An investment that has lasted in perpetuity — Chaanga Rural Health Centre, Siavonga District, Southern Province of Zambia

Tokozile N. Ngwenya

It is amazing to see a testament to the longevity of the installations and lighting equipment first hand. This is a good example to other health facilities, showing that when equipment is well taken care of, it can last and benefit the clinic and community over a long period of time, beyond the time limit of a project. As the solar lights previously installed were not placed in every ward, the health facility is eligible to receive support. In addition, the clinic was recently expanded to include a maternity ward and mothers shelter that will benefit by being provided with solar lights and medical equipment.

“The solar lights have been helpful especially during the night in the wards and outside to provide us with security.” — Innocent Mwale of Chaanga Rural Health Centre

Chaanga Rural Health Centre, pictured March 2021. Photo credit SolarAid

Chaanga Rural Health Centre is located in Siavonga district about 100 kilometres from Siavonga town, in the Southern Province of Zambia, on the north shore of Lake Kariba. Siavonga district is separated from neighbouring country Zimbabwe by the lake, and the main activities in the area include tourism, boating and fishing.

The clinic has five technical staff and four support staff. They are committed community members who receive informal training to provide life-saving interventions. They also promote good nutrition, sanitation, and hygiene, as well as, link families to essential services.

The health centre serves a community of about six thousand people and has nine neighbourhood health committees. One of the community-based structures in the health system in Zambia is Neighbourhood Health Committees (NHC). The NHC embraces community-based health workers and volunteers, and all other members locally trained and working in their own communities.

Lack of access to electricity is a common yet crippling problem faced in Zambia, especially in rural areas; this has negatively impacted the delivery of service within the healthcare system. Health facilities such as Chaanga Rural Health Centre have a secure grid connection, however, they frequently suffer from power outages, as a clinic that operates 24 hours, this limits their ability to deliver safe health care.

In 2011, SolarAid and the Churches Health Association of Zambia (CHAZ) began a collaboration to install solar systems to provide lighting and refrigeration for vaccines and essential medicines to eighteen clinics in Zambia. SolarAid’s solar installation programme was centred on a strong selection and training process that emphasized sustainability of systems and benefit to the health facility staff and surrounding communities. Following the initial identification of appropriate clinics by CHAZ and their recommendation to SolarAid, a thorough site evaluation was conducted by the SolarAid team, including an application by each health facility. After the final selection, each health facility was installed with a solar system and health facility staff were put through detailed technical training.

Solar lights installed in 2011, pictured March 2021. Photo credit SolarAid

In October 2011, SolarAid and CHAZ installed solar lighting at Chaanga Rural Health Clinic in the main office, wards, inspection room, second office, storeroom, outpatient department (OPD), and entrance outside, for security. A vaccine refrigerator was also installed at the clinic.

“All the bulbs that were installed in 2011 are still in good shape and condition, they have never needed to be replaced.” — Innocent Mwale of Chaanga Rural Health Centre

During the baseline activity conducted in March 2021, the team was pleased to observe that the solar lights donated ten years ago were still functional. Although the solar batteries, charge controller, solar panels and cables require maintenance and replacement for some parts, how Chaanga Rural Health Centre has taken care of the equipment is commendable. This is a good example to other health facilities, showing that when equipment is well taken care of, it can last and benefit the clinic and community over a long period of time, beyond the time limit of a project. As the solar lights previously installed were not placed in every ward, the health facility is eligible to receive support. In addition, the clinic was recently expanded to include a maternity ward and mothers shelter that will benefit by being provided with solar lights and medical equipment.

“The solar lights have been helpful especially during the night in the wards and outside to provide us with security.” — Innocent Mwale of Chaanga Rural Health Centre

Solar vaccine fridge installed in 2011, pictured March 2021. Photo credit SolarAid

The Frontier Technologies Programme, which is funded by the Foreign, Commonwealth and Development Office has partnered with SolarAid and successfully distributed solar-powered non-contact infrared thermometers, pulse oximeters, foetal dopplers and digital blood pressure monitors to offer safe assistance with medical care to rural health facilities. We believe that by doing this we can achieve the range of quality of health services available, increase patient satisfaction, provide enough power to charge the medical equipment provided and that the solar lights and medical equipment will be easy to use and meet the demand faced at the rural health clinics. We also believe that medical staff will find value in using new medical equipment.

In an effort to expand on the success of the first pilot conducted on three rural health facilities in 2020 here, SolarAid, together with our collaborating partner, CHAZ conducted the second sprint of the Solar Health pilot. This second sprint, which was a baseline assessment, involved obtaining information directly from the rural health clinic staff in seven districts, across four provinces, covering over 4,800 kilometres across Zambia. This activity was conducted over a period of one month through in-person interviews by the monitoring and evaluation team and physical inspections by technical installation staff to assess their current status and need for solar lighting and solar-charged medical appliances.

Health facility register reviews

The monitoring and evaluation team observed health facility registers to observe data in light of the solar lighting interruption intervention as it is ideal to monitor past trends to evaluate the effects of an intervention. The indicators detailed below have been identified as the key indicators that may be most affected and impacted by the intervention at hand.

The observation of registers looked at:

• Outpatient department attendance, antenatal visits (1st and 2nd)
• Institutional deliveries, deliveries supervised by skilled personnel and deliveries by other staff
• The number of live and stillbirths, admissions as well as referrals

Each of the indicators were prescribed on the support to the designated departments, which are antenatal care (ANC), labour, delivery and outpatient services. Most medical staff identified that they wanted solar lights placed in those areas, hence why information is collected from these specific registers to be able to see the benefit to the health facility and community that would come from these interventions and equipment.

In-person Interviews

The monitoring and evaluation team spoke to the health facility In-charge. In cases where the In-charge was unavailable, the team engaged with the second in command of the clinic. The key takeaway from this was the need to determine the current status of the clinic and whether it was in need and eligible to receive solar lighting and medical equipment support. It was also important for the health facilities to understand the purpose and details of the support that was being offered.

The in-person interviews were one-on-one and set out to:

• Understand the current medical available and equipment needed to improve service delivery
• Identify the perceived benefits of receiving the solar rechargeable medical equipment beforehand
• Confirm that health facilities need and would benefit from this intervention
• Current availability of alternative sources of light (excluding candles) and their duration
• Investigate the number of hours of electricity available for clinics that are connected to the grid and how many hours of power are available through solar lights for clinics off-grid
• Number of patients seen after dark

Inspection by technical installation staff

The solar installation staff spoke to the staff and inspected the entire facility to better understand the building materials used to construct the health centre structure, understand which rooms and wards were of priority to the clinic and observe the roofing formation and placement.

The physical inspections set out to:

• Understand the physical makeup of the clinic structure, which would advise which tools would be used during the installation of the solar lights
• Identify key rooms, office, labs and wards that have been identified to receive solar lights to allow the technicians to plan for the quantities of materials needed and the length of time installation would take
• Understand potential barriers that would present themselves during the installation phase

Learnings

Through the baseline assessment, we have been able to sharpen our hypothesis, that the distribution of solar-powered equipment can help us to achieve our outcomes and target the following more specific needs where we think solar health equipment can deliver benefits:

• Facility staff are more satisfied from working in a more enabling environment.
• Improvements in quality of care delivered due to the availability of high-quality diagnostic medical devices.
• Increased range of services provided due to provision of medical equipment facilities may not have had previously.
• Fewer non-medical referrals because providers can deliver care during power outages and at night.
• Greater patient satisfaction with care received at rural health facilities (e.g shorter wait times)

From the baseline assessment we share the following advice:

• We learnt that not all health facilities recommended to receive support would need or benefit from our proposed intervention upon physical assessment. One unnamed facility visited had recently received a large donation of 40 solar panels and 20 batteries from an international partner. In this case, our recommended intervention would not yield the desired impact, further highlighting our need and justification for conducting a baseline survey. This has resulted in this facility being replaced. It has also highlighted the need for possibilities around the Ministry of Health migrating hard copy registers to an open-source register as this would greatly benefit not only the Ministry, clinic, district and provincial staff. It would reduce costs across an array of projects that deal directly with rural health facilities.
• The physical inspection allowed for the technical installation team to understand the specific health facility structures and better plan for the installation phase without any unexpected requirements.
• Some medical staff expressed interest in potentially buying solar equipment to use for lighting, watching television and charging mobile devices.
• The baseline visit presented a solid foundation for the team to build a relationship of trust with the health facility staff to ease the progression of the installation phase, monitoring visit activities and access to clinic data to facilitate the monthly reports.
• Medical staff expressed the need for portable lights to be able to carry out medical procedures such as stitching properly, as well as for safety in moving from different wards and from their homes.
• The team was able to narrow down three facilities out of seven that would be deserving of the vaccine fridge and have the most impact, without a physical visit, this would not have been possible.

We are keen and excited to observe the characteristics that allow certain facilities the ability to better maintain donated equipment over a period of time, for sustainability among other factors in comparison to other clinics as this may allow us in the future to determine health facilities that will yield the highest impact over a longer period of time and can be prioritised for support. This may be done by closely observing rural health facilities such as Chaanga Rural Health Centre. As we are currently implementing our third sprint whose main focus is to successfully install solar equipment in the wards and distribute solar-powered medical equipment, the next medium post will share the process and experience across the seven rural health facilities that have been earmarked to receive these donations.