A review of the Powering Healthcare Clinics pilot

Tokozile N. Ngwenya

Limited access to electricity is one of the key challenges to Zambia’s health sector. National access to electricity averages at 31% with 67% of the urban and 4% of the rural population having access to power. In comparison, the Sub-Saharan African region’s access averages at 47.9%, while the overall global average is understood to be at 90%. Across all the main health facilities in Zambia, only around 35% of those in rural areas have a functional connection to the grid.

Off-grid, rural health posts across Zambia are unable to provide access to modern healthcare due to a lack of access to both electricity, as well as the latest energy-efficient medical appliances. Many solar projects have a history of failure as systems fail over time with limited access to the technicians, finance and spare parts necessary to ensure they remain operational. This pilot sought to address these challenges through the deployment of the latest plug-and-play Pay-As-You-Go (PAYG) solar systems, with the latest energy-efficient medical appliances across selected rural, off-grid, health posts in Zambia.

The Frontier Technologies Programme, which is funded by the Foreign, Commonwealth and Development Office, partnered with SolarAid. The partnership resulted in the successful distribution of solar-powered non-contact infrared thermometers, pulse oximeters, foetal dopplers and digital blood pressure monitors to offer safe assistance of medical care to rural health facilities. The entire project ran from October 2020 through to March 2022, in the Lusaka, Central, Eastern, Southern, Northern and North-Western province.

Early Impact

The largest impact has been the increased number of working hours to attend and care for patients. Facility staff are more satisfied with working in a more enabling environment, improvements in quality of care delivered due to the availability of high-quality diagnostic medical devices and an increased range of services provided due to the provision of medical equipment which the facilities may not have had previously. There are fewer non-medical referrals because providers can deliver care during power outages and at night and greater patient satisfaction with care received at the rural health facilities (e.g shorter wait times).

What did we see

Outputs

i) The number of solar lights at baseline in the clinics increased from 41 — to 122 at endline (34%)

ii) The number of hours of lighting available to the clinic increased on average from 14 hours to 20 hours, a 70% increment each day

iii) Mothers before and after delivery have shared that they are no longer afraid of staying in dark wards

iv) Rural health facilities collectively used solar-powered pulse oximeters and infrared thermometers to detect 347 suspected cases of COVID which were later proved to be positive

v) Patients across all clinics expressed greater involvement, 77%, in their care

vi) Expecting mothers indicated that they were now able to hear their baby’s heartbeat, something that is impossible with a foetal scope. Patients were now able to read their own temperature pulse oximeter readings and be more involved in their care

vii) During monitoring visits the following vaccines and others have been observed to be present in the vaccine fridge, namely, BCG, OPV 1 and 2, ROTA, and Oxytocin.

Short Term Outcomes

i) Facility staff recorded their performance to have improved as a result of the lighting and equipment to now stand at 93%

ii) 85% of staff believe that they now have adequate lighting to do their jobs

iii) 97% of staff believe the quality of care has improved because of the Solar Health equipment

iv) 93% of patients agree that health services have improved since the Solar Health intervention began

v) Services which patients believe improved as a result of the intervention include maternal and newborn child health 100%, Outpatient department 55%, emergency and inpatient department 22%

vi) 100% of the rural health facilities recorded that they did not have a foetal Doppler prior to the intervention to perform ultrasound inspections for pregnant mothers

vii) 33% of the rural health facilities recorded that they did not have a pulse oximeter to observe patient’s oxygen levels, which from the data shows has been useful in diagnosing some Covid 19 cases and monitoring the progress of patients who tested positive for Covid 19

viii) 88% of the patients expressed satisfaction with care received at rural health facilities as a result of the intervention

Demonstrating social and health impact

After several consultations within the team, it was agreed that based on previous experience, a solar lighting package would be developed for health facility staff to sell. This would address two of the concerns, firstly health facility staff would be able to purchase solar lighting for home use. Secondly, profits from the sales could be shared among the clinic and the person in charge of selling lights to provide additional income to sustain the maintenance of the lighting, medical equipment and overall upkeep of key line items at the clinic.

Solar lights were credited to health facilities to enable them to access high-quality brand new solar lights to sell. In the event that the solar lights would not be sold, provisions in the contractual agreement were made that allowed for the equipment to be returned within three months in the same condition it was given, or to be kept for an additional three months. Only health facilities that had deposited money from sales were able to put in a request for additional stock to sell.

Demonstrating plug and play systems — rapid deployment of GSM enable equipment

GSM enabled lighting systems to provide real-time feedback regarding the activity of the system, as well as what it is currently being used for. They also send updates on any faults that occur and are able to identify what the faults are.

Seven out of ten rural health clinics have this type of lighting solution whilst the other three are non-GSM enabled. The other three have been monitored manually by staff, via monthly reports that show quantitative data on usage and faults occurring. This has helped give a comparison to accurately reveal the differences between the two systems.

Across all facilities, the impact observed since the delivery of medical appliances was an increase in satisfaction from both medical staff and patients. The solar system has improved the way that the health facilities operate, now they have a backup that ensures that they are able to continue their work without disruption.

Previously the laboratory would close and night nurses on duty would wait until daylight to conduct screening. The foetal doppler allows for closer interaction with the mother and her unborn child, as the mothers are now able to hear for themselves the baby’s heartbeat, rather than waiting for the medical attendant to complete the diagnosis and relay the status of the foetus. The proximity between the patient and the medical attendant allows for a good distance, bearing in mind the Covid-19 guidelines and measures being implemented.

The infrared thermometers were offered at an appropriate time where Covid-19 measures are being observed. Temperature can now be observed without physical contact as is done with the traditional thermometers. The infrared thermometers are also faster and provide a reading that the patient is able to clearly read for themselves, thus increasing a sense of comfort.

Final sprint

The data collected shows a positive immediate and promising long-term impact on key health metrics and the increased range of services now being made available at these rural health facilities. These include antenatal screening with the use of a foetal doppler, as well as possible Covid-19 detection with infrared thermometers and pulse oximeters.

The pilot through its successful implementation has demonstrated the business case that will enable the new wave of plug-and-play solar companies rising up across the continent to scale up this intervention across the country. Finally, the pilot has illustrated how these systems and appliances can be rapidly deployed and maintained by local solar companies.

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