Lighting the Path to Health Equity: Decentralized Renewable Energy for Universal Health Coverage
Last week, for the first time, the Conference of Parties, which concluded on 12 December 2023 in Dubai, UAE, hosted a Health Day, recognizing the interlinkages between climate change and health. Over 120 countries signed the COP28 UAE Declaration on Climate and Health emphasizing climate action and accelerating, climate-resilient and equitable health systems.
Today, as we celebrate Universal Health Coverage Day, it is important to underscore the need for access to sustainable, reliable, and affordable sources of electricity in rural health facilities.
Earlier this year, a joint report by the World Health Organization, the World Bank, the International Renewable Energy Agency and Sustainable Energy for All estimated that globally, nearly one billion people access health facilities that are either unelectrified or have unreliable electricity.
In India alone, the Rural Health Statistics (2021-22) revealed that over 18,000 sub-centers and primary health centers were functioning without an electricity connection. To bridge this energy access gap, decentralized renewable energy (DRE) has emerged as a viable solution to power rural and remote health facilities. However, to scale this solution, there is a need to showcase evidence that can help identify both best practices and challenges.
To build local evidence base, WRI India undertook a study that explores the role of DRE interventions in rural health facilities and studied its linkages to provisioning of health care services, especially for underserved populations. Out of 3,000+ health facilities that have been solarized by various government and select non-government agencies, the study looks at a sample of 22 facilities across six Indian states - Assam, Chhattisgarh, Jharkhand, Meghalaya, Karnataka and Odisha.
The facilities studied represent a variety of geographic locations, number of patients served, affordability of health care services provided, tiers of health care, and DRE powered electricity solutions adopted.
The study analyzed the various processes in the DRE project life cycle: site selection, need assessment, solar energy system sizing, financing requirements, selection of technology provider, and capacity building. Eighty percent of the health facilities surveyed already had an existing grid connection and reported varying hours of power outages, where a variety of decentralized solar energy configurations were connected. The report also threw up some interesting findings:
Health facility staff reported several benefits in terms of staff satisfaction, fewer blackouts and greater energy and fuel savings. Facilities that were earlier unelectrified were now able to commence critical medical functions such as vaccine storage and functioning of laboratory services. Further, staff believed that additionally connecting decentralized energy systems with the health staff quarters would greatly improve their quality of life.
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While energy system sizes across multiple facilities of the same tier remained similar, the size of population served, disease profiles addressed, and types of services provided varied.
Procurement of DRE solutions have generally followed the least-cost bidder method. However, the adoption of a quality cost-based system (QCBS) can ensure the most technical and financially compliant solution is chosen.
After installation, the focus shifts to operations and maintenance (O&M). Although medical staff are aware of the need for routine maintenance of solar panels and batteries, the frequency of timely maintenance is unclear due to various reasons.
Here, identifying the right stakeholders within the health facility to maintain the solar energy system becomes crucial. Some states have adopted public-funded service teams who conduct monthly field visits, thereby freeing up health facility staff from this task. Simpler awareness-building measures, like posters displaying contact details of technology providers and establishing dedicated customer care helplines for solar-related issues, have proven effective in facilitating the adoption of these measures, even by new staff.
Financing electrification at health facilities is the need of the hour. The Ministry of Health and Family Welfare (MoHFW) through the renewed Indian Public Health Standards and under its flagship program, the National Programme on Climate Change and Human Health, has paved the way for states to include green and climate resilient health facilities.
States should leverage this opportunity to solarize health facilities with poor or no electricity provision, along with the use of existing flexible and state-specific budgets such as District Mineral Funds, Local Area Development Schemes etc.
Combining data from existing health MIS systems with geospatial mapping exercises can help prioritize health facilities that need to be electrified and assess their need based on which systems can be designed.
Public budgets also need to be supported by philanthropy and corporate social responsibility (CSR) funds, especially for not-for-profit hospitals providing affordable care to underserved populations. Here, there is a need for extended-term capital financing.
As we mark Universal Health Coverage Day, ensuring access to sustainable electricity in rural health facilities is imperative. WRI India’s study, 'A Spoonful of Solar to Help the Medicine go Down: Exploring Synergies Between Health Care and Energy' emphasizes the positive impact DRE has on health services, underscoring the need for strategic financing, informed decision-making, and collaborative efforts to bridge the energy-access gap in healthcare.