An AHP-Based Multicriteria Framework for Evaluating Renewable Energy Service Proposals in Public Healthcare Infrastructure: A Case Study of an Italian Hospital

Public healthcare infrastructure is among the most energy-intensive of public facilities; therefore, it needs to become more environmentally and economically sustainable by increasing energy efficiency and improving service reliability. Achieving these goals requires modernizing hospital energy systems with renewable energy sources (RESs). This process often involves Energy Service Companies (ESCOs), which propose integrated RES technologies with tailored contractual schemes. However, comparing ESCO offers is challenging due to their heterogeneous technologies, contractual structures, and long-term performance commitments, which make simple cost-based assessments inadequate. This study develops a structured Multi-Criteria Decision-Making (MCDM) methodology to evaluate energy projects in public healthcare facilities. The framework, based on the Analytic Hierarchy Process (AHP), combines both quantitative (net present value, stochastic simulations of energy cost savings, and CO2 emission reductions) with qualitative assessments (redundancy, flexibility, elasticity, and stakeholder image). It addresses the lack of standardized tools for ranking real-world ESCO proposals in public procurement. The approach, applied to a case study, involves three ESCO proposals for a large hospital in Southern Italy. The results show that integrating photovoltaic generation with trigeneration achieves the highest overall score. The proposed framework provides a transparent, replicable tool to support evidence-based energy investment decisions, extendable to other public-sector infrastructures.