Testing a sustainable model towards the maintenance of Solar lighting equipment beyond the Powering Healthcare Clinics pilot lifespan
Tokozile N. Ngwenya
Due to Covid-19 restrictions across the country in the third quarter of the year, travel to rural health clinics was not possible. However, as soon as restrictions were lifted, the team was able to begin travel to all health clinics on the project again. This monitoring visit saw all (10) ten clinics receive ultrasound gel and health educational material via USB to be played on the solar televisions.
The Frontier Technologies Programme, which is funded by the Foreign, Commonwealth and Development Office 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 of medical care to rural health facilities from December 2020 through to June 2021, in the Lusaka, Central, Eastern, Southern, Northern and North-Western province.
As a team, we’ve been having growing discussions on matters regarding the long-term ownership and sustainability of the solar lights and rechargeable medical equipment we had provided to Rural Health Centres as part of this pilot. For this sprint, we wanted to test the hypothesis that the sale of solar lights to the wider community might enable health centres to sustain installations and equipment beyond the lifespan of the pilot.
SolarAid put together a package of lights ranging from portable handheld lighting costing as little as £4 to home solar systems costing £66 to be tested on three rural health clinics among the projects list of health facilities.
Demand from rural health centres for additional solar lights
During monitoring trips across all rural health facilities, a common request that kept presenting itself was:
i) Beyond receiving lights for the clinic, health facility staff also had a need for solar lighting equipment to light up their homes.
It was communicated that whilst it was convenient to have solar lighting during working hours, it was inconvenient for the staff to return home and not have solar lighting to be able to conduct basic duties.
ii) Questions around the maintenance of solar lighting equipment beyond the lifespan of the project.
Whilst it has been appreciated that during the project, SolarAid has been responsive with replacing rechargeable medical equipment such as the infrared thermometer and maintaining solar lights, health facility staff have been concerned as to how they would manage this beyond the lifespan of the project.
Pilot rural health centres with solar lights to sell
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 answer two of the concerns:
i) Health facility staff would be able to purchase solar lighting for home use.
ii) Profits from the sales could be shared among the clinic and the person in charge or 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 would be 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 have been made that allow 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 have deposited money from sales are able to put in a request for additional stock.
Lights credited and quantity table
In addition, health facilities that exceed sales targets will be eligible to receive one bicycle per clinic from SolarAid to provide transport to conduct trading of solar lights within the community and beyond.
Selection of health facilities
SolarAid carried out discussions with all health facilities to determine the level of interest in being involved in this exercise, demand for solar lighting within surrounding communities and lastly, electricity supply in the area. This information was tabulated to determine which facilities would most benefit from this exercise. As a result, three health facilities out of ten were selected.
i) Chilala Zonal Rural Health Centre — Kalomo District, Southern Province
This health facility, located in the Southern province of Zambia is off-grid with no access to electricity. Currently, Chilala area does not have an outlet for solar lights. In previous months there was another company that had sent out mobile agents to sell lights; however, it was observed that SolarAid lights appear to be superior in quality and durability. The nearest place that sells lights is in Choma town, roughly 80 kilometres away.
ii) Jagaimo United Church of Zambia Mission Rural Health Centre — Kalumbila District, North-Western Province
Jagaimo health facility with no access to electricity is located in Mehaba refugee camp. A settlement area that was established in 1971, located within North Western Province. The refugee camps population mainly consists of displaced persons from Angola, Rwanda and the Democratic Republic of Congo. Access to retail shops that sell solar lights is 70 kilometres away in Solwezi town.
iii) St. Luke’s Zonal Health Centre — Mambwe District, Eastern Province
This health facility is located 100 kilometres from the provincial capital, Chipata town, which has the availability of solar lights for vending. Whilst St. Luke’s has access to electricity, the health facility is faced with massive power outages, lasting as long as 8 hours at a time.
Solar lights credited to health facilities
The monitoring team is often composed of a driver, a partner member representative and the monitoring evaluation consultant, however, to execute the pilot exercise of distributing solar lights on credit to health facilities, the SolarAid sales agent accompanied the team.
The sales agent’s role involved the following:
i) Identify together with the in-charge, two suitable members of the health facility to be responsible for selling the lights, and to sign the credit contract.
ii) Explain in detail each solar light’s functions.
iii) Share the recommended retail price list.
iv) Convey cash deposit procedures and record-keeping of sales.
v) Liaise customer care contact numbers.
Early learnings so far
As the pilot was only recently implemented, comprehensive findings will be compiled at the end of the project. However, we have identified some early learnings.
i) Demand for specific lights varies from one geographical area to another. Demand for the home systems has been high at St Luke’s in Eastern province whereas the request for smaller portable lights has been high at Jagaimo clinic based in a refugee camp with temporary smaller accommodation structures.
ii) A majority of the health facility agents sold the lights on credit and not on a cash basis.
iii) Clients prefer to pay for lights in instalments.
iv) Cash deposits have been reflected in the SolarAid account from all three clinics, repayment of loans ranging from 4% — 25%, showing positive signs of success.
Given the early data presented on the current status of solar lighting loan repayments, we are drawn to the conclusion that this model has the potential to achieve long term sustainability. A clear need for solar lights has been shown with most clinics having depleted their stocks of lights and payments being made steadily. With additional funding, SolarAid would be able to scale up this model to the other seven clinics we are currently working with.
As we approach the last sprint, the final post will tie in comprehensive learnings from the powering healthcare project.
