Sarguja, a district in India’s central Chhattisgarh state, is representative of the country’s rural healthcare situation: high infant mortality (52 per 1000 live births) and low proportions of children who are fully immunized (58%). For a largely rural population, only a small proportion (about one-third) of the state’s rural health centres have regular electricity supply.
But evidence is emerging for the first time that the introduction of solar power has the ability to significantly improve healthcare delivery to poor, rural communities.
The National Health Mission and Chhattisgarh Renewable Energy Development Agency provided 2 kWh off-grid solar photovoltaic systems (with battery backup) to more than 570 primary health centres (PHCs) across the state since 2012. These systems were designed to address power deficits across a third of the health centres in the state. They were connected to “critical loads” such as cold-chain points (to facilitate vaccine storage and immunization) as well as lights and equipment in the labour room.
Recently, the Council on Energy Environment and Water (CEEW) released an independent study, funded by Oxfam India, evaluating the role of electricity access on health outcomes in rural Chhattisgarh. The study is based on an evaluation of 147 PHCs, including 83 having solar systems, across 15 districts.
The study finds that facilities with solar performed significantly better than those without. On average, health facilities with solar treated 50% more out-patients each month, conducted 50% higher institutional deliveries, admitted a higher number of in-patients as well as provided round the clock services. This was true even for ‘power-deficit’ health centres (i.e. health centres with electricity supply of less than 20 hours per day). Staff from the health centres had positive perceptions of such systems. About 98% of staff reported lower disruptions in day-to-day functioning and 80% reported savings in electricity costs.
These results are not only encouraging for India, but also for the many other countries in Africa and Asia with rural health facilities that are either without electricity or suffering from irregular power supply.
Solar systems have several advantages. They provide: flexibility to design systems that can cater to the power load of a health centre; reliability of performance; critical loads such as vaccine refrigerators; and service to remote or disaster-prone areas where access related challenges are most acute. However, care must be exercised to develop adequate operations and maintenance protocols to ensure success of these systems.
Scaling up these systems is in India’s strategic interest.
India's National Solar Mission has a target of achieving an installed capacity of 100 GW of solar by 2022 of which 40 GW is envisaged to come from rooftop solar. Providing solar to all PHCs across the country (5 kW systems) can contribute about 160 MW of the rooftop target. If solar were to be extended to cover Sub-Centres (1 kW systems) and Community Health Centres (8 kW systems), the total potential would be about 415 MW.
At the same time, electricity access can be an enabler of the National Health Mission target for Universal Healthcare. Similar advantages may be experienced in parts of sub-Saharan Africa, South Asia and Latin America where millions of people live in resource-constrained settings that have a strong overlap between poverty, poor energy access and high disease burdens. Resource savings from such systems can be directed towards procuring life-saving medicines and equipment.
Scaling up of solar for healthcare will be facilitated by several macro-level trends. First, innovations in panel technology have significantly reduced the costs of solar. Secondly, a positive signal from the demand side was the launch of the International Solar Alliance (ISA) in Paris during COP21. Demand aggregation through ISA can spur investments in innovation as well as attract better terms of finance, thereby bringing depth in market design.
The world is witnessing a major transition both in energy and health. The share of renewables in our energy mix is unprecedented and global health indicators are better than they ever were. Accelerating deployment of renewable energy to health centres is a need of the hour. Powering health systems with renewable energy such as solar could address energy (Sustainable Development Goal 7) and health (Sustainable Development Goal 3) concerns simultaneously.