3.1.0. Defining Energy Needs
The first step in conducting a health center (HC) energy needs assessment is to determine energy end-use requirements by facility type corresponding level of care in compliance with country standards. Country standards for health center levels of care are generally established by Ministries of Health.
The Ministry of Health (MoH) of the Republic of Uganda has established a policy standard, technically referred to as a "health facility availability standards framework," for health center facilities by type. The standards framework defines facilities by the level of health care services provided and by population, or "catchment area," served.
Uganda’s health facilities are classified into seven levels: Health Center levels (HC I or Clinic, HC II, HC III and HC IV); General hospital, Regional Referral hospital and National Referral hospital. The respective services provided at each level of care and catchment area (in population) are identified in Table 1, Service Delivery by Level of Health Facility, from the National Health Facility Master List, published by the MoH, and referenced below:
The Ministry of Health (MoH) of the Republic of Uganda has established a policy standard, technically referred to as a "health facility availability standards framework," for health center facilities by type. The standards framework defines facilities by the level of health care services provided and by population, or "catchment area," served.
Uganda’s health facilities are classified into seven levels: Health Center levels (HC I or Clinic, HC II, HC III and HC IV); General hospital, Regional Referral hospital and National Referral hospital. The respective services provided at each level of care and catchment area (in population) are identified in Table 1, Service Delivery by Level of Health Facility, from the National Health Facility Master List, published by the MoH, and referenced below:
Table 1. Service Delivery by Level of Health Facility
Source: National Health Facility Master List, Published by the Ministry of Health (Ref: 3.0. Bibliography, Supplementary Reading, Item 1, page 7).
National Heath Facility Availability Standards for Uganda are further described in Health Sector Strategic and Investment Plan, Promoting People’s Health to Enhance Socio-economic Development, 2010/11 – 2014/15. (Ref: 3.0. Bibliography, Item 2, Section 1.3.1., pages 3-5). These standards are designed to facilitate the goals of the Uganda National Minimum Health Care Package (as articulated in the National Health Policy, Promoting People’s Health to Enhance Socio-economic Development (NHPII, 2010), published by MoH.
HC levels of care listed in Items 1 - 4, below:
HC levels of care listed in Items 1 - 4, below:
1. Health Center I (HC-1) / Clinic or Village Health Team (VHT): HC-1s provide the following services:
|
(a)
(b) (c) (d) (e) (f) (g) (h) |
identify local community health needs and take appropriate measures;
mobilize and monitor community resources; mobilize communities for health interventions, e.g., immunization, malaria control, sanitation and promote health seeking behavior; maintain a register of members of households and their health status; maintain birth and death registration; serve as the first link between community and formal health providers; provide community-based management of common childhood illnesses, including malaria, diarrhea and pneumonia; and manage and distribute health commodities. |
2. Health Center II (HC-2): HC-2s provide the first level of interaction between the formal health care sector and
local communities. HC-2s provide out-patient care, community outreach services, and linkages with
HC-1 facilities and Village Health Teams (VATs).
3. Health Center III (HC-3): HC-3s provide preventative, promotive, and curative care, and the supervision of
HC- II facilities under their jurisdiction. HC-3s also provide laboratory services for diagnosis, maternity care and
first referral cover for the sub-district (county) level (HC-4).
4. Health Center IV (HC-4): HC-4s provide oversight function for curative, preventative, promotive, and
rehabilitative health activities carried out within the sub-district level by lower level HCs.
local communities. HC-2s provide out-patient care, community outreach services, and linkages with
HC-1 facilities and Village Health Teams (VATs).
3. Health Center III (HC-3): HC-3s provide preventative, promotive, and curative care, and the supervision of
HC- II facilities under their jurisdiction. HC-3s also provide laboratory services for diagnosis, maternity care and
first referral cover for the sub-district (county) level (HC-4).
4. Health Center IV (HC-4): HC-4s provide oversight function for curative, preventative, promotive, and
rehabilitative health activities carried out within the sub-district level by lower level HCs.
Table 2, Conceptual Framework for Energy Use in at HC Levels of Care, provides a snapshot of energy uses and "outputs" that are typical for levels HC-1 through HC-4:
Table 2, Conceptual Framework for Energy Use in at HC Levels of Care
Source: The role of energy in health facilities: A conceptual framework and complementary data assessment in Malawi (Plos One, 20 July 2018); Modified chart for use in Lesson 3.0. Energy Needs Assessment.
Health Centers (HC-1, HC-2, and HC-3), or equivalent facility designations, are the principal facilities that deliver community-based health services throughout the developing world. Hence, electrification of HCs are critical to the impact of national health care systems. However. national data on the electrification of HC facilities are lacking across more than 100 low-income countries, and especially the 51 least-developed countries.
According to the United States Agency for International Development (USAID) Africa Renewable Energy Access Program, the status of electrification of deep-rural HCs that are more than 5 kilometers beyond the electric power grid is largely unknown. Recently, the World Health Organization (WHO) has commissioned a global study to quantify lack of access to electricity in HC-levels of care globally. (See Global Assessment of Electricity in Healthcare Facilities, Call for Expression of Interest, Ref: 3.0. Resources, Item 2.) The global study is scheduled for compeletion by September 2021.
Uganda is one of the developing countries for which the status of rural electrification has been assessed in the he National Health Facility Master List as a component of the Global Environment Facility (GEF) funded Energy for Rural Transformation (ERT), and the USAID Africa Renewable Energy Program. The Table 2, Uganda Indicative Rural Electrification, provides the latest published data available from 2010, as follows:
According to the United States Agency for International Development (USAID) Africa Renewable Energy Access Program, the status of electrification of deep-rural HCs that are more than 5 kilometers beyond the electric power grid is largely unknown. Recently, the World Health Organization (WHO) has commissioned a global study to quantify lack of access to electricity in HC-levels of care globally. (See Global Assessment of Electricity in Healthcare Facilities, Call for Expression of Interest, Ref: 3.0. Resources, Item 2.) The global study is scheduled for compeletion by September 2021.
Uganda is one of the developing countries for which the status of rural electrification has been assessed in the he National Health Facility Master List as a component of the Global Environment Facility (GEF) funded Energy for Rural Transformation (ERT), and the USAID Africa Renewable Energy Program. The Table 2, Uganda Indicative Rural Electrification, provides the latest published data available from 2010, as follows:
Table 2. Uganda Indicative Rural Electrification
Source: USAID Africa Renewable Energy Program (2010 data); From: Modern Energy Services for Health Facilities in Resource-Constrained Settings: A Review of Status, Significance, Challenges and Measurement (2015); Published by the World Health Organization (WHO). (Ref: 3.0. Bibliography, Required Reading, Item 1, Annex 2, page 77.).
Note that an assessment of access to electricity at the HC-1, or Clinic, is lacking in Table 2. Uganda Indicative Rural Electrification for the 1,578 HC-1 facilities referenced in Table 3, Quantity of Health Facilities in Uganda by National Health Availability Standards Framework, below, from the National Health Facility Master List, published by the Ministry of Health (see 3.0. Bibliography, Supplementary Reading, Item 1, page 9)
Table 3. Quantity of Health Facilities in Uganda by National Health Availability Standards Framework
Source: National Health Facility Master List, Published by the Ministry of Health (see 3.0. Bibliography, Supplementary Reading, Item 1, page 9)
Extrapolating from the data for the total combined number of HC-1, HC-2, and HC-3 facilities (tnHCs) provided in Table 3, Quantity of Health Facilities in Uganda by National Health Availability Standards Framework (tnHCs = 6,510), and multiplying the percentage (%) of non-electrified HC-1, HC-2, and HC-3 (%neHCs) facilities (%neHCs = 60) derived from Table 2, Uganda Indicative Rural Electrification Plan, 2008, the total non-electrified HCs (tneHCs) in Uganda is calculated as follows: tneHCs = tnHCs x %neHCs (6,510 x .6 = 3,900, rounded)..
This estimate corresponds closely with the WHO estimate of 58% of tneHCs as indicated in Table 4, Health care facilities with no electricity access (2013), as referenced below and published in Modern Energy Services for Health Facilities in Resource-Constrained Settings: A Review of Status, Significance, Challenges and Measurement (2015), page published by the WHO. (Ref: 3.0. Bibliography, Required Reading, Item 1, page 17.)
.
This estimate corresponds closely with the WHO estimate of 58% of tneHCs as indicated in Table 4, Health care facilities with no electricity access (2013), as referenced below and published in Modern Energy Services for Health Facilities in Resource-Constrained Settings: A Review of Status, Significance, Challenges and Measurement (2015), page published by the WHO. (Ref: 3.0. Bibliography, Required Reading, Item 1, page 17.)
.
Table 4. Health care facilities with no electricity access (2013)
Source: Compiled from (Adair-Rohani et al , 2013) for sub-Saharan Africa; data for Guyana and Egypt is from the Service Provision Assessment (SPA) of USAID’s Measure Health initiative (United States Agency for International Development, 2013) (Ref: 3.0. Bibliography, Required Reading, Item 1, page 17.)
The total cost for universal health care electrification (tcuHCe) from solar (photovoltaic systems) in Uganda can be derived by calculating the minimum average recommended installed capacity (maric) of HC solar systems in kilowatts (kw) for HC-1, HC-2, and HC-3 level facilities, as detailed in the Health Facility Needs Assessment: Uganda Country Summary Report (2015), Annex 3: Design Recommendations by District and Facility (see Annex 3). Utilizing Annex 3 site survey data from 100 HCs, the HC maric is estimated at 3.6 kw (HCmaric = 3.6kw).
Utilizing the data in Table 5, Systems Recommendation Summary, below (also sourced from Health Facility Needs Assessment: Uganda Country Summary Report (2015), the median estimated cost (mec) of a 3.6kw solar system (mec3.6kw) is $17,205 (mec3.6kw = $17,205). Hence, tcuHCe = mec3.6kw x tneHCs, or $17,205 x 3,900 = $67,149,500 (rounded), is the minimum investment required for the Republic of Uganda to achieve universal health care electrification for HC-1, HC-2, and HC-3 level healthcare facilities.
Utilizing the data in Table 5, Systems Recommendation Summary, below (also sourced from Health Facility Needs Assessment: Uganda Country Summary Report (2015), the median estimated cost (mec) of a 3.6kw solar system (mec3.6kw) is $17,205 (mec3.6kw = $17,205). Hence, tcuHCe = mec3.6kw x tneHCs, or $17,205 x 3,900 = $67,149,500 (rounded), is the minimum investment required for the Republic of Uganda to achieve universal health care electrification for HC-1, HC-2, and HC-3 level healthcare facilities.
Table 5. Systems Recommendation Summary
Source: Health Facility Needs Assessment: Uganda Country Summary Report (2015); Prepared principally by African Solar Designs, and published by the United Nations Foundation (UNF). See 3.0. Bibliography, Supplementary Reading, Item 1, page 9.
At issue is the risk factors:
(a) the HC maric estimated at 3.6 kw (HCmaric = 3.6kw) is not a sufficient power supply for the HC-1, HC-2
and HC-3 levels of health care, especially when taking into account of the health care objectives of
Uganda Vision 2040;
(b) that the COVID-19 pandemic requires a re-assessment of electrification requirements across HC levels of
care; and
(c) that the HCmaric is an undersized installed capacity to achieve financial sustainability for operations
and maintenance (O&M) services.
(a) the HC maric estimated at 3.6 kw (HCmaric = 3.6kw) is not a sufficient power supply for the HC-1, HC-2
and HC-3 levels of health care, especially when taking into account of the health care objectives of
Uganda Vision 2040;
(b) that the COVID-19 pandemic requires a re-assessment of electrification requirements across HC levels of
care; and
(c) that the HCmaric is an undersized installed capacity to achieve financial sustainability for operations
and maintenance (O&M) services.
Accounting for the risk factors as referenced above, it is likely that the cost of universal electrification at the HC levels of care for Uganda may increase from $67.5 million to a range totaling $135 million to $200 million.
3.2.0. Defining Energy Needs (specification for HC level of service)
Defining the energy needs for Health Centers (HCs) at each level of service for HC-1, HC-2, HC-3 and HC-4 facilities requires an understanding of emerging policies and technical standards that are arising from various initiatives for HC electrification sponsored by government agencies and multi-lateral donors.
The Government of Uganda (GoU) has principally adopted A National Standardization Strategy (NSS) based on an ISO (International Organization for Standardization) Methodology standards for solar (photovoltaic) electrification, and solar thermal, which are contained in the NSS 2019-2022, published by the Uganda National Bureau of Standards. The applicable NSS standards for solar photovoltaics and solar thermal are as follows:
The Government of Uganda (GoU) has principally adopted A National Standardization Strategy (NSS) based on an ISO (International Organization for Standardization) Methodology standards for solar (photovoltaic) electrification, and solar thermal, which are contained in the NSS 2019-2022, published by the Uganda National Bureau of Standards. The applicable NSS standards for solar photovoltaics and solar thermal are as follows:
Table 6. Annex A: National Standardization Plan (Photovoltaic and Solar Thermal Systems)
Source: National Standardization Strategy 2019-2022; Uganda National Bureau of Standards, Annex A, National Standardization Plan
Note that beginning with NSS 1487 electrification standards for micro-grids are lacking. Solar micro-grids, including solar-diesel hybrid systems standards (for both stand alone and grid connected systems) are recently emerging as a consequence of three national electrification projects: the Uganda Photovoltaic Pilot Project for Rural Electrification; the Energy for Rural Transformation Project; and the Uganda Energy Access Scale-up Project. These projects---and "best practices" and/or "electrification standards" emerging from field experiences---are discussed below:
|
1.
2.
|
Uganda: Photovoltaic Pilot Project for Rural Electrification (1995-2010); GEF Project ID: #295: The Government of Uganda is committed to addressing the energy needs of the majority of its citizens who live in the rural areas. To achieve the objectives, the project strategy will be to establish programmatic and/or commercial linkages between local industry/importers, banking institutions, NGOs/cooperatives, training institutions, and government agencies through the financing, design, installation and maintenance of at least 840 household and 4 community-based PV systems in 4 trading centers on a pilot basis. The project will test the effectiveness of several models of financing mechanisms which have succeeded in other countries to induce demand for PV technology.
The major project objectives included: (a) expanding private sector involvement in the private sector in providing energy services; (b) determining the necessary policy, technical, social, financial and institutional requirements to expand the market for PV systems on a demand-driven, full cost recovery basis; (c) strengthening the capacity of the private sector to manufacture, design, install, and service PV systems; (d) providing the government policy framework to stimulate the expanded use of PV systems nationally; and enabling the preparation of an investment plan for the use of PV technology on a national scale in Uganda utilizing one or more proven implementation strategies. Key lessons learned are the importance of establishing equipment standards and codes of practice that meet either locally developed or internationally recognized standards, and the formulation of technical standards that underpin all related project objectives and outcomes, including scalability, financing, operation and maintenance (O&M), stable supply chains, and inform workforce development standards and credentials. (Source: Uganda: Photovoltaic Pilot Project for Rural Electrification, Project Proposal. (Scale of project: 840 households and 4 community micro-grids at a project value of $2.8 million. Executing Agency: GoU Ministry of Natural Resources.) . Energy for Rural Transformation (2016-2026); GEF Project ID: #9513: The Energy for Rural Transformation (ERT) is 10-year Adaptable Program Loan (APL) project divided into three phases to increase access to electricity in rural areas of Uganda. Phase I will be designed in detail along with more general designs and triggers for release of the second and third phases. Building on the lessons learned in Photovoltaic Pilot Project for Rural Electrification, the ERT project development objective (PDO) is to build effective bridges to private sector PV market development and financing that permit a logical maturation to commercial delivery and finance mechanisms to ensure commercial sustainability.
At present, the power sector in Uganda is in a state of transition moving from a state-owned vertically-integrated power utility to a competitive, unbundled, privatized model, with transmission being retained as a monopoly. This shift has direct implications for renewable energy small-scale power producers (SPPs), as, over time, these SPPs will no longer be able to sell their power to the power utility, but would instead have to sell either directly to individual large consumers or to distribution companies under a “Multiple Buyer, Multiple Seller” model. There would be no power purchase agreement (PPA) between the generator and the main grid; rather, the grid would merely serve (for a fee) as the “highway” over which power is transported (wheeled) from the generator to a third-party customer. The development objectives of the proposed program are to: (a) provide rural households the direct and indirect benefits of increased access to adequate and reliable supplies of electricity, which could be in the form of conventional alternating-current (AC) power or direct-current (DC) power produced by stand-alone solar photovoltaic (PV) systems; (b) increase electricity access of rural public institutions, such as health and educational facilities; and (c) increase productivity and income for rural enterprises due to the benefits arising from electricity access. The ERT program is projected at a project cost of up to $176 million (rounded), with original and actual expenditures projected through 2022 Q4, as follows: 
Uganda Energy Access Scale-up Project (EASP) - WBG P166685
|
Defining the energy needs for Health Centers at each level of service for HC-1, HC-2 and HC-3 facilities in compliance with the Ugandan health facility availability standards framework can be best approached in a tiered approach according to the prioritization of needs, sometimes referred to as the "medical services value chain."
Uganda photovoltaic pilot project for rural electrification
Uganda photovoltaic pilot project for rural electrification
3.2.1. Inventory of end-use devices requiring electrification
[1] Health Facility Energy Needs Assessment: Uganda Country Summary Report:
| |||
|
Pages 44 - 48 provide an overview power requirements. (Begin reading from section labeled Future Load Requirements, page 44.) Note that the table on page 46 details the appliances associated with the six essential energy demands listed on the the top of page 45, as follows:
|
|
| |||||
[2] Modern Energy Services for Health Facilities in Resource-Constrained Settings:
| |||
|
Pages 21 - 29 provide an overview power requirements. See Table 3, Indicative power requirements of electrical devices for health services (pages 23-24), and Table 4, Example of an average load calculation using selected medical equipment (page 25).
|
|
|
| |||||||
[3] Powering Health: Electrification Options for Rural Health Clinics:
| |||
|
Section II, Understanding General Energy Needs (pages 3 - 7) provides an overview power requirements by facility types (see Table 1).
|
- Appendix A, pages 21 - 22 provide useful for end-use power calculations.
- Appendix B, page 23 provides a useful estimating exercise.
|
|
|
| |||||||||
[4] Conducting the Energy Audit:
|
Annex 1 of Modern Energy Services for Health Facilities in Resource-Constrained Settings provides an audit form --- the SARA (Service Availability and Readiness Assessment) Energy Survey Module --- developed by the World Health Organization (WHO).
The WHO SARA questionnaire has been developed to inform further discussion on the measurement of energy access in health care facilities. It is intended to provide indicative examples of questions concerning energy end-use for a healthcare facility that can be rapidly modified for different settings. Review the SARA Module Questionnaire and use the Annex 1 Worksheet (below) to create an initial inventory of end-use devices for the classification of healthcare facility to be evaluated, or create an audit form in Microsoft Excel that can be readily adapted for healthcare facilities by types of facilities and/or classification of heath care services. Fill out the form for the classification of healthcare facility to be evaluated using standards provided in previous documents, as listed above. |
|
| |||||
|
Alternately, you can begin using the Energy Audit Reporting Worksheet developed by Mark Hankins, Abdalla Kyezira, and Walt Ratterman for the Powering Healthcare program at the United States Agency for International Development (USAID) which is provided for your use in Item 9, below. However, before moving to that level of complexity and detail, it is recommended that you use the Annex 1 Worksheet, above, to construct a preliminary audit form.
|
[5] Compendium of existing health services surveys:
FOR CLASS REFERENCE 18FEB2021:
|
| ||||