Solar holds promise for remote health facilities, but key gaps remain

NAIROBI – An estimated 41% of health care facilities in low- and middle-income countries have reliable electricity. Stand-alone solar units are playing a key role in increasing access to electricity, but often lack proper funding for follow-up and maintenance after installation.

At the United Nations Foundation "Clean Energy for Health Care" conference this week in Nairobi, Kenya, speakers noted that donors were often willing to help provide access to off-grid solar units, but the lack of follow-up was hurting the health facilities that initially benefited from the sustainable energy and are leaving solar power systems sitting around unused years after installation.

“That is probably the biggest problem with solar systems in development,” said Jeff Lahl, project director at the Solar Electric Light Fund. “Funders like to fund the actual installation but they don’t like to fund the operations and maintenance costs going forward.”

When health facilities don’t have electricity, vaccines are left without refrigeration, medical devices aren’t charged, emergency care is provided in the dark, or not at all, and health workers are left to operate in unsafe working conditions, they said. It’s also more difficult to attract and retain quality health staff under these conditions.

“This compromises the ability of health staff to provide services,” said Jem Porcaro, senior director for energy access at the U.N. Foundation, which released a report Thursday, “Lasting Impact: Sustainable Off-Grid Solar Delivery Models to Power Health and Education,” analyzing case studies of existing off-grid solar projects.

Many in the development community have focused on these small-scale solar units in places where the grid doesn’t reach because they are more cost-effective and more environmentally friendly than the alternatives, including diesel-powered generators.

But experts say a key oversight is sustainable funding for maintenance in the years that follow.

Maintenance can include anything from routine check-ups to replacements of parts such as the batteries or inverters. Monitoring these systems can even be done remotely. A stand-alone solar unit, if maintained properly, should last about 15 years, said Christine Eibs Singer, senior associate at Catalyst Off-Grid Advisors.

“That’s why there is a lot of unused solar systems around the world, especially in Africa,” said Lahl. “They work fine for a number of years. In fact, they require very little maintenance compared to a generator. But when the battery wears out, there is generally no money set aside to replace that battery.” A battery can need replacement in anywhere from four to 10 years, he said.

Rahul Srinivasan, an energy specialist at the World Bank, said he visited a health center in sub-Saharan Africa last year and was told it had been empty for two weeks because the solar units were not working and nobody from the government had come to fix them.

Private and public sector solutions

Ideally, governments would include operation and maintenance costs into their national budget, Lahl said.

“But they have a hard time doing that,” he said. “They are struggling to pay their nurses or to find money for needed medicine. This becomes just another budget item that they can’t meet.”

Because of this, the private sector plays a critical role, Srinivasan explained. Ideally, the private sector would procure and install the solar units, but also have a 10 to 15-year operations and maintenance contract for upkeep.

But for companies, this can be a risk because a government might not pay them for the services provided.

One effort to create more of an incentive to the private sector is the World Bank’s Regional Off-Grid Electrification Project that works with 19 countries in West Africa. One component of the project includes electrifying community institutions like health facilities. To do this, the World Bank will implement risk-mitigation mechanisms and guarantees for the private sector hoping to create an incentive for investing in these operations and maintenance costs.

The World Bank, for example, could set up a guarantee with a country’s ministry of health to help cushion the private sector if the government couldn’t pay companies for operation and maintenance costs.

The bank is currently in the beginning phases of these efforts in Nigeria and Niger but aims to scale it to other countries in the future.

Key to this project’s success is a government’s willingness to prioritize and create a favorable regulatory environment for these projects to grow, said Raihan Elahi, lead energy specialist at the World Bank.

There is also a crucial need for the energy and health sectors to increase coordination, the U.N. Foundation’s Porcaro said.

“We often work in silos,” he said. “The health sector often doesn’t think about energy as an issue that is important to them. And the energy sector is in the business of supplying electricity to a country but often doesn’t have a good sense of the energy needs of the health sector,” he said.

Ultimately, there is no one-size-fits all solution to this problem, said Eibs Singer.

“It’s very contextual to the stakeholders involved, to the country context and to the strength of the public sector partners,” she said.