DIPTI

PERSPECTIVE

Analysis: Enabling effective healthcare provision through resilient energy systems


823

Un-electrified Primary health centres


39,122

Un-electrified sub-centre

 

 

230 million

People dependent on health-care facilities without electricity access


 

2200+

Existing health facilities powered through distributed solar solutions

 

INR 6 billion

Required funding from government to power un-electrified facilities through solar systems 


1. Rural Healthcare in India

The rural health care infrastructure in India, which entails a total of 189,784[1] healthcare institutions, shoulders the responsibility of serving the medical needs of 65% of the country’s population. The primary tier of health care facilities operates at three levels i.e. the sub-centre, Primary Healthcare Centre (PHC), and the Community Healthcare Centre (CHC) wherein a sub-centre typically serves 4~5 villages, PHC caters to 25 villages and a CHC serves typically 114-119 villages[2]. These centres are usually the ‘first point of contact’ for crucial health-care services such as vaccination, labour and deliveries, neonatal care, eye-care services, etc.

Over the last decade, the government has endeavoured to improve the healthcare metrics in India, but still faces the challenge to shape improvements across all states. The maternal mortality rate (MMR) in India during 2015-17 stood at 122[3] with states such as Assam, Jharkhand, Chhattisgarh, Rajasthan and UP reporting MMR higher than 160. While the rate has improved over the past decade, targets for good health and well-being (SDG 3) aim to reduce the global MMR to less than 70 per 100,000 live births by 2030. Even for vaccination, India has strived to improve and managed the vaccine coverage for children to 62% in 2015, yet certain states (such as Rajasthan, UP, Mizoram, etc.) continue to lag with less than 60% coverage. 

There is a well-recognized supply gap in manpower (both doctors and support staff) and essential equipment/infrastructure in existing centres. Even when resources - both human and technical (albeit limited) - are available, there are additional constraints imposed by inadequate supply of electricity limiting the functioning of the equipment thus affecting the provision of services. Given that energy forms an intrinsic part of the health-care infrastructure, it is perceived to be positively correlated with the reliable functioning and delivery of these services.  Thus, in order for them to function at their full capacity, it is important that these facilities have a regular and reliable supply of electricity.  

2. Interlinkages of electricity and provision of healthcare services

There are many aspects that influence quality of healthcare delivery such as availability of trained medical staff, provision of infrastructure like labour rooms, necessary equipment and sanitation, etc. with energy being a key input for several of the services. At the most basic level, the availability of electricity is crucial for the running of important medical equipment. Apart from in-patient and out-patient services, two most critical services provided by these health centres (especially PHCs and CHCs) requiring regular and reliable supply of electricity, are maternal deliveries and vaccination. Deliveries, especially those that take place at night, require a light source and fans for the comfort of the mother. Moreover, when a child is born, radiant warmers are crucial to ensure the health of the new-born. With regards to refrigerated infrastructure, most vaccines must be kept at a constant temperature of 4 degree Celsius, which requires a regular supply of electricity to the ice-lined refrigerator and the deep freezer. Further, devices such as autoclaves are critical for sterilisation of equipments and other objects. Thus, an improved supply of electricity can especially be seen as positively affecting the provision of these services. The table below highlights the services that are dependent on electricity supply and equipments/appliances typically installed across different kinds of healthcare facilities in rural India. 

Table 1: Electricity requirement for provision of healthcare services in different types of facilities

Note: Only essential equipments have been included; Source: IPHS Revised Guidelines 2012

 3. Electrification of PHCs in India

The previous table underscores the dependence of healthcare on electricity supply. While the central government has concluded the electrification drive under the Saubhagya scheme, the focus was solely on households and therefore, the health institutions (particularly rural sub-centres) were left out of the purview. As a result, 3.2% of all rural PHCs and 24.7% of all rural sub-centres in India are still un-electrified[4].  The heatmap illustrates the states with un-electrified sub-centre or PHCs in the state i.e. a darker colour indicates that a higher number of un-electrified health centres; while the un-shaded states indicate that it has no unelectrified PHC/sub-centre as per the government data.

Figure 1: Heat-map of the higher number of un-electrified (a) PHCs and (b) Sub-centres in India

With respect to PHCs, Jharkhand lags with over 40% of PHCs (129 PHCs) still un-electrified. However, while the focus has typically been on PHCs, a number of sub-centres seem to have been out of the purview of the government with around 65% of the sub-centres remaining un-electrified in Bihar, Jharkhand and Assam.  Moreover, in some of these states, the typical population covered far exceeds the prescribed number of 20,000-30,000 people coverage under the IPHS. For instance, a Jharkhand PHC serves an average rural population of 84,077, while for Bihar, the corresponding number is 48,626. Overall, around 230 million of the rural population is dependent on health-care facilities with no access to power (as highlighted in Table 1). Moreover, even among these centres that have electricity supply, many face intermittent power supply or the supply is marred by voltage fluctuations, which also come in the way of healthcare delivery.

Table 2: Summary of health centres statistics

Type of facility

Total

(in rural areas)

Un-electrified

No. of rural population served by each PHC

No. of rural population served by un-electrified health centres

PHC

25743

823

32,387

26 million

CHC

5624

NA

148,248

NA

Sub-Centre

158417

39122

5,236

204 million

Source: Rural Health Statistics, 2019


4. Role of distributed solar solutions in powering the health centres

Given the terrain vulnerability of many of these rural and remote areas, one of the feasible solutions for electrification of rural healthcare is the adoption of solar PV systems, which might either provide complete power supply or might act as a back-up (potentially coupled with storage) to ensure regular power supply, especially during peak hours. With regards to having a backup, PHCs usually tend to rely on diesel generators. But having a solar PV system as a backup provides many more benefits - economically, environmentally and in relation to health. Though, diesel generators have a lower capital cost (INR 90,000 for a 5 kVA system) compared to solar  PV systems with a battery (INR 400,000[5] for a 3-hour battery back-up system), they have higher operational expenses. The operational cost of a diesel generator assuming a back-up of 3-4 hours would vary from INR 200,000 annually for a 5kW system, given a delivered cost of diesel of INR 26-27 per kWh[6]. Thus, the energy needs of sub-centres, PHCs and CHCs in rural and remote areas, where there is electricity deficiency, can be fulfilled through off-grid solar installations. Nevertheless, it is necessary to evaluate each centre before finalizing a solar installation to fully account for its energy needs as also to decide whether it needs an installation for the entire load or an installation as backup. Based on the electricity needs of the health centres, government has undertaken efforts to power these facilities either through stand-alone solar systems with battery back-up or grid-interactive solar PV only systems to ensure reliable electricity supply.

In addition to standalone solar systems providing electricity supply to health facilities, energy efficient/innovative appliances are required which are customized for rural requirements and can work even during outages (such as Godrej’s Surechill vaccine and blood bank refrigerator, refer to the article linked below).Thus, several institutions such as GE healthcare, SELCO foundation and Godrej appliances are focussing on coupling energy efficient appliances along-with distributed solar systems. Moreover, institutions like SELCO foundation have also helped enable mobile healthcare facilities by piloting boat clinics to provide healthcare services in Island areas of Assam which are otherwise difficult to reach.

Given that there are multiple stakeholders involved in the health-energy nexus in India,  a snapshot of key players in the value chain is illustrated below.

Figure 2: Key players across the 'health-energy' value chain In India