* Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.
Coronavirus has exposed the weaknesses of public services in India but off-grid renewable energy is a key way to improve healthcare
For a while now, there has been considerable debate around weaknesses in the delivery of public services like education and health, especially for poor and marginalised communities, which is an underlying cause of rising social and financial inequities.
COVID-19 has shone a spotlight on those gaps, especially in the health sector in developing as well as developed countries. As with climate change, the poor face an unfair share of the brunt of the coronavirus pandemic, although they are not responsible for causing it.
Present delivery mechanisms for healthcare have to be challenged. Access to affordable and reliable healthcare should be a fundamental right for any citizen of the world. However, the focus of advancements in medicine is more on technology and less about accessibility.
The innovations and corresponding efforts are put towards developing products and systems based on the primary assumption that resources are not a constraint - human, financial or even energy - thereby making them accessible only to those who can afford to pay.
In India, the National Rural Health Mission aims to provide equitable, affordable and quality healthcare to rural populations. These services are administered via community-owned, decentralised healthcare systems which play an important role in births, immunisation, antenatal and neonatal care.
But numerous problems exist - for instance, inefficient and poorly designed buildings and medical equipment, ill-equipped staff quarters, unreliable power and water supply, and untrained employees.
Each of these challenges can be resolved with sustainability at the centre of the thought process. Efficient infrastructure built with local materials, medical equipment that uses few resources, highly trained local staff complemented with tele-medicine, decent living staff quarters – and all of it powered by renewable energy.
This holistic approach to implementation would prove that not only is renewable energy inexpensive, but it also makes delivery of health services more resilient to external shocks.
These solutions have to be rolled out together to make sustainable delivery of healthcare affordable and accessible: government policies, innovative health-centre designs, low-resource technologies by manufacturers of medical equipment and localised training of personnel.
According to the 2018-2019 Rural Health Statistics report, 39,286 sub-centres in India are without electricity. These sub-centres can be models of decentralised health delivery points, leading to true democratisation of services for the 230 million people they cater to, as well as creating solar jobs in those regions.
Here are some priorities for achieving that goal:
Solarising health centres
The Chhattisgarh Renewable Energy Development Agency (CREDA), in collaboration with the state health mission, has installed off-grid solar PV for 900 rural health centres across the state, with a cumulative capacity of 3 MW, an average of 3.3 kW per centre. Building design and equipment efficiency will result in more services being provided by the same centres and contribute towards meeting the country’s goal of ensuring universal rural healthcare.
Allocating dedicated funding
India’s national budget currently includes a combined US$12.8 billion allocation to energy and healthcare. In order to supply 800 unelectrified primary health centres (PHCs) and 39,000 sub-centres with solar PV plus 3-hour storage capacity, the initial capital expenditure would be as little as $85 million – a mere 0.6% of the 2020-21 energy and healthcare budget.
Ensuring long-term sustainability
There is also a need to ensure the sustainability of these systems in the long term. By working through existing structures, such as the state-level National Rural Health Missions, the renewable energy agencies and others, ongoing operations and maintenance of infrastructure can be budgeted for. In Chhattisgarh, health-centre staff were trained to optimise system use and CREDA took over system maintenance for government-owned facilities after the five-year warranty period and provides monthly performance monitoring.
Promoting innovation
Medical equipment today is not very energy-efficient, increasing the financial burden of clinics. Incentivising manufacturers to develop more efficient appliances suitable for conditions under which rural healthcare facilities operate will spur innovation and improve health outcomes.
COVID-19 has shown us that well-functioning decentralised health systems would make rural areas more resilient. We need facilities that are designed to be efficient and long-lasting, and innovation that aims to make medical equipment more modular and transferable to rural environments.
The current crisis has opened up the opportunity for the health and energy sectors to work together as a longer-term resilience intervention. Now is the time to look at how our systems can be restructured to better serve rural populations, and to enlist support and action from the government and other stakeholders to make it a reality.
Harish Hande is Founder and Chairman of SELCO Foundation; K. Srinath Reddy is President of the Public Health Foundation of India.
