| For a long time, the focus of electricity access has been largely at the household level. It is only recently that access to electricity is also being recognised as critical for public services like electricity for health facilities, schools and street lighting. In health facilities, regular electricity access is necessary for deliveries, storage of vaccines, provision of emergency services, supply of clean water, and retention of skilled staff. In India, Primary Health Centres (PHCs) ensure last-mile delivery of healthcare services, that is, at the village level. However, one in every two PHCs in India, and one in every three in Chhattisgarh, is either un-electrified or suffers from irregular power supply. This extent of power deficiency across PHCs could hamper the provision of healthcare services in the country. Still, the impact of access to electricity on healthcare service delivery has rarely been explored in detail in India.
While performing relatively better than India as a whole in terms of electricity access for its PHCs, Chhattisgarh is no different when it comes to health outcomes. Indeed, the infant mortality rate (IMR) in rural Chhattisgarh (43) is higher than that in rural India (41). Although Chhattisgarh is a power-surplus state, only 66% of PHCs have regular power supply. To augment electricity supply at the PHCs, the Chhattisgarh Renewable Energy Development Agency (CREDA), in collaboration with the Chhattisgarh Health Department, installed off-grid solar photo-voltaic (PV) systems of 2 kW each starting in 2012. We carried out an evaluation study to assess the impact of the installation of solar PV systems on improving access to electricity at the PHCs, and thereby improving health service delivery. The evaluation was intended to:
i. Understand the synergy between electricity access and delivery of healthcare services
ii. Evaluate the impact of installed solar PV systems on addressing gaps in access to electricity
iii. Assess the gaps in the transition to higher standards of primary healthcare in Chhattisgarh
A comprehensive questionnaire on health and energy was administered to a total of 147 PHCs (83 solar
and 64 non-solar) in 15 districts of Chhattisgarh. The synergy between access to electricity and delivery
of healthcare services was explored by classifying the PHCs into two sub-groups: (a) power-deficit PHCs:
defined as PHCs with regular power supply of 20 hours or less a day; and (b) non-power-deficit PHCs:
defined as PHCs with regular power supply of more than 20 hours a day. Some of the key findings were:
• Combined capacity unable to meet needs
About one-third (36%) of all sample PHCs reported that their electricity needs were not met by the available sources of electricity supply. Second, although the duration of power supply in a day averaged about 20.5 hours, the quality of electricity supply differed across districts.
• Ability to provide care on demand
About 90% of the PHCs reported undergoing power cuts between 9.00 a.m. and 4.00 p.m., a period during
which the PHC functions at its peak capacity. In addition, emergency and delivery services are subject to
the need of the patient, and hence require access to electricity on demand. Power cuts in the evenings could significantly affect the ability of PHCs to provide the required service.
• Cold chain and newborn care
The ability of a PHC to operate cold chain and newborn care equipment is substantially influenced by its
access to regular electricity supply. About 22.4% of power-deficit PHCs currently rely exclusively on solar as a backup to run cold chain equipment. About 21% of power-deficit PHCs do not have solar backup to operate newborn care equipment.
• Transition to higher standards of care
About one-third of power-deficit and power non-deficit PHCs reported power cuts in the evening. About
46% of PHCs were in the power-deficit category and without the support of solar PV systems. This affects
the ability of PHCs to transition to higher standards of providing 24x7 health services as suggested by the new guidelines of IPHS.
• Other needs
Access to regular electricity also enables access to regular water supply for many PHCs. About 37% of the
sample PHCs reported that their water supply was adversely affected due to lack of electricity supply. The lack of adequate and quality water supply compromises the ability to provide basic, routine services such as child delivery, and weakens the ability to prevent and control infections (WHO, 2015b).
Significant opportunities exist to simultaneously address the (often competing) goals of energy access, energy security, resource management, and health outcomes. Solar for health is one such opportunity. Chhattisgarh provides evidence to scale this intervention to meet the national targets for both health and energy.