The private health system, which we all thought was the solution, has had its own challenges. Cost of care has gone up. People are running from hospital to hospital looking for private-sector care and its very challenging for someone in India because they’re stuck between underfunded public system and a potentially exploitative private health. Now in a rural area, the private health sector is what?
Mr. Satya Brahma, Editor-In-Chief, Pharma Leaders in interaction with Mr. Mayank Gandhi, Social Activist, Founder Global Parlie at the most awaited & iconic 12th Annual Pharma Leaders Summit & Awards 2019 under the theme “Healthcare Innovations – Beyond the Headlines” on Saturday,21st December 2019 at Hotel Sahara Star, Mumbai, India.
You don’t even have private hospitals in many rural areas. What you have are the Government Public Health Centres and Community Health Centres. And you have the informal providers. What we call the alternative healers. Ayush practitioners, unqualified practitioners. They are the backbone of India’s Health System. In fact, 70 per cent of rural primary care is the informal sector.
For as little as Rs 6 billion (USD $85 million), India can use rapidly-deployed solar technology to bring reliable healthcare to the nearly 40,000 rural clinics across the country that are still unelectrified. Now is the time to seize this opportunity with the government’s solarizing rural healthcare facilities program ending this year.
While the central government has concluded the national electrification drive under its Saubhagya scheme, the focus was solely on households and therefore, health institutions (particularly rural sub-centres) were left out of the purview. As a result, 3.2% of all rural primary healthcare centres (PHCs) and 24.7% of all rural sub-centres in India are still unelectrified, according to 2018 Rural Health Statistics. Overall, around 230 million of the rural population is dependent on health-care facilities with no access to power.
While no comprehensive data exists, at least 2,200 health centres in India have been powered through distributed solar solutions, with more than 50% in Chhattisgarh state alone, which has invested around INR 791 million.
Besides Chhattisgarh, local governments in Tripura, Assam, Kerala, Nagaland and Puducherry are also showing leadership in adopting solar for healthcare. Assam and Kerala have floated tenders for deployment of off-grid systems.
But in order to scale these efforts nationally, a more comprehensive inter-agency approach is required, as well as a full impact evaluation of early efforts to identify best practices and the potential for introducing energy efficient appliances such as solar-powered refrigerators and blood collection machines.
Rural healthcare centres serve the medical needs of 65% of the country’s population. The primary tier of health care facilities operates at three levels.These centres are usually the first point of contact for crucial services such as vaccination, labour and deliveries, neo-natal care, eye-care services, etc.
Healthcare delivery has improved over the past decade, but it has not been uniform, with many poorer states (Rajasthan, Jharkhand, Assam, UP, Mizoram) failing to meet government targets for maternal mortality or vaccination rates. A supply gap in manpower (both doctors and support staff) and essential equipment/infrastructure still persists. Inadequate and irregular supply of electricity also limits the functioning of crucial equipment.
Apart from in-patient and out-patient services, two most critical services provided by these health centres 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.
Sub-centres deserve special attention, as around 65% of them remain un-electrified in Bihar, Jharkhand and Assam, while often serving much greater populations then designed to do. Moreover, even among centres that have electricity supply, many face intermittent power supply or the supply is marred by voltage fluctuations, which can destroy sensitive equipment and disrupt service.
A feasible solution for electrification of rural healthcare is replacing diesel generators with solar PV systems, which can either provide complete power supply or back-up (potentially coupled with storage) to ensure regular power supply, especially during peak hours. According to a cKinetics analysis, the energy needs of health centres in rural and remote areas where there is electricity deficiency can be fulfilled through off-grid solar installations. In addition to standalone solar systems, energy efficient appliances need to be customized for rural requirements and be able to work even during outages. Organizations such as GE, SELCO Foundation and Godrej are focussed on coupling energy efficient appliances with distributed solar systems.
The impacts of regular electricity supply from solar are clear, with significant improvements in number of deliveries per month, child immunization and neo-natal care. Further, annual electricity costs reduced by 30% post installation of the solar grid-connected systems in one state, Maharashtra.
While a comprehensive assessment of every health centre is required, if the government were to power the existing un-electrified health centres in India, states’ objectives maybe best met by emulating Chhattisgarh’s footsteps. This would require a minimum cumulative funding of at least INR 6 billion (USD $85 million), (given a benchmark cost of INR 77 per system for a 3-hour back-up) both from state and central governments. This is excluding centres which currently face intermittent supply of power and can be retrofitted with solar systems to provide reliable electricity supply.
As phase III of the government’s off-grid and decentralised energy for healthcare scheme concludes this year, there is merit in continuing beyond 2020, specifically targeting sub-centres. The implementation and scale up of the scheme would be dependent on coordination between multiple institutes such as the health and the energy department. Lastly, emerging financing and delivery models can help in scaling up electricity access to rural areas, which would need to be complemented with energy-efficient solutions.
