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    A matter of life and death

    Aqilah Rahman

    Electricity is needed to power the most basic services in healthcare, from lighting and communications to ensure appropriate storage of vaccines, blood and medicines that require refrigeration.

    Yet, almost one billion people in low- and lower-middle income countries are served by healthcare facilities with unreliable electricity supply or no electricity access at all, according to a new report from the World Health Organization (WHO), the World Bank, the International Renewable Energy Agency (IRENA), and Sustainable Energy for All (SEforAll).

    Titled Energizing Health: Accelerating Electricity Access in Health-Care Facilities, the joint report states that access to affordable, reliable, sustainable and modern energy – particularly electricity – is a critical but under-recognised enabler of health services. Without access to reliable electricity in all healthcare facilities, the aspiration for universal health coverage cannot be achieved.

    “Electricity access in health-care facilities can make the difference between life and death,” said Assistant Director-General ai for Healthier Populations at WHO Dr Maria Neira.

    “Investing in reliable, clean and sustainable energy for healthcare facilities is not only crucial to pandemic preparedness, it’s also much needed to achieve universal health coverage, as well as increasing climate resilience and adaptation.”

    According to the report, almost two-thirds of healthcare facilities in 63 low- and middle-income countries require a new connection or a backup power system. Regions that urgently need intervention are South Asia and sub-Saharan Africa, followed by East Asia and Pacific.

    At least 25,000 healthcare facilities in sub-Saharan Africa have no electricity access, while over 68,000 have unreliable electricity. In comparison, only half of hospitals in sub-Saharan Africa have access to reliable electricity. An estimated USD4.9 billion is needed to provide the required healthcare facilities and ensure provision of essential health services in the assessed countries.

    Disparities in electricity access within countries are also stark. Primary healthcare centres and rural health facilities are considerably less likely to have electricity access than hospitals and facilities in urban areas.

    For decades, centralised grid extension has been the main electrification approach. Grid connections are often the primary source of power if grid electricity is available but this could be difficult in low-income countries particularly rural and remote regions. At least 433 million people worldwide are served by healthcare facilities without any access to electricity whatsoever, often because conventional grid connections simply do not exist.

    In rural and remote areas, grid extension is often slow because of the distance between the user and the existing grid, challenging terrain and a low population density. Furthermore, grid power interruptions and irregularities in voltage and frequency have a dramatic impact on the health services available and can damage sensitive medical equipment. In other cases, healthcare facilities are connected to the central grid but the power supply is unreliable.

    To tackle this issue, decentralised renewable energy systems are often the most economical and technically viable solution. One example the report highlights is a system based on solar photovoltaics (PV) panels, which is cost-effective and readily deployable for healthcare facilities not reached by the central grid. Decentralised sustainable energy systems also save costs of fuel for generators and reduce air pollution, creating a pathway to a low-carbon future.

    As global health systems face increasing burdens from climate change, they are also a growing source of emissions that contribute to climate change, says the report, noting that the health sector must build facility-level and systems-level resilience while also reducing its carbon emissions. It adds that sustainability and climate impact mitigation must therefore be central to all efforts to close the energy gaps in healthcare facilities across the world.

    The report also highlights that the “install and forget” approach also needs to be transformed into “install and maintain”. Long-term operation and maintenance of energy systems must be ensured, along with replacement of batteries and spare parts. Funding in the long term should also be an integral part of budget planning, with funds allocated accordingly. Installed energy systems should be monitored, with accountability procedures in place.

    In addition, the report underlines that it is essential that programmes focussing on electrification of health-care facilities coordinate with programmes focussing on providing medical devices and appliances. In order to really generate impact, electricity must be provided together with all other components including suitable medical devices and staff training. The report calls for government actors and development partners to increase coordination efforts in this direction.

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