Marking World Health Day: Powering healthcare sustainably

Today, 7 April 2020, is World Health Day. This is an opportunity to recognise the important work of nurses and midwives and remind leaders of the critical role they play in keeping the world healthy.

Especially in this time of Covid-19 when nurses and healthcare workers are at the forefront of the pandemic response worldwide. Providing care in a crisis is a difficult and dangerous task. This is even more challenging in the developing world where many healthcare centres are off the grid or have no reliable access to energy.

To mark World Health Day and shine a light on this energy access issue, we speak to our colleague and SNV Energy Advisor Biplav Kafle who gives an overview of energy access for off-grid healthcare facilities in Nepal. He also explains what SNV and the Government of Nepal are doing to improve the current situation using sustainable energy.

Can you explain your position and role with SNV?

I have been a Renewable Energy Advisor at SNV since 2015. My role is to provide technical and managerial advisory support to local partner organisations, partner NGOs and government stakeholders while implementing renewable energy projects. At SNV, I have been involved in different projects related to pico hydro systems, cookstoves, biomass gasifiers, solar mini-grid systems, and solar water pumping systems.

How many people are currently living without electricity in Nepal?

The official figure is that 23% of the total population does not have access to electricity of any form (Nepal Electricity Authority report (NEA) 2016).Unofficial sources suggest that this percentage has been decreased to 10% today.

An important fact is that although electricity access has increased rapidly in the last few years through expansion of the national grid or off-grid sources, reliable and continuous electricity supply is still limited to major cities and towns. Due to poor transmission and distribution infrastructure, the majority of remote districts do not have reliable electricity access. Off-grid electricity sources, mainly hydro and solar mini-grids, generally provide electricity to households in the evenings (normally from 5 to 9pm) and this access is limited to lighting.

What is the situation in terms of off-grid medical centres?

Most off-grid health facilities (HFs) do not have a reliable electricity supply. Many of them only have small solar home systems (50  – 100 watts) for lighting purposes allowing them to respond to emergency cases at night times.

The government of Nepal has a subsidy programme to provide 1 kW institutional solar PV systems but due to a limited budget, only a few HFs are benefiting from this facility. The capacity of these systems is insufficient to operate basic medical equipment necessary for small birthing centres which all HFs are mandated to operate. Infection prevention, sterilization, vaccination storage, operation of pathological labs, waste management processes require electrical power. However, some of these vital processes are done using firewood or chemicals and others are simply omitted in the absence of sufficient power.

How can off-grid healthcare facilities be powered sustainably?

Currently, different off-grid technologies are available which can provide electrical power to HFs. Some of these technologies, like hydro mini-grids or wind power systems, might not be technically feasible in all geographies. However, solar mini-grids are technically feasible in most areas and also less prone to breakdown as they do not have dynamic components.

Hence, in my opinion, solar mini-grids are the best and most sustainable off-grid solution for powering HFs. Another important factor to be considered is the need to design solar mini-grid systems capable of powering basic medical equipment so that HFs can deliver all the required  services.

Can you explain what the programme Nepal Health and Hygiene Activity (HHA) is trying to achieve in terms of powering healthcare facilities?

The objective of the HHA project which is funded by USAID is to improve the infrastructure of HFs for better service delivery. It includes continuous and drinkable water supply, WASH facilities, waste management facilities and continuous and reliable power supply to HFs.

In terms of powering HFs, the HHA project aims to provide reliable and continuous AC electricity supply for lighting and the operation of basic medical equipment through the installations of 2-3 kW  solar PV system. Additionally, the HHA project aims to ensure the sustainable operation and maintenance of the systems.

Ultimately, by powering HFs, the project wants to achieve a better and more sustainable health service delivery for communities residing in the remote locations of Nepal.

What has the project achieved so far? And what benefits have the healthcare workers found?

The project has successfully installed solar PV systems in 62 HFs in remote areas of Nepal. The project collaborated with local governments for cost-sharing, as they have allocated budget to supply medical equipment and establish small labs. By doing so, health facilities were able to provide better health services for local communities and for mothers and newborns in particular.

Health workers appreciated several benefits including easy sterilization of medical equipment using autoclaves, operation of laptops (to maintain database and MIS system provided by Nepal government), operation of freezers/refrigerators to store vaccines or chemicals, possible service delivery during nighttime, etc.

In two cases, where the HFs did not have a water supply system, the project also installed solar water pumping systems in a cost-share arrangement with the rural municipality providing 24-hour water supply.

How far do you think solar can go in terms of ensuring universal energy for all?

When it comes to power, solar PV systems can be established in any geographical location, have become reliable and cost-effective and can be installed in a short time frame with minimal repair and maintenance. Hence, solar systems will play a key role in the future to ensure universal energy for all.

How important is the off-grid electrification of healthcare facilities now considering the coronavirus epidemic?

Though there are still many things unknown, the outbreak of the COVID-19 has been linked to sanitation habits, improper cleaning and handwashing, waste management, etc. In the case of remote off-grid HFs, we can relate it with sterilization of reusable medical equipment like scissors, blades, forceps, etc. Proper waste sterilization before disposal might also be linked with such a virus outbreak. Electricity supply at HFs will enable health workers to take proper measures for sterilization. Additionally, in some cases, vaccine and medicine storage in freezers/refrigerators, as well as the operation of nebulizers and ventilators, will also be supported by electricity supply in HFs.

To learn more,_ please read our blog - Solar PVs and hygiene training improve health post’s maternal health services._