The use of clean energy such as solar power can not only help take health services to remote unelectrified areas, especially in low- and middle-income countries, but also mitigate climate change.
Solar technology has ushered in a profound transformation in healthcare delivery.
Photo: Jeroen van de Water
In Somalia, where the healthcare system remains exceptionally fragile, access to quality medical care has long been a struggle. Data from the World Health Organization (WHO) reveals just 27% of the population can afford healthcare. The pandemic worsened the shortcomings, with only 25% of health facilities equipped with oxygen supplies.
To address this critical shortage of oxygen, an innovative collaboration has emerged between the WHO, Grand Challenge Canada, and the WHO headquarters' innovation lab. The proposed solution is surprisingly simple: oxygen concentrators powered by solar energy.
"Investing in solar is not only an infrastructure investment, but it also contributes to improved service delivery."
These devices, which cost as little as US$700 each, extract high-grade medical oxygen from air. Designed to run on electricity, the devices produce a continuous supply of oxygen, despite the erratic power supply, thanks to solar energy.
Solar technology has ushered in a profound transformation in healthcare delivery across Somalia. Medical facilities have uninterrupted access to life-saving oxygen, and the solar-powered systems require minimal maintenance beyond the timely replacement of battery acid.
“Investing in solar is not only an infrastructure investment, but it also contributes to improved service delivery,” said Dr SK Md Mamunur Rahman Malik, WHO’s representative and head of mission in Somalia, at a session titled ‘Role of Solar in Building Resilient Health and SDGs’, attended by Re:solve Global Health on the sidelines of the World Health Assembly 2023 in Geneva.
The tangible impact of the solar-powered oxygen concentrators has inspired trust in remote areas of the country. Healthcare utilisation rates have since soared by 15%-20%.
“We are collecting information from hospitals every month using a standardised form. What we have seen until now is that 98% of the 3,000-plus care seekers were saved from death,” Malik says.
Patients spend anywhere from a few hours to three days in hospital, having oxygen levels restored and recovering without any lasting disabilities. Consequently, the shortened hospital stays have led to significant cost savings for patients and their families.
Unpacking a core problem
“Recent data shows that universal health coverage is going at about half the pace needed to reach the sustainable development goals, so we need to double the pace,” says Dr Peter Singer, special advisor to WHO’s Director-General. “The way to double the pace is through innovation… to reach as many people as possible, especially the most vulnerable, in hard-to-reach places…”
Low- and middle-income countries (LMICs) often face challenges in providing healthcare services that are timely, dependable, and affordable. The working of primary healthcare facilities in remote locations can be hindered by lack of power supply or frequent power disruptions. For patients, this means longer waits, repeat visits, and delayed diagnoses, resulting in higher out-of-pocket expenses.
To ensure comprehensive coverage of essential health services, the WHO emphasises the urgent need for approximately US$4.9 billion to improve the standard of electrification in healthcare facilities in 63 LMICs to a minimum or intermediate level.
Widening the access to reliable health services and medications through the deployment of clean energy and adequate human resources and capabilities will enhance the overall delivery of healthcare services and reduce costs.
The good news is that the energy sector is witnessing unprecedented investments by corporations, research facilities, and government entities in the quest for potential future energy solutions.
A World Bank report highlighted the importance of off-grid solutions—small photovoltaic solutions not connected to the grid—in advancing Sustainable Development Goal 7 (SDG7: Affordable and clean energy) in LMICs. It had projected that between 2020 and 2030, off-grid solar technologies would be the most cost-effective solution for 41% of new household connections, contributing to the goal of universal electricity access by 2030.
Access to electricity and improved health outcomes
Ensuring reliable and affordable access to healthcare is at the heart of achieving Sustainable Development Goal 3 (SDG3), which targets good health and wellbeing for all. But the needs vary across different countries. Delivery of health services requires energy, water, transportation, and infrastructure development. Most of these are dependent on fossil fuels or are highly carbon-intensive. In fact, healthcare is responsible for 4.4% of global carbon emissions.
LMICs are also disproportionately affected by the adverse impacts of climate change such as heat stress and unpredictable rainfalls, and natural disasters such as floods and cyclones. With the rising incidence of such climate risks and emergencies, public health delivery in these communities becomes especially crucial.
The use of sustainable energy can help ensure uninterrupted delivery of critical care services for communities affected by climate risks and disasters, while also contributing towards current and future climate mitigation efforts.
“If you start with saving lives in solar powered facilities, people understand that and then link the solution to climate change mitigation,” Singer says.
Charting the impact of renewable energy
Designing last-mile health facilities with energy-efficient equipment and decentralised renewable energy has a profound impact on three crucial aspects of care: maternal care, vaccine storage, and telemedicine.
"If the grid goes off, it does not give you warning—it can go off in the middle of surgery. The solar system is the backup that we need."
For maternal care, functional medical appliances like spotlights, baby warmers, and suction apparatus are essential for safe delivery rooms. Without them, the risk of infections and fatalities significantly increases, affecting mothers and newborns. In remote areas, vaccine maintenance is challenging in the absence of reliable power for refrigeration. So also, telemedicine relies on electronic devices that require consistent power supply for screening and consultations.
By deploying solar power, health facilities can deliver government schemes, improve access to services, and provide the kind of vital healthcare support that was previously unimaginable in unelectrified areas.
In Makueni County, Kenya, solar innovation in the healthcare system is a key part of the government’s strategy, explains governor Mutula Kilonzo Junior. “If the grid goes off, it does not give you warning—it can go off in the middle of surgery. The solar system is the backup that we need. All major hospitals have fridges for keeping vaccines, so it is important not to have cold chain interruptions,” he says.
Solar powered health facilities are also helping improve obstetric care and facilitate telemedicine solutions. "We have eight out of 260 primary care centres using [solar] technology,” Kilonzo Junior says. “The idea is to start at the top where you have the highest level of patient traffic and where you can immediately reduce costs, and then move to the primary health facilities.”
Panellists at the ‘Role of Solar in Building Resilient Health and SDGs’ session, held on the sidelines of the World Health Assembly 2023 in Geneva. From left to right: Peter Singer (WHO), Dr Rahman Malik (WHO Somalia), Pooja Sikka (Apex Ventures), Oren Ahoobim (Dalberg), Sarah Hubar-Fisher (Global Surgical Initiatives), Mutula Kilonzo Junior (Governor, Makueni Province, Kenya), Joshua Wycliffe (ISA)
Photo: Maurizio Arseni
Financial mechanisms to support solar for health
In his opening remarks at the Geneva event, Ajay Mathur, director general of the International Solar Alliance (ISA), an intergovernmental organisation that promotes the adoption and use of solar energy globally, presented a new initiative in collaboration with Selco Foundation, Ikea Foundation, and the Government of Meghalaya, India, to build 75 health facilities running only on solar. There are plans for similar projects in Tanzania and Mali.
Mathur is hoping to quickly scale up his model and help India become a research and development centre for solar initiatives. He hopes to eventually reach “one billion people in Africa and one billion people in South Asia to provide better health services”.
ISA suggested three business modes for solar initiatives for health. The first, dubbed the ‘CAPEX model’, is self-funding, requiring the end user to cover all the initial capital expenses associated with installing a rooftop system. In the pay-as-you-go (PAYG) model, customers make advance payments for their electricity supply. Funds are deposited onto a prepaid meter, allowing customers to use an equivalent amount of electricity. In the OPEX model, also known as the Renewable Energy Service Company (RESCO) model, the solar project developer retains the ownership of the system, while the consumer pays solely for the energy consumed.
NGOs are also experimenting with new financing structures to support solar solutions for the health sector. Global Surgical Initiatives, an NGO founded by the chief of surgery at Mount Sinai Hospital in New York City, has facilitated over 3,000 surgeries in Uganda powered entirely by solar energy and with the use of recycled rainwater. It has also provided diagnostic and therapeutic treatments to more than 7,000 patients.
Global Surgical Initiatives is set to launch the world's first renewable energy certificate directly linked to health outcomes. “By linking kilowatt hours directly to a searchable health app, demonstrating the value of decentralised renewable energy tied to health outcomes, we offer a cost-effective alternative to traditional utility packages,” says board member Sarah Hubar-Fisher.
“We hope to create a marketplace that will incentivise public and private sector organisations, development finance institutions, philanthropic organisations and other donor types to come together and invest in renewables."
Exploring challenges and solutions
Given the tremendous potential for solar to improve healthcare delivery in LMICs and with financing solutions in place, why is it taking so long to scale up?
At the Geneva event, Michel Sidibe, former Minister of Health and Social Affairs in Mali, recounted his experience setting up such programmes. He pointed to three main bottlenecks: high initial investment cost, regulatory incertitude, and post-installation maintenance challenges.
"As policymakers, we have many competing demands on innovation, improving the lives of people, and providing what is needed to have healthcare facilities work better to serve our populations. But it's probably easier said than done,” Sidibe says.
"This is the future—sustainable energy for the development of LMICs—but there is still the question of how to make the cost reasonable and the technology easily understandable by the people who use it and maintain it.
“My suggestion is to prioritise capacity-building initiatives that enable individuals to effectively utilise this technology. While investment itself is important, ensuring longevity and sustainability requires proper maintenance and wise utilisation, which can also contribute to job creation.”