Powering Humanitarian Health Operations - Q&A

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This page documents the questions that were asked during the webinar: Powering Humanitarian Health Operations: Sustainable Energy Solutions

Questions Asked to all Speakers

  • In post-covid world (assuming COVID is here for some time) how to leverage this clear need for sustainable energy especially during COVID for 'no going back' in our organizations and sector on a more political and collaborative level?

Talal - There needs to be a forward looking approach for investing in the needed infrastructure, to build more resilient critical services around the world, especially where it's needed most. Understanding the importance of such priority in a time that is facing intensified extreme weather conditions, repercussions of climate change, conflicts, and natural disasters, requires the international community and all stakeholders to mobilize effectively to achieve this.

  • Is solar in humanitarian settings really useful for security of supply or simply greenwashing? aren't diesel gensets more reliable? would be better to install solar e.g. at HQs and not in remote areas?

Inaki - At least in MSF it does make sane. In all the places we have installed the ROI has been less than 5 years due to high diesel price and we also have generators as a backup. Gensets might be more reliable in some ways (>90% of our facilities still use them as main energy source) but in some remote areas where the supply of diesel might be a big challenge (due to geographical challenges, very high price or just limitations set by the army) PV is a very good alternative to consider. And we also have PV in our HQ

 Talal - on the contrary actually. Solar PV can be a cheaper, cost effective option (considering cost of deployment and cost of diesel in the respective area), and can be more reliable options (considering availability of fuel in market). So it depends on the context, to determine which energy mix makes sense.

Questions to Inaki:

  • Can you share with us the name of the company who helped electrify the health center un Sud Kivu?

GoShop    https://www.goshop.cd/

  • "2-4kW, seems quite short. Are you using air condition for intensive care rooms?

We only have ACs in the OT and the pharmacy. This areas of Congo are in the mountains, around 900 masl, and the temp is not unbearable

  • What is the % of total project budget kept aside to cover 10 years warranty and O&M?

None. The material we used comes with this warranty by default. The O&M is a separate contract, in this case it cost around 300 USD/visit, 75% of this price of because of the remoteness of the place and the difficulty of the teams to get there

  • What is the best way to ensure that there are technicians available for operations and maintenance of the energy systems? Training people at the hospital or engaging private sector to take care of it? How was this handled in DRC?

In my experience private sector. Nowadays there are private companies with this experience and capacity in almost any country; and training them would take several weeks at best

  • Is it right that you installed the solar panels flat (horizontal)? Don't you expect problems due to stagnant rainwater mixed with dirt ?

DRC is almost at the equator so to get the most efficiency they solar modules must be flat. They have a small 8% inclination for rain. So far they are fine, lots of rain up there and during regular cleaning we see that they didn’t get dirty during the previous month

  • what are the challenges in O&M of this system ?

The transport of the technicians from their base to the hospitals. Very remote areas so not easy to get motorbikes or any other means of transport

  • You described the labor cost of$5000 for the installation. Please confirm

That’s what the installing company charge us. We also bought all the materials from them, so that also helped to bring the labour cost down

  • The energy installation for the health care, was it shared with the local communities?

No, it is exclusively for the hospitals

  • What's the expected lifetime of the hospital/energy installation (just to understand better why lithium batteries)

According to the manufacturer >10 years. Even if that’s not entirely accurate the batteries would still be under warranty so the manufacturer would replace them for free. Anyway the choice of lithium batteries is not only because of this:

  • Lithium batteries are 1.8 times more efficient than lead-acid batteries (this means the size of the battery bank will be 1.8 times smaller with lithium than with lead-acid to have the exact same storage capacity)
  • Expected life is 2 - 4 longer with lithium batteries
  • Lithium has a 3 time more expensive initial cost. Even if you go for the worst case scenario (the batteries life is only 2 time that of lead-acid) 1.8x2 = 3.6 > 3 so it will be cheaper than lead-acid in the long-term
  • Have you considered using liquid sodium batteries?

Yes, but they are heavier than lithium batteries, and they have not been tested enough to ensure the reliability that we need for these projects. At least that was our assessment

  • Follow-on comment on fuel cells for Inaki -- A cluster of four (4) compact 1.5 kW fuel cell systems, each with < 50cm x 50cm footprint would produce up to 144 kWh/day, available 24/7 AND an equal amount of (free) high quality heat.

Thanks for your comment

  • What kind of medical operations have been enabled by the electrification of this hospital? Has there been a major increase in needs for medical interventions linked to Covid, or would you say that the medical needs in the Kusisa region (and DRC in general) are still mostly other types of interventions?

In this area of DRC (east) that impact of covid has so far been very low. Specifically in Kusisa and Kigulube we haven’t identified any increase in number of patients.

Energy has enabled this hospitals to have oxygen supply, surgery, c-section, deliveries at all hours, run lab tests, have heating mattresses/lamps for neonates, store medicines in the pharmacy at correct temperature, have blood bank, cold chain for vaccines

  • A few questions to Inaki from MSF: 1) who is the local company that installed the solar systems? With which local company was the O&M contract done? 2) the systems were installed within 6 weeks. How this timeline might have changed in covid times? 3) if hospital technicians cannot solve the problems, how does the escalation steps look like, meaning can they turn to more specialised technicians/a central entity? 4) Inaki explained the O&M provisions. What is envisaged for the replacement? Are hospitals expected to pay for it?
  1. Both same company, GoShop https://www.goshop.cd/
  2. COVID would have affected mostly the international supply (from the manufacturer’s warehouse to the final destination country). Then the technicians could be asked to do a 2 weeks quarantine. The installation itself would still take the same number of weeks
  3. The company in charge of the O&M is also in charge of any corrective maintenance that might be needed
  4. If it is a replacement of part of the material the warranty will most probably cover it. We would only have to pay for the transport and time of the technician. If MSF is still supporting the hospital MSF will pay for it. If not 
  5. then then the hospital will have to pay for it, but there are many agencies and INGOs .that can support in covering these type of maintenance costs 
  • Was spare parts provided by the project?

No. The expected life and price of these items is so high that usually no spare parts are in place. We rely on local supplier’s stocks 

  • Paralell to the maintenace question, there is a plan for maintenance and/or eplacement after their lifespam?

No. Lifespan is 10 years, so we didn’t consider it worth doing a maintenance plan for a situation so far in time

  • How were the solar pv systems in Kusisa and Kigulube financed? And how is the opex being covered to ensure sustainability?

MSF payed for all the installation and the maintenance. No financing. MSF supported hospitals don't charge the patients, MoH ...

  • What is the community reception of such systems?

Very happy to see their hospital being renovated, working better, the patients can go to the toilet during the night with light, ...

  • I agree on the lithium batteries versus lead acid, but have you considered Sodium nickel batteries?

Yes, but they are heavier than lithium batteries, and they have not been tested enough to ensure the reliability that we need for these projects. At least that was our assessment

  • Are they doing AC coupled or DC coupled systems for off-grid installation with PV and Diesel Gensets?

The PV modules are DC coupled. We have a changeover switch to select either the charger/inverter or the genset as energy source

  • How was the size of the generator that you used for the 80 bed hospital before switching to Photovoltaic

9 kVA prime power

  • How many patient wards and oxygen contractor do you have in this hospital ?

80 beds, usually with an occupancy rate of 50 - 80%. We have 7 oxygen concentrators, not all running at the same time 

  • Can you share total cost for installation of this PV system and how many batteries did you use for energy storage?

Total cost 148 kUSD. We have 7 battery modules of 13.8kWh each, so a total 96.6 kWh battery bank

  • Could you please remind us again how long the systems installed in the DRC has been running

Kusisa started operating in December 2018 and Kigulube in December 2019. So 18 and 6 months respectively

  • What would you do differently for a similar project, next time?

Maybe have a smaller charger/inverter, think twice before deciding on installing the PV modules on the roof

Questions to Talal:

  • Regarding the battery replacement, do you have a special recycling program for them?       

 The recycling of batteries is an important consideration when planning the project. Depending on the type of batteries used and the location of the project, the recycling process can be determined. In some cases the manufacturers would be happy to take them back and recycle them. In other contexts (when a manufacturer scheme is not applicable/available in the area, local battery suppliers or distributors may be able to benefit from the used batteries or even dispose of them in an environmentally friendly manner.

  • What is the modality for the design process which presents more advantages for the humanitarian sector in terms of flexibility and efficiency?

The design modality and the system set-up depends on the type of application for the intervention. Whether it is a hospital that depends on diesel, with or without certain hours of grid availability, and the intensity of energy demand. The optimal design must incorporate all these variables to determine the most flexible and efficient design. Qualified personnel must be engaged in the process.

  • Follow-on for talal. 1) non-hydrogen fuel cells have been interfaced with solar to replace batteries, 2) they were proven on military on diesel and kerosene. 3) On renewable biofuels, such as jatropha, palm and croton nut oil, and used cooking oils, a new currency is created for local farmers, who can grow and press non-food oils and barter this for access to electricity.

Fuel cells economic viability will be the factor to determine its competitiveness compared to batteries. Not yet viable to replace batteries. Jatropha, and the lignocellulosic, or even algae based biofuels are important commodities and very promising sources of energy. They are viable only when in consideration of the water-energy-food nexus, where arable land is not used mainly for bio-energy when food production should be prioritized. The WEF nexus should be a criteria for the assessment of such options for local farmers, where the viability/attractiveness would vary from one place to another.

  • Are there any specific business models for off-grid energy companies that are more suited to powering health facilities?

Certain areas with the risks can accommodate business viability, it is possible to have a PAYG scheme (Pay-As-You-Go) which may end up in full local ownership after investment is retrieved for the electricity generated and consumed at the facility. However, this is based on the possibility for the health facility (or relevant authorities) to commit payments for the electricity consumed, which is also based on the possibility of having a local revenue stream that allows for it.

Another consideration that would help stirr sustainability for the health system O&M (from a business-model point of view) is a possible scheme of selling excess electricity generated from the solar PV system at the facility to local nearby productive activities and business, and then having the revenue generated going into a sustainability fund for the system. 

  • What kind of business driven innovation do you suggest should happen in order to address the biggest challenges in powering healthcare facilities?
  • More energy efficient appliances for health care
  • Advanced and more affordable batteries that can live many years without maintenance 
  • Plug-and-play and affordable remote monitoring systems for solar PV