We know electricity is essential for delivering health care worldwide. It’s not just for clinics but also for cold chain support for vaccine storage, warehousing, laboratories, waiting areas, water, equipment, records management, and more. Still, less than 30% of health facilities in sub-Saharan Africa have reliable access.
One of the promising solutions for health facility electrification is off-grid solar photovoltaic, or PV, systems, particularly in rural areas where most are far from the grid. We’re seeing many new initiatives with ambitious targets to connect thousands of facilities to solar PV. Yet, what percentage will still be operational in one year, three years, or five years? If we’re not addressing its durability, we’re putting the intended social impact of improved health outcomes for potentially millions at risk.
We’re also undermining the co-benefits of PV systems such as carbon avoidance and digital connectivity. Installing these systems is not always the challenge; it’s making them reliable. This is often overlooked or tasked to someone else to worry about because it requires a systems-thinking approach — connecting institutions and creating relationships that will affect the demand and supply of power — that complexifies the otherwise straightforward task of connecting the facilities to solar.
Boosting reliability
By making reliability a cornerstone of health electrification, we can avoid some of the unintended impacts and implications such as declining access to health services, vaccine waste, lower retention of health workers, or return to diesel generators. Operations and maintenance, or O&M, is fundamental to the reliability of solar PV systems. We often take for granted that daily management and normal repairs will take care of themselves. But for a health facility, the interruption of these PV systems can be life-threatening.
While not exhaustive, here are three ways to help boost reliability:
1. Pick sites with markets.
Budget constraints tend to limit the government’s ability to fully subsidize PV installation and/or the O&M for health clinics. This is particularly challenging for Africa’s remote communities dependent on rural health posts and clinics. Selecting locations for PV systems is more than just the site’s physical condition; it’s also about the surrounding market where the health facility is located. In other words, there should be productive uses, such as agriculture or night markets, and customers for the generated power that can support the PV system’s upkeep. In many cases, rural health clinics in sub-Saharan Africa can’t pay for the power or repairs because they don’t always generate revenue from health services. To subsidize the maintenance, you may need an anchor business or active enterprises willing to pay for the connectivity to keep the PV system running for the health facilities.
This is the approach of the Partnership Initiatives in the Niger Delta’s Access-to-Energy project. The certainty of demand and supply is the basis of PIND’s delivery model. Demand-side market analysis identifies the communities and productive uses, which informs site selection. An added value of market analysis, as in the case of PIND, is the opportunity to educate and shape the decision processes of third parties around what’s an ideal location and the reasons why. This preempts the tendency of third parties to preselect sites that turn out to be less than optimal.
2. Standardize your designs.
To improve health outcomes in sub-Saharan Africa, PV systems need to be scaled to reach thousands of rural facilities, and having several contractors involved is prudent. However, if different contractors are producing multiple designs, these PV systems will vary significantly, making the installation and O&M inefficient, time-consuming, and more expensive. One issue that arises is that you’re engaging with numerous providers with different standards and pricing. When we standardize technical requirements, guidelines, characteristics, and more, we integrate, streamline, and optimize the O&M, which can bolster the system’s performance to deliver power more reliably, resulting in more consistent quality and access to health services.
3. Future-proof procurement.
Initial prices from PV equipment providers are not always dependable. In other words, whatever you negotiate today may not be the cost tomorrow. This is particularly relevant in the current economic environment of inflationary pressures and other factors. According to Energy for Growth Hub, unsubsidized solar costs in Ghana are 140% higher than in the U.S., and risk premiums are increasing. This matters because any significant delay is an opportunity lost to save a life or make someone healthier.
Once suppliers are preapproved, do an advanced purchase of material and equipment, including surplus orders to head off future damages or replacements, focusing on items that have long lead times or that are required at the start of installation.
Logistics is another complicating factor for these last-mile communities, including transportation routes, natural hazards, social instability, storage, and more. It’s less of a concern for a few PV installations handled by local contractors, but at scale, early strategic planning is critical to managing these uncertainties in order to get the right resources and equipment to the sites.
The scale and reliability of health facility electrification enable millions to access health services and solar connectivity is part of the solution. It’s also a pathway to strengthen the region’s health and climate resilience.
Global engineering and construction companies such as Bechtel have a unique set of experiences, competencies, and resources to help tackle this challenge. Our relentless focus on infrastructure quality and delivery, controlling the critical path for scaling up, and shoring up local capabilities can be an important contribution to any partnership effort to electrify health facilities.
Visit bechtel.org to learn how Bechtel is using its infrastructure capabilities to deliver social impact.
About the author
Tam Nguyen
Tam Nguyen has over 20 years of progressive, diversified experience leading CSR, sustainability, and ESG in large, complex multinational corporations. He’s the global head of impact and general manager of bechtel.org, the social impact company of Bechtel, an international engineering and construction firm. He was serving concurrently as Bechtel’s global head of sustainability, and prior to joining Bechtel, he served as global manager for strategic issues, policy, and corporate responsibility at Chevron, and worked for the Asian Development Bank in Manila and the Inter-American Development Bank in Washington, D.C.