NOTE: THIS SECTION WILL BE COMPLETED PRIOR TO THE 11 MAY 2021 WEBINAR
INTRODUCTION
Conducting an energy needs assessment for health care facility electrification is a requirement of the MEC 4722 Renewable Energy Capstone Project. Capstone Project students, therefore, need an understanding of how electricity is used in deep-rural communities of the developing world as a health care intervention.
As noted in Section 2.0, National Health Facility Mapping (see Section 2.0. Mapping Lesson), there are no international standards for healthcare facility electrification. However, the multilateral donor community, including the World Health Organization (WHO), the World Bank, the United Nations Foundation, the United States Agency for International Development (USAID), the Sustainable Energy for All (SEforALL) Initiative, and others, are seeking to establish healthcare facility electrification intervention standards as it applies to rural healthcare facilities at various levels-of-care and service availability.
Please review the healthcare facility electrification standards in the SEforALL Initiative publication, Powering Health Facilities - Approach, (2020) [1] reviewed in Section 3.0, Standards, and the emerging donor requirements for health facility mapping reform in the Republic of Uganda and the World Health Organization (WHO) in Section 2.0. Mapping Lesson, before proceeding to the lesson plan, below.
As noted in Section 2.0, National Health Facility Mapping (see Section 2.0. Mapping Lesson), there are no international standards for healthcare facility electrification. However, the multilateral donor community, including the World Health Organization (WHO), the World Bank, the United Nations Foundation, the United States Agency for International Development (USAID), the Sustainable Energy for All (SEforALL) Initiative, and others, are seeking to establish healthcare facility electrification intervention standards as it applies to rural healthcare facilities at various levels-of-care and service availability.
Please review the healthcare facility electrification standards in the SEforALL Initiative publication, Powering Health Facilities - Approach, (2020) [1] reviewed in Section 3.0, Standards, and the emerging donor requirements for health facility mapping reform in the Republic of Uganda and the World Health Organization (WHO) in Section 2.0. Mapping Lesson, before proceeding to the lesson plan, below.
LESSON PLAN
The International Renewable Energy Agency (IRENA), Figure 1, Energy for Health Services, offers a useful illustration of the impact of electrification on a deep-rural healthcare facility:
Figure 1. Energy for Health Services
Source: International Renewable Energy Agency (IRENA), adapted from World Health Organization (WHO)
The illustration identifies key applications for energy services, all of which can be provided with electricity from solar photovoltaic (PV) energy systems, or other renewable energy resources, including passive or active solar thermal applications, biomass energy, low-head hydro, etc., as shown in Figure 2, Conceptual Framework for Energy Use at Health Center (HC) Levels of Care, below:
Figure 2. Conceptual Framework for Energy Use at Health Center (HC) Levels of Care (Click image to Enlarge)
Source: The role of energy in health facilities; Plos One, (20 July 2018); Note: Original table modified for use in Lesson 3.0.
NOTE: The Conceptual Framework for Energy Use at Health Center (HC) Levels of Care is a service developed and maintained by the Service Provision Assessment (SPA) team within the Demographic Health Survey (DHS) Program Group of the United States Agency for International Development (USAID), and codified within the annual Service Availability and Readiness Assessment (SARA) of the World Health Organization (WHO). Review Section 2.0. Mapping Lesson for additional information.
The MEC 4722 Capstone Project will focus PV energy systems; hence, Section 3.0, Energy Needs Assessment, provides basic information on health care interventions utilizing end-use devices that require electric power. It provides a listing of end-use medical devices and the power requirements from various resources, including the key agencies referenced in the note, above.
CONDUCTING THE NEEDS ASSESSMENT:
The first step in conducting an energy needs assessment for deep-rural health centers (HCs) in developing countries is to identify the classification of the facility within the hierarchy of the national health system by "level-of-care and service availability" (health care services provided) in compliance with country health care delivery standards.
The Ministry of Health (MoH) of the Government of Republic of Uganda (GoU) has established a policy for health facility classification referred to as the "Health Facility Availability Standards Framework." This standard is articulated in the National Health Facility Master List [3], published by the MoH, and shown in Table 1, Health Facility Availability Standards Framework, below:
Table 1. Health Facility Availability Standards Framework*
Source: Ministry of Health; National Health Facility Master List, Item 1, page 7 (See: Section 3.0. Bibliography).
*Level 1, Clinic, defines a health team in the field typically with no physical infrastructure.
*Level 1, Clinic, defines a health team in the field typically with no physical infrastructure.
Uganda’s healthcare facilities are classified into seven levels: HC I (or Clinic), HC II, HC III and HC IV; General hospital; Regional Referral hospital; and National Referral hospital. The Framework defines the classification or categorization of health facilities by: (a) "level-of-care" (health services); and (b) "catchment area" (population).
The site selected for the MEC 4722 Capstone Project is the Kigambo Health Center II (HC II) located in the
Kyegegwa District of Southern Region of Uganda. The Kigambo HC was selected due to prior work completed on the site by the United Nations Foundation (UNF) [4] to electrify 64 healthcare facilities in Uganda and Ghana, allowing the Capstone Project students to gain access comparative site data.
The site selected for the MEC 4722 Capstone Project is the Kigambo Health Center II (HC II) located in the
Kyegegwa District of Southern Region of Uganda. The Kigambo HC was selected due to prior work completed on the site by the United Nations Foundation (UNF) [4] to electrify 64 healthcare facilities in Uganda and Ghana, allowing the Capstone Project students to gain access comparative site data.
Figure 3. MEC 4722 Capstone Project Health Center Site Selection
Source: United Nations Foundation (2015); Health Facility Needs Assessment, Uganda Country Summary Report
The most recent Ministry of Health SARA 2013 Report [5] provides a list of availability of health facility equipment for healthcare facilities, including "power source," at HC II levels of care. Table 4, Basic Equipment at HC II Level-of Care, provides a health systems equipment from the 2013 SARA Report based upon a survey of 209 health facilities.
Figure 4. Basic Equipment at HC II Level-of-Care
Figure 5, Basic Equipment at HC II Level-of-Care, provides an inventory of medical equipment, including "light source." Note the absence of medical equipment requiring electricity for clinical care, as well as the absence of refrigeration for cold chain storage.
The Kigambo facility at the time of the UNF site survey was previously provided with a 50Wp solar system that provided for total electricity consumption on-site of 1 kWh/day for lighting, phone charging and battery charging. Developing a future load profile for the site assumes providing for increased lighting (including staff quarters), information and communications technologies, water pumping, refrigeration and sterilization (at minimum), as referenced in the Energy Needs Assessment Report for Kigambo Health Center, Uganda [6], published by the United Nations Foundation.
The Kigambo facility at the time of the UNF site survey was previously provided with a 50Wp solar system that provided for total electricity consumption on-site of 1 kWh/day for lighting, phone charging and battery charging. Developing a future load profile for the site assumes providing for increased lighting (including staff quarters), information and communications technologies, water pumping, refrigeration and sterilization (at minimum), as referenced in the Energy Needs Assessment Report for Kigambo Health Center, Uganda [6], published by the United Nations Foundation.
MEC 4722 Capstone Students utilized Modern Energy Services for Health Facilities in Resource-Constrained Settings: A Review of Status, Significance, Challenges and Measurement (2015) [7], published by the World Health Organization (WHO) to develop an energy needs assessment for the Kigambo Health Center II facility. The WHO publication provides a comprehensive overview of electrical equipment required for health services by two categories: (i) infrastructure; and (ii) specific services (medical devices and appliances). Table 2, Electrical Devices for Rural Health Center Services:
Table 2. Electrical Devices for Rural Health Center Services
*Health Center Levels II, III and IV.
Source: WHO (2015); Modern Energy Services for Health Facilities in Resource-Constrained Settings: A Review of Status, Significance, Challenges and Measurement (2015), pgs., 23-24 |
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See MEC 4722 Renewable Energy Capstone Project Report to be published prior to the scheduled 11 May 2021, webinar.
PRIOR CONTENT
Table 2. Quantity of Health Facilities in Uganda by National Health Availability Standards Framework
Data from the MoH Master List, the ERT and EASP projects and other reports (including the Health Facility Needs Assessment: Uganda Country Summary Report - 2015) indicate that facilities that are currently electrified are provided with stand alone solar photovoltaic (PV) systems at .250kWp to 440kWp, far below power requirements to provide the level of services mandated under the MoH Health Facility Availability Standards Framework to facilitate the goals of the Uganda National Minimum Health Care Package (2010); specifically, energy for HC medical equipment and staff living quarters, with a focus on lighting, cold chain, sterilizing and telecommunications.
3.0.2. Defining Energy Needs in Deep-Rural Health Care Facilities in Uganda
1. Health Center I (HC-1) / Clinic or Village Health Team (VHT): HC-1s provide the following services:
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(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).
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).
Category I Health Clinic (low energy requirements, 5 – 10 kWh/day)
- Typically located in a remote setting with limited services and a small staff
- Approximately 0 – 60 beds
- Electric power is required for:
- lighting the facility during evening hours and to support limited surgical procedures (e.g. suturing)
- maintaining the cold chain for vaccines, blood, and other medical supplies – one or two refrigerators may be used
- utilizing basic lab equipment – a centrifuge, hematology mixer, microscope, incubator, and hand-powered aspirator
Table 3, HC-1 and HC-2 Level of Service Delivery (Click images to enlarge)
Table 4, HC-1 and HC-2 Minimum kWh/Day Requirements
Table 5, HC-3 Level of Service Delivery
Table 6, HC-3 Average kWh/Day Requirements (O&M Assumptions, see Table 4)
Table 7, HC-4 Level of Service Delivery
Table 8, HC-4 Average kWh/Day Requirements (O&M Assumptions, see Table 4)
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:
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.)
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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.)
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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.
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