What have we learnt from our first installation of lights in rural Zambia?
SolarAid recently started a pilot project as part of the Frontier Technology Livestreaming Programme, which is funded by the Foreign, Commonwealth and Development Office — read our introductory Medium post here. Along with the Churches Health Association of Zambia (CHAZ), we are working together on a Powering Healthcare grant which will provide innovative solutions to increase medical capacity within Zambian rural health centres. We have begun installing GSM enabled multi-light solar homes systems that have the additional capacity to recharge batteries which can be used for small scale medical equipment, such as a foetal dopplers, pulse oximeters, blood pressure cuffs and infrared thermometers.
The first sprint of this pilot is currently underway, in which we have disseminated the multi-light solar solutions to 3 out of 10 rural health care centres (RHCs) within Central and Lusaka provinces of Zambia. All 10 RHCs are to receive lighting solutions and energy-efficient medical appliances to help increase the range and quality of the health services they provide .
How will the GSM enabled equipment help us monitor impact?
GSM enabled lighting systems provide real time feedback regarding 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.
7 out of 10 RHCs will have this type of lighting solutions whilst the other 3 will be non GSM enabled. The other 3 will be monitored manually by staff, via monthly reports that will show quantitative data on usage and faults occurring. This will help give a comparison to accurately reveal the differences between the 2 systems.
How we chose the 10 clinics
Based on the type of equipment, we had to think of criteria that we would use to manage which RHCs would be good candidates for installation. After all, we needed to consider what kind of indicators can be monitored to show the level of impact the solutions introduced will have.
The clinics we picked met the following criteria:
- Limited access to power to better monitor the effectiveness of the energy efficient medical appliances;
- Presence of labour wards to monitor the number of births taking place;
- In patient admittance;
- Open 24/7 to monitor activity during long periods of darkness when power is unavailable.
Maternal health and births
Having our criteria in place, we set off on our sprint to the first 3 installation sites with our CHAZ colleagues. We arrived at Chipembi in Central Province where our learning started immediately. Our vehicle was the only one for a large radius that could help pick up a pregnant woman and get her to the RHC to deliver her baby. The baby was delivered safely but within moments the electricity cut and they were in darkness until we completed our installation.
The head nurse at Chipembi Rural Health Centre, Esther Sakala, said, “I am extremely grateful for the lighting provided as I have delivered many babies by torchlight and using the phone light.” This means having to remove human resources that are desperately needed at understaffed facilities to ensure the best delivery possible for mother and baby.
She was overjoyed when the maternity ward lights were installed. This became the first trend for all three RHCs. Healthcare staff were insistent on labour wards having lights for the sake of safe deliveries. Witnessing the lights turning on gave a sense of accomplishment, but we also acknowledged there were surrounding areas left in darkness which was another aspect of learning.
Hours of available electricity at RHCs
Some of these RHCs go for 3 days without electricity, including staff housing surrounding them. During the rainy season, this leaves staff and patients at risk of dangers, such as snakes and other animals, and injury.
A nurse from St Paul’s Rural Health Centre, Kasongo Phiri, stated “there is a large health risk with no electricity. When the power is cut that means we have no water. No water means we are not able to clean bed sheets or tools as needed or they cannot be used because they have not been cleaned. We also feel unsafe walking from our homes in complete darkness and it can be demotivating.” But she further said “We are so grateful for these lights. They will make a very big difference. I am very excited about the pulse oximeter, we don’t have one.”
Funding received by RHCs
These health centres are all funded by the government for essential equipment and medication that is given to them depending on whether they are zonal RHCs or standard RHCs. What they are provided is dependent on prioritisation based on that distinction and as such if they wish to obtain other equipment, they may need to source out funding on their own accord.
Rooms chosen for the lights installation
There was consistency in the rooms where the lights were installed. These were either the labour/maternity ward or the pharmacy or laboratory. Samples and medications need to be kept at specified temperatures to remain viable but in addition to this, lab technicians and pharmacists need to be able to clearly see in order to perform very specific and technical tasks in which lack of lighting can have negative impacts.
Moving forward
As a result of lights installation in these clinics, staff expect to see higher numbers of patients in the evening and more mothers once they are made aware the RHCs have a foetal doppler. They also showed great appreciation towards equipment that can increase their efficiency. In the past, many patients would rather find a way to go home, if they are admitted, to be in the comfort of their own homes once the power cuts, which is not the best option. We will continue to collect baseline data, install lighting systems and distribute the equipment for the final 7 health centres as well as keep monitoring the first 3. As we continue to collect data in this first sprint, we will be able to adapt our indicators to have a deeper understanding of the type of impact the systems will have as well as make comparisons in how the data has been compiled and analysed.
Watch this space for more learning!
