Photovoltaic (PV) for Health Centers - Project Experience

This articles aims at compiling experience from past and ongoing PV programmes for rural health centers. For each project the following issues are covered:

I) Project Approach,

II) Project Outputs & Technical System Details,

III) Evidence for Impacts, and

IV) Lessons Learned.

GTZ-PREEEP, Uganda

Project Approach

PREEEP has supported a number of social institutions in Uganda with access to solar energy (health centres, boarding schools, vocational training centres, orphanages). This has been done through extension of subsidy to these institutions. GTZ operations are currently focused on Northern Uganda, but institutions in other district can also receive support. However, to qualify for this subsidy, a number of conditions need to be fulfilled. These are listed below;

• The institution should be located in Northern Uganda or another district where PREEEP is already active
• The institution could be a boarding school, a health centre, a vocational training centre or an orphanage.
• The institution should be located not less than 5 km from the nearest grid and should also not be in an area earmarked for grid extension in the next 10 years. If the grid is nearby and the costs for grid connection are low, PREEEP can also support grid connection.
• The institution should be willing to contribute a percentage of 20% of the overall cost of the proposed system and will be responsible for operation and maintenance.

Process:

• GTZ identifies institution /institution applies to GTZ
• Check whether selection criteria are fulfilled
• GTZ conducts survey of electricity requirements; this includes a sketch of the premises with measurements and distances between buildings
• GTZ designs the system and calculates the estimated costs incl. the 20% financial contribution by the institution
• GTZ gets back to the applicant and checks whether the institution is ready / able to pay the contribution and in which time frame (payment in instalments is possible); for public health centres, the partner is the District Health Office
• GTZ and institutions sign MoU that includes the amounts to be contributed by both partners and the payment schedule
• Institution transfers financial contribution to GTZ account
• GTZ launches procurement process
• Local company installs
• GTZ inspects installation
• Monitoring visits / impact assessment

 

Note that the institution is required to meet the costs for operation and maintenance, which includes replacement of batteries after approx. 4-7 years. This is a major reinvestment! It should also be noted that the institution has to stick to the uses that the system was designed for. Connecting additional buildings and appliances is not possible! If the institution wants to use computers or other appliances that require a lot of power, they should buy energy efficient ones from the start (e.g. laptops). If they want to use inefficient appliances, the system has to be much bigger and is therefore significantly more expensive for both parties.

Project Outputs & Technical Details

Total number of electrified institutions since 2006: 73, of which 55 are Health Centres (category II and III, see table below for definition). The remaining institutions are schools (mostly secondary boarding schools), orphanages, vocational institutions and youth centres. In the current programme phase (since June 2008) 32 solar PV systems have been installed in rural health centres.

Structure and health infrastructure of National Health System in Uganda

Health unit	Physical structure/ services	Beds	Location	Target population
HC I (VHT)	None	0	Village	1,000
HC II	Outpatient services only	0	Parish	5,000
HC III	Outpatient services, maternity, general ward and laboratory	8	Sub county	20,000
HC IV	Outpatient services, wards, theatre, laboratory, blood transfusion	25	County	100,000
General Hospital	Hospital, laboratory, X-ray	100	District	100,000 to 1 million
RRH	Specialist services	250	Region (3 – 5 districts)	1 - 2 million
NRH	Advanced tertiary care	450	National	Over 20 million

The average size of solar PV system installed is 630 W_p. The systems range from 160 W_p to 2580 W_p. The earlier systems were standardized in terms of size (one system for lighting, one for cooling, if applicable one for staff quarters). Since 2008 the individual energy needs of each health centre are assessed and systems designed accordingly. Since then, system size has increased in comparison to the earlier systems.

The installed systems are majorily AC systems. However, until last year (2009), the project still opted for DC systems in staff quarters and health centers that only needed electricity for lighting. The DC option has proven to be, albeit more efficient and cheaper, less convenient and effective. DC bulbs are more expensive than AC bulbs. Health Centres are hence less likely to replace blown DC bulbs than the cheaper AC bulbs. Furthermore, some Health Centres work with small appliances such as electric microscopes that do not consume a lot of energy and are therefore not covered in the energy assessment. These small appliances can only be used on AC power. In the staff quarters, DC systems have proven ineffective, because users do not make use of their DC sockets because they do not know where to buy the right adapters for radios and phone charging (some radios also don’t have the right outlets). Therefore since mid 2009 only AC systems are installed in Health Centres and their adjacent staff quarters. However, overusage is more frequent on AC systems than on DC ones.

The typical connected appliances range from light bulbs (CFLs from 5-14 W depending on purpose – security light, general room lighting, medical spot light), energy efficient computers and printers, DC refrigerators to small medical equipment such as electric microscopes. Because GTZ PREEEP requires a 20 % contribution by the district government responsible for the Health Centres, the size and number of connected appliances also depends on the district’s budget and willingness to spend money.

The average cost for equipment and installation rank at 11 EUR per Wattpeak (30,000 Uganda Shillings).

Evidence for Impacts

Impact Study. Harsdorff, Market and Friends Consult (2009): Impact Assessment of the Solar Electrification of Health Centres. Kampala, GTZ PREEEP.

Results of Impact Study:

1. The use of solar PV at HCs enhances the delivery of medical services through the provision of quality light for use during treatment of night time emergencies, emergency deliveries and for security purposes at the HC and staff quarters. The solar fridges also facilitate the service of instant immunization of children at HC that previously did not have fridges.
2. Whereas Health Centres continue to use traditional sources of energy (kerosene for waste burning and charcoal for sterilisation/cooking), solar electricity reduces expenditures on energy sources for lighting and gas (replaced by solar fridges).
3. HC II without staff quarters mainly operate during the day hence under-utilize the installed lighting systems which are only used for security lights.
4. Although the availability of solar is not a decisive factor for the deployment of health staff, it is likely to increase motivation and morale of health staff whose living standards are improved by access to cheaper and quality light
5. Solar has facilitated communication and notably work related communication between health workers in far off locations, through the provision of electricity for phone charging, thereby enhancing efficiency of medical service delivery.

Lessons Learned

To enhance impact, installation of PV systems should prioritize Health Centers that operate at night and/or those with staff quarters, because they are more likely to effectively use systems by opening for night time emergencies. These tend to be bigger and are more expensive to electrify.

Solar fridges should be part of the system package as they increase the impact of solar PV for Health Centres. However, the type of fridges to be installed should be selected carefully. Only durable and easy to repair fridges should be installed (products known on the local market).

The district as owner of the Health Centres has to budget for operation and maintenance costs. Apart from regular replacement of blown out bulbs, the batteries have to be replaced every 4-7 years (depending on usage). Battery replacement is a major reinvestment that the district has to be prepared for. Awareness and education about battery replacement is a crucial part in electrifying institutions.

User training has to be conducted thoroughly and in detail. The durability and lifetime of a solar PV system depends heavily on its user. Follow up visits have shown that some systems are overused, esp. in staff quarters. An in-depth user training with appropriate material that can stay with the health centre can help raising awareness about the system’s potential and limits.

Staff changes occur rather frequently during a solar PV system’s lifetime. It is necessary that the old staff properly initiates his/her successor in the usage of the solar system. Durable awareness/user training material as well as self-explanatory information about the load schedule at a central point can be helpful.

Theft of solar system components (e.g. modules) is a major problem in some areas. Therefore it is necessary to analyze the security situation around the Health Centre during the initial assessment. The modules should preferably be mounted on the roof and protected against theft, e.g. with self-sealing screws. In some cases, the building of a fence or the appointment of additional security personnel might become necessary. The project should advise the Health Centre/district on these issues.

GTZ AMES, Ethiopia

Project Approach

AMES-E is disseminating photovoltaic systems to 50 health centers in rural areas all over Ethiopia.
AMES-E is financing the hardware (panel, charge controller, inverter, batteries, fuses, wires, distribution board, installation materials) and the installation. Most of the hardware is imported. The procurement was organised by GTZ based on a Europe wide tender. The tables for the panels, the panel frames and the installation material are produced or bought locally.
The health centers were selected by the programme planning department, the regional health bureaus, zonal health administration and the project. Minimum requirement is that corresponding communities are not electrified, will not get grid electricity within the next 3 years and that the health center is operational and equipped with basic medical equipment.
The design of the system was developed in co-operation with the German organisation Deutsche Gesellschaft für Solarenergie (DGS).
The installation of the PV-systems is carried out by 5 Ethiopian companies which were selected by a national tender procedure. The installation company has also to train local staff in operation and basic maintenance measures and is obliged to carry out a service/maintenance visit 6-9 month after commissioning hand over or by request. All work is supervised by AMES-E.
In addition to the installation of PV-systems AMES-E is promoting the training of solar technicians in cooperation with SELAM. The technicians are nominated by the installation companies. It is planned to offer training courses in solar technology which are open to all interested technicians (e.g. technicians from health centers).

Project Outputs and Technical Details

The photovoltaic systems of the health centers have a generation capacity of 1,5 kWp, which is enough for lighting and to run small medical appliances, a dry-air sterilizer, a centrifuge, a microscope and a fridge.

• The system consists of the following components (for photos see annex):
• 16x Sharp thin layer panels each with 90 Wp (25 years guarantee),
• aluminium tube carry structure for the panel,
• 24 x 2V, 200 Ah deep cycle lead acid solar battery,
• Sunny Island, Sunny Boy charge controller and inverter
• 7W CFL lamps
• Power cable, switches, tubes etc.

Evidence for Impacts

Evidence for impcats is only available from field visits and observations; no impact study has been carried out yet.

• Service time and work facility is increased
• Health professionals are motivated
• Community members could get near by health service and their expense for transportation to go far town for same service is saved
• Death rate by different disease could be decreased
• Productivity could be increased
• Communication and information could increased by using mobile phone, radio, TV.
• Air pollution by fuel from vaccine refrigerator is avoided and expense for fuel is saved
  (1 liter per HC and 50 liters from total installed HC (health centers))
• Awareness about the technology is created
• Market for PV-technology is opened