligible interventions include thermal insulation, replacement of windows and doors, replacement of air-conditioning systems with heat pump systems, replacement of traditional water heaters with heat pump or solar collector water heaters for production of domestic hot water, and passive air-conditioning systems (shading systems, filtering of solar radiation, etc.). In addition to these, interventions for the installation of intelligent and integrated remote control, regulation, management, monitoring and optimisation of energy consumption and polluting emissions, and for the production of electricity and heat from renewable energy sources for self-consumption may also be carried out.

NE RP 2021-27 was approved on 21.10.2022 and is to be managed by the North-East RDA as Managing Authority. PA 3, RSO2.1 supports transition to low-carbon economy through EE measures in public buildings eligible in both urban and rural areas and residential buildings in urban areas only (Tot budget 233.7 M€). Estimated opening of the 1st call of proposal is Oct 2023. The projects must respond to a local community territorial strategy or a plan for improving EE, mainly aiming at the rehabilitation of buildings with low energy performance and high annual energy consumption.
By statistics, the region registers 1,001 public-owned healthcare units, of which the most relevant and targeted by the policy instrument are 49 public hospitals including their integrated outpatient clinics, 350 school medical offices, 311 medical labs, etc. Healthcare is also a sector promoted in the RIS3 NE strategy. Investments in digitalisation of the medical sector, such as electronic registers & diagnosis, data reporting statistics, scheduling surgical interventions, etc, will also be supported. Other interventions will implement and combine a functional-spatial layout of a modern healthcare facility with adaptability, flexibility, and responsiveness. These features can be guaranteed only by buildings with optimised configurations, which will assure the ability to respond to sudden changes and shifting needs in real-time and in direct line with the European Green Deal principles.

The Policy Objective addressed within the Regional Programme "Thessaly 2021-2027" is priority 2: Environment and Resilience, Specific Objective 2.1: Promoting energy efficiency measures and reducing greenhouse gas emissions, Action: Energy upgrading of public buildings.
The action concerns the upgrading of public buildings in Thessaly, with the possibility of integrating RES and continues the corresponding action implemented in Thessaly 2014-2020 programme in the context of which many public buildings were upgraded in terms of energy. The aim of the action is to improve the energy efficiency of buildings in accordance with the Energy Performance Code.
Indicative buildings covered by the action are education and public health infrastructures, buildings administration buildings, courts, prisons, etc.
Focusing on the efficiency of the intervention, priority is given to the energy upgrade of public buildings with low energy class and high energy consumption through the adoption of energy efficient systems for space cooling and heating and hot water production as well as energy saving technologies. The upgrades may involve interventions in the building envelope (thermal insulation), replacement of frames, supply of energy efficient lighting, etc. in accordance with the energy upgrade study to be carried out for each building.
Priority 2 has a total budget of €17.8 million euro.

The SEAP sets the framework of the strategy for achieving the City of Elk's CO2 reduction goals and responds to the national low-carbon policy. It also takes into account the local conditions and aspirations of the city. This is the strategic goal: “Maintaining low-carbon economic development and satisfying the needs of the community”. In this context, the policy should support economic and social progress of the City of Elk, proceeding with no or minimal increase in demand for primary and final energy.
The numerous specific goals of SEAP identify priority areas in which the city can take measures to reduce CO2 emissions. The measures proposed include the following sectors: public buildings, municipal infrastructure housing, services and transportation.
The actions included in the plan do not focus directly on the health sector. SEAP measures include, among others, “Improving energy efficiency through complex thermomodernization of public buildings”. As the hospital in Elk is a municipal public building, it can be included in this measure. In addition, the measure “Green roofs and living walls - thermomodernization of roofs and walls of buildings”, includes public buildings such as hospitals.
As all EU Signatories of the EU Covenant of Mayors, Elk City is now facing the challenge to upgrade the SEAP and turn it into Sustainable Energy and Climate Action Plan (SECAP) by mid-2025, aligning with new emissions-reduction targets and timeframes, and integrating adaptation measures.