How APS is transforming Patient Outcomes in Zimbabwe with Affordable Solar and Data Mining
I’m Mike Rosenberg, Founder and Managing Director of APS (Africa Power Storage), a funded start up that makes smart, off grid energy storage solutions to enable affordable energy access for classrooms, clinics, homes and small businesses across Africa.
I launched APS in response to challenges I faced electrifying clinics in Southwest Nigeria; and the realisation that to replace diesel generators and overcome the market poisoning of solar that has occurred from failed installations (such as solar traffic lights in Abuja that no longer work), off grid solar systems needed to be more affordable, monitored remotely and embrace Lithium storage with its 10 year lifecycle.
Since installation of our Smart Solar & Storage solution at health clinics in Zimbabwe in May 2018, we have seen a 12x month-on-month increase in out of hours procedures, including childbirth.
This article will explain how affordable solar electrification achieved such results and how we have mined our system’s data to better size solar for future clinics in rural Zimbabwe.
Why Electrification Matters for Healthcare
For clinics, electricity is binary — health services cannot be delivered without it. Without a vaccine fridge (cold chain), a clinic can’t provide needed immunisation; without reliable lighting and power for medical devices such as sterilisers, safe procedures and deliveries cannot be performed. As one clinician commented in our site assessment, “Candles are not appropriate to suture an episiotomy.”
As outlined by WHO and the World Bank in their landmark 2015 study Access to Modern Energy Services for Health Facilities in Resource-Constrained Settings, the benefit of electrification is also indirect — in that electricity helps retain and attract staff at rural health centres too.
There are many other interventions that can transform a clinic; from better Water, Sanitation, and Hygiene (WASH) facilities to staff training or pharma availability. We sought to show that electrification (performed affordably) would not be “solar for the sake of it” but would yield clear impact on patient outcomes. For this we were extremely fortunate to work with Crown Agents (with a long history in Zimbabwe healthcare), to not only select clinics but monitor outcomes. As Zimbabwe clinics are funded on Results Based Financing (RBF), this provides a sustainability as increased results yield increased revenue for the clinic.
Baseline Power — Taking Clinic Electrification from Project to Rapid-Install Product
The challenge with off grid solar is knowing in advance how much power is required by day and by night. With the diesel generator we seek to replace, a clinic need only know their peak load (the size of the generator) and ensure there is fuel — affordable initially and expensive long term. Renewable energy represents an upfront investment; and the challenge for every donor project has been that assessment. The consequence has been expensive surveys followed by an expensive project approach.
Our testing hypothesis with the Frontier Technology Livestreaming project was to use our low cost product to ensure baseline power — and use the real-world data from our integrated SIM card to assess how much power clinics across Zimbabwe actually need. That feedback loop would then allow us to determine power requirements for secondary clinics in the second sprint.
Jari & Kahmonde — Affordable Electrification
Even with expensive freight, clearance, local transport and installation costs, we enabled electrification for less than £9000 or only £2.72 per Watt of Solar (Watt peak, ie £9000 divided by 3300 Watt peak of Solar panels) and only £0.21 per kWh over 10 years — an essential yardstick for any donor activity.
Both of these sites were completely off grid and so lacked medical appliances common in grid-challenged sites or larger District Hospitals. To provide utility to clinicians, we equipped each with numerous high-brightness LED ceiling lights and in the case of Kahmonde we co-invested by equipping the clinic with a large fridge for staff to store perishable food.
Immediate Impact: The Power of Lighting
The consequence of this APS intervention was profound. Within one month we witnessed a 10x increase in night-time procedures including deliveries. This underscores the power of lighting above all for clinics. Expectant late term mothers in the community had previously been told to bring their own candles for their delivery and opted to stay home. As word spread that both Jari and Kahmonde Clinics now had reliable 24 hour electricity, clinic attendance soared. This is shown in the graph below — with an averaged 12x increase between the Jari and Kahmonde.
Insights: Value for Money through Data Mining not Remote Monitoring
The unique APS remote monitoring software captures data every second across numerous parameters and uploads it to our cloud dashboard every two hours via our integrated roaming SIM card (free monitoring for the life of the product is included in our price so there is no ongoing cost). This “firehose of information” is only as useful as the insights it provides and to date these have been focussed on:
· Overcoming market poisoning through predictive maintenance. The consequence of failed solar installations across the region is scepticism and resistance by the market. Our software’s proactive alerts allows us to not only track faults (and their source) remotely but see whether inverters are regularly overloaded or if dust is building up on the panels.
· System sizing and Energy assessments. Advance surveys are notoriously unreliable. Few medical device manufacturers provide accurate power figures and it’s impossible to know how often a steriliser will be used (and when) or a vaccine fridge door will be opened.
The consequence of a lack of insights is solar deployments that risk being not only expensive per Watt but vastly over-specified. Our drive has always been electrification of ALL clinics, not isolated examples, and to achieve this we must mine the data of our system to determine a blueprint for clinic solar requirements across Zimbabwe.
Here is where start — with our live Solar Solutions in Jari and Kahmonde displayed on our dashboard:
And here is the data for the first week of August at Kahmonde:
As predicted, we see solar (pink) bell curves — the sun rises in the course of the day and drops at night. But more than that, that line represents the theoretical amount of solar power Kahmonde could generate at that exact moment and that exact location; based on the size (19 square meters) and the efficiency (16.97%) of our 10 solar panels. The blue line represents how much solar power those clinics consumed — and that drops off in the late morning, not at dusk.
The question here is why — and the answer lies in the battery level graph (orange) and the bar graphs shown below. Here you can see the busiest day (Saturday the 4th of August) in detail:
What this graph tells us is that Kahmonde could have generated an enormous 20kWh that day (slightly less than a UK household uses) but it only consumed a third of that. The reason is that we can see that by midday the BYD Battery is fully charged but, as there is no other load (i.e. medical devices), there is nowhere for that power to go — unlike with grid-tie applications where excess solar can be fed back.
Implications for system sizing — surplus power for cooking with Electricity not Firewood
The value here is we know the battery is being used almost entirely (to power night time lighting) but that there is immense surplus power. The next clinic with the same requirements could manage with half of that installed solar. Another insight is that nearly 12kWh per day of excess power (two thirds of the total) could be utilised without compromising night time lighting. This power could enable daytime use of high load medical devices (such as a steriliser) or patient appliances such as a low cost electric hotplate. The latter would remove the need for families to gather firewood to prepare meals for their patient relative during recovery — a poignant request highlighted by Crown Agents in their outstanding Monitoring and Evaluation and an example of indirect benefits from energy access.
Next Steps — Enabling Cold Chain & Medical Appliances
In our next sprint of work[HW1] , beginning in October, APS will be providing power to clinics that are equipped not with a Solar Direct Drive (SDD) vaccine fridge (which costs as much as our power solution) — but with grid-connected vaccine fridges that regularly suffer power cuts, with dire consequences for immunisation programmes.
Our vision is overcome the challenges set out by WHO and the World Bank in the figure below by providing not only lighting (out of hours procedures) but cold chain (immunisation) and medical devices (sterilisers top the list) as well as the indirect benefit of retaining staff (through interventions such as a staff fridge). Stay tuned.
Find out more about APS and its work online at www.africapowerstorage.com
