Insights into Editorial: Powering rural healthcare

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Insights into Editorial: Powering rural healthcare


Context:

Around 38 million Indians rely on health facilities without electricity. Without access to regular power supply, numerous life-saving interventions cannot be undertaken.

A study, ‘Powering Primary Healthcare through Solar in India: Lessons from Chhattisgarh’, highlights the role of solar energy in bridging the gaps in electricity access in rural healthcare facilities.

Providing solar-powered systems across primary health centres can improve health outcomes.

Health: The Essential Element of Well-being

Health and well-being play a vital role in development and poverty reduction. Good health is one of the most valued aspects of well-being and a critical element in the quality of life. Good health also represents instrumental values through the enhancement of opportunities to participate in education, training, and the labour market  .

Human Development Index (HDI) and the Multidimensional Poverty Index (MPI), have some parameters that reflect the status of good health of a community.

The Sustainable Development Goals (SDGs), apart from setting targets for reduction in maternal and child mortality and other health risks, explicitly state the need for universal health coverage (UHC) as well as recognise the need for an affordable and robust health delivery system. UHC includes financial risk protection, access to quality essential healthcare services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all.

In India, about 55% of all households depend on the public health system to meet their healthcare needs. This dependence is higher in rural areas. For most people, the PHC at the village level serves as the first point of contact or the first referral unit. Therefore, the effective functioning of PHCs plays an important role in facilitating UHC.

However, the lack of healthcare infrastructure has been a limiting factor in the ability of the system to provide timely and quality care to all those who need it.

Electricity as an enabler of health service delivery

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.

A recent publication by the WHO and the World Bank maintains that besides improving the direct functionality of health facilities, access to electricity is equally instrumental in attracting and retaining skilled health workers, especially in rural areas.

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.

Ground report

A study, ‘Powering Primary Healthcare through Solar in India: Lessons from Chhattisgarh’, published recently by the Council on Energy, Environment and Water (CEEW) and supported by Oxfam India, evaluated 147 primary healthcare centres (PHCs) across 15 districts in Chhattisgarh.

  • It highlights the role of solar energy in bridging the gaps in electricity access in rural healthcare facilities. In rural India, PHCs provide the last-mile delivery of healthcare services.
  • The Rural Health Statistics 2016 data find that India has around 25,000 PHCs, and of the functional PHCs, 6% are not electrified implying that over 38 million rural households depend on health facilities that have no electricity.
  • Further, the fourth round of District Level Household and Facility Survey data indicates that one in every two PHCs in rural India is either not electrified or suffers from irregular power supply. This also results in health facilities having to rely on expensive backup options like diesel generators that have significant cost implications.

The use of renewable energy sources such as solar could help PHCs augment or even substitute traditional grid-based power systems. This would also help the transition towards a low-carbon, climate-smart healthcare system. Moreover, solar systems can facilitate reliable and uninterrupted electricity supply critical for 24/7 emergency services, deliveries and neonatal care, as well as inpatient and outpatient services.

Chhattisgarh: State of Healthcare and Health Infrastructure

Chhattisgarh, as a state with a predominantly rural population, Chhattisgarh faces the challenges of inadequately skilled human resources, poor physical infrastructure, and other supply-side gaps with respect to the delivery of quality healthcare.

In order to augment electricity supply across PHCs in power-surplus Chhattisgarh, the Chhattisgarh Renewable Energy Development Agency (CREDA), between 2012 and 2016, installed off-grid solar photovoltaic (PV) systems of 2kW each in 570 PHCs.

Electricity Access and Its Impact on Healthcare Services in PHCs in Chhattisgarh:

  • Districts in Chhattisgarh with a higher share of power-deficit PHCs (with less than 20 hours of electricity supply per day from the grid), showed a higher infant mortality rate, a higher under-five mortality rate, and a lower proportion of fully immunised children.
  • The CEEW study found that the solar-powered PHCs in Chhattisgarh admitted over 50% more patients and conducted almost twice the number of child deliveries in a month compared to the power-deficit PHCs without a solar system.
  • The ability of solar-powered PHCs to maintain cold chains to store vaccines and drugs and operate new-born care equipment has significantly improved.
  • Almost one-fourth of the power-deficit PHCs in Chhattisgarh relied exclusively on solar as a backup to run cold chain equipment.
  • Continuous electricity supply must be ensured to cold chains at PHCs, especially in rural Chhattisgarh, which has an infant mortality rate that is higher than the average for rural India. Further, patients showed more willingness to get admitted for treatment at the solar-powered PHCs due to facilities like running fans.
  • Also, 90% of PHCs with solar systems reported cost savings due to lower electricity bills or reduced expenditure on diesel.

Key Lessons for Electricity Access and Intervention Designs

The role of electricity as an enabler of the cost-effective and targeted delivery of health services is being recognised across the world.

Scaling-up solar-powered systems across PHCs in rural India is dependent on various factors.

  1. The first is to recognise the critical nature of electricity access in the entire health system infrastructure.
  • The Indian Public Health Standards has set minimum service-level benchmarks for all activities of PHCs, indicating that every PHC should have power supply with a back-up option with the aim of providing a minimum service level of healthcare to all citizens across the country.
  • The National Health Policy 2017 reiterates the commitment to improve primary healthcare by strengthening infrastructure.
  1. The ability to adapt solar systems around the local needs and considerations of PHCs including the burden of disease, weather, terrain, and power availability.
  • For example, disaster-prone areas that need blood storage units and other health services could invest in higher capacity systems or greater storage capacity.
  • There must be a focus on making ‘Solar for Health’ a national priority.
  • Scaling solar systems (5kW) across PHCs to power healthcare services could contribute to about 160 MW of decentralised energy capacity.
  1. Augment electricity supply with solar systems and give priority to power-deficit health facilities.

Conclusion

There are significant opportunities to simultaneously address the goals of energy access, energy security, resource management, and health outcomes. Solar for health is one such opportunity to achieve this goal. Chhattisgarh provides evidence for scaling this intervention to meet the national goals for both health and energy.