PERSPECTIVE

The SELCO Foundation focuses on using sustainable energy as a catalyst for rural healthcare, along with those of rural households, education, and livelihoods by supporting high-risk innovation and ecosystem development for under-served communities by using philanthropic capital and in many cases by unlocking local finance. The foundation has customized power and health requirements in more than 75 healthcare facilities across India.  Many of these are run by public charitable trusts/ non-profit organisations primarily in Karnataka, Tamil Nadu, Assam, Odisha, MP, Jharkhand, Meghalaya, and Bihar. Over a recent interaction, Huda Jaffer, Lead Designer, SELCO Foundation shared about the activities of the foundation in this area and her perspectives on the role and potential for distributed renewable energy solutions in addressing the healthcare needs for rural and hard to access areas in India.

SELCO Foundation aims at working towards a “Health Energy Nexus,” with an approach that ensures energy independence, in the most efficient manner, for the rural healthcare delivery centres. The Foundation has mainly been focused on the implementation of pilot programmes through collaborations with state and centre governments, private players and local stakeholders to build on-ground evidence in order to scale up to larger programmes within the country and globally.  

To ensure a comprehensive and scalable construct, SELCO Foundation’s intervention model entails energy-efficient appliances, distributed renewable energy systems for the health centres according to different topologies, and the centre building itself designed with sustainable principles. Highlighting this aspect, Huda shares, “if the efficiency piece is not looked at, then the system cost for energy significantly increases. The energy costs reduce by 60-70 percent when a programme is combined with energy-efficient appliances. In addition, the center’s energy needs are designed to be powered by a solar PV system - the system is designed based on the physical area in which the healthcare facility is located and as per the needs of the centre to ensure that there is no overutilization or underutilisation of the system. Lastly, there is also a focus on green building design that includes optimisation of aspects such as natural light and ventilation, passive heating and cooling, placement of windows, etc. These aspects allow cost gains to the key stakeholders i.e. healthcare facility and the government. 

Figure 1: Solar-powered boat clinic in Assam

Services/facilities at the healthcare centres and the dependence on electricity

The critical loads in the centres which need uninterrupted and reliable power supply include ice Pack Freezer, Ice Lined Refrigerator, Baby Warmer & Semi-autoanalyzer, etc. During evaluation of these centres, SELCO Foundation focusses on not only how the provision of energy can help improve certain services but also takes into consideration aspects such as improvement in human resources and appliance maintenance that can help sustain these efforts. The interventions, therefore, have varied from introducing mobility in healthcare (installed solar-powered vaccine refrigerators) in boat clinics, providing maternal kits, etc.

Huda highlights that while working with healthcare facilities it is critical that these centres are compliant with Indian Public Health Standards (IPHS) guidelines. These guidelines recommend a set of essential and desirable standards for different types of facilities to provide quality healthcare delivery in the country.  This ensures that these facilities are well equipped for electricity to be utilised effectively and there is adequate staff to run the appliances. The approach thus followed entails identification of health facilities, needs assessment, system design, and financing. “Only when all the aspects are considered, will energy access help make a difference in the healthcare space and be catalyst in bridging the health gap”, Huda iterates. 

Typical funding needs of a solar-powered PHC 

The financing requirement of these centres varies with respect to the services provided and in the region in which they are located. The table below captures the typical funding requirement of different type of healthcare facilities. On average, SELCO foundation has intervened in more than  75 healthcare facilities across India by providing financing to the tune of INR 37.5 million primarily in Karnataka, Tamil Nadu, Assam, Odisha, MP, Jharkhand, Meghalaya, and Bihar.  Since 2016, their distributed solar systems have improved the quality and quantity of healthcare services for around 4.5 lakh individuals spread across a number of PHCs, sub-health centers and boat clinics in these various states.

Table 1: Typical size and financing requirement of different health facilities

Source: SELCO Foundation

In many states, for the running/operational cost, SELCO ensures that maintenance can be covered through the existing un-tied funds earmarked by the state health society for the health department, which varies from INR 50,000 to INR 175,000. The PHC is free to use these funds for any kind of need for that year for the health-centre. These funds are typically used for furniture replacement, building painting, diesel for back-up power, inverter replacement, etc. The functioning and management of the health centres is the responsibility of Rogi Kalyan Samitis/Aarogya Raksha Samitis (which consists of members from local Panchayati raj institutions, NGOs, government officials, etc.) SELCO facilitates contracts between the Rogi Kalyan Samiti/Arogya Raksha Samiti and local energy enterprises for operation and maintenance of the solar systems. Subsequently, around 1-2% cost of the system is kept aside every year for maintenance. Once in 5 years, 40% of the untied funds are kept aside for the replacement of the battery. SELCO also collaborates with corporate private entities through their CSR initiatives to procure and manage important medical equipment. For example, it partnered with GE Healthcare to provide energy-efficient radiant warmer and phototherapy machine for PHCs in Karnataka, which led to 100% increase in the average number of low-birth-weight babies handles every month. 

With regard to providing financial support to these facilities, Huda highlights that the capital cost for any infrastructure support to such institutions has to be funded through philanthropic capital. Typically, the government supports the capex for financing the health-care facilities. However, the state or the centre can also get a long term loan from institutions like the World Bank or ADB to power these health centres. To support the financing needs of partner facilities, SELCO foundation also provides funds from its own corpus, co-leverages CSR fund and also identifies locally availably funds (such as under Aspirational district fund, MP funds, etc.)

Table 2: Impact created so far

Intervention/Solution	Region	Impact
DRE solution for PHCs	Karnataka, Orissa, North East (Assam, Meghalaya* Arunachal Pradesh*)	1,000,000 people impacted
Cold chain (Solar-powered Vaccine Refrigerator)	Karnataka, NE, Odisha, Chhattisgarh	258,000 children immunized

Source: SELCO Foundation

Key policy drivers and /or limitations to be addressed in scaling the use of decentralized renewable energy at PHCs in India

SELCO team’s experience indicates that typically governments focus on strengthening the grid and there is no policy stakeholder doing a cost benefit analysis of strengthening the grid vs. provision of distributed renewable energy solutions. Since grid power is subsidised, DRE loses the argument and if one goes to the government to provide DRE solutions to health centres, it is deemed that electrification is complete. SELCO Foundation believes that irrespective of electrification status, the use of solar systems with battery is a much more sustainable pathway for the health sector as a whole. When DRE solutions are taken in conjunction with energy efficiency and green buildings, the health sector has a great capacity to reduce the carbon footprint by a huge percentage. Certain measures/interventions that can enable a greater push for electrification of health centres through decentralised renewable energy includes:

• Provision of necessary capex to every state to power the health value chain
• Ensuring that there is a complementing training and capacity building for ANM (Auxiliary Nurse Midwifery), medical staff at the RKS level (last mile level) for ensuring that the centres are running as DRE becomes commonplace,
• Policy to allow for the utilisation of the untied funds for the maintenance supply and battery replacement of these DRE systems and
• Promotion green building design and energy-efficient equipment. 

Way forward

In terms of incorporating energy efficiency into the solutions, energy efficiency appliances currently have been mapped for maternal and child healthcare. Over the next three years, SELCO’s plan is to work on sterilisers, and radiology as well.  SELCO continues to place emphasis on partnerships (with technology providers, local NGOs, etc.) for scaling up its operations. Since the organisation has a strong focus on implementation and building on-ground evidence, it plans to also intensify its engagement with evaluation and policy partners to synthesize evidence and formulate inputs for evolution of more robust and enabling policies for the sector.