Healthcare for All using Decentralised Renewable Energy
Decentralised renewable energy can make essential healthcare services accessible to hundreds of people in remote areas all over the world
Kalahandi district in Odisha is among the most backward districts in the country. The district had come into the limelight in 2016 when Dana Majhi, a resident of Melghara village had been forced to carry the body of his deceased wife for 10 kilometres because the hospital where she passed away did not provide a hearse for her final rites.
“This is a really remote region and it is difficult for people to get any kind of healthcare,” says a senior doctor from Swasthya Swaraj, an organisation that aims to provide healthcare and education to people in Kalahandi. The organisation is currently active in over 75 villages and is the only care provider for over 15,000 people in the region. They operate hospitals as well as primary health care (PHC) centres where there is little to no other health facility available. The doctor who did not wish to be named has been working in the tribal regions of the Kalahandi district for the past eight years. She adds, “Since we installed the decentralised solar energy systems with Selco Foundation’s assistance, it has really improved our ability to provide medical care for people here. It is excellent for investigation, patient care, and many other aspects of providing healthcare. In fact, our primary source of power in hospitals and PHCs here is solar, no doubt about it. It is only when there are some issues with the panels that we face some difficulties since it takes a long time to get it repaired.”
As of March 2019 there were 24,855 PHCs, 1,57,411 SHCs, and 5,335 CHCs in rural India. According to government data, it is estimated that more than 39,000 SHCs and nearly 800 PHCs still operate without any access to electricity.
The primary health centres (PHC), sub health centres (SHC), and community health centres (CHC) are the first port of call to avail public healthcare services for most rural communities in India. Given the various stresses on India’s electricity supply systems, it is a safe bet that Decentralsied Renewable Energy (DRE) installations such as the ones at the Swasthya Swaraj centres in Odisha will undoubtedly benefit all these centres and the millions of Indians who depend on them for their healthcare needs.
Climate change and healthcare in India
The deadly heat waves that have afflicted most of continental India in the past few months is only the latest recorded evidence of the effect that extreme weather exacerbated by climate change can have on Indians. The impacts of climate change in India are manifold and public health will be one area where the impact will be felt most severely and has the opportunity to help communities combat it.
According to the WHO, climate change is expected to cause the additional death of 2,50,000 people between the years 2030 to 2050. They expect these deaths due to a variety of reasons including but not limited to malnutrition, malaria, diarrhoea, and heat stress.
Shweta Narayan, international climate and health campaigner at Healthcare without Harm, believes interventions in how healthcare centres are powered is essential to providing quality and accessible healthcare.
It first makes the health system resilient because in the event of a flood or extreme weather, when the grid fails, DRE continues. During extreme weather, pressure on public health increases. In those situations, health systems and related infrastructure should be the last building standing. DRE can play a significant role in making this a reality and make healthcare resilient to the climate crisis.”
Healthcare without Harm is a global non-profit dedicated to helping build low-carbon and climate resilient health care. Narayan has been actively working for improving public healthcare in India for over two decades.Shweta Narayan, Helathcare without Harm
Even though they have played no part in creating the climate crisis, multiple studies have shown that it is the poor and disempowered communities, especially in rural regions, who suffer the worst effects of climate change.
These communities can be fishermen and women who are forced to migrate because of ever increasing cyclones, poor farmers in central India who are forced to work in extreme heat or even communities in mountainous terrains who are affected by increasingly intense rainfall over shorter periods of time. All of these vulnerable communities already had poor access to healthcare. This is only made worse due to climate change.
Another aspect of the healthcare sector’s relationship to climate change is the large emissions the sector makes. As Narayan says, “The carbon footprint of the health sector is huge and energy consumption is a significant part of it. Using DRE effectively can make a significant dent in this too.” Apart from the emissions that are a result of the amount of power the sector consumes.
When electricity from the central grid is not available, as is the case in many rural healthcare centres, many health facilities have no choice but to depend on expensive, polluting and inadequate alternatives such as diesel generators or kerosene lamps. If DRE systems are used to power just the last mile health facilities in India (Sub Centres and PHCs), it is estimated that over 6,200 kg CO2 of harmful carbon emissions per year can be abated.
As an earlier report by Healthcare without Harm states, “The health sector must decouple growth from its climate emissions. The sector must reinvent ways to deliver quality care and follow a need based approach which is driven by challenges of geography, disease burden, specificities of the demography etc. The health sector must also simultaneously build resilience — facility resilience and systems resilience, while enhancing its role as an integral member of many communities to serve as an anchor for community, climate and economic resilience.”
DRE as a viable solution for increasing access to healthcare in India
According to a report in The Lancet, almost 122 Indians per 100,000 die due to poor quality of care each year. When their livelihoods are already precarious, being forced to travel long distances to receive healthcare further reduces the chances of someone from a disempowered community visiting a health centre. In this context, it becomes important for the health sector to look towards expanding its reach to achieve universal health coverage.
As Rachita Misra, Associate Director at the SELCO Foundation says, “When local health systems do not function because of lack of power, then the healthcare burden only increases in the few centres that do function. What we learnt from many stakeholders in the sector was that last mile health facilities, critical care during pregnancies, and more diagnostic facilities made available locally were desperately needed. And this just means more burden on the existing energy infrastructure that is already struggling to meet even basic demands. So we wanted to make interventions using DRE that can change that effectively.”
Through SELCAP, SELCO Foundation has been using DRE to improve the quality and access to healthcare across multiple states in India. Based on the knowledge emerging from the program, SELCO Foundation is now also working in partnership with the World Health Organization (WHO) to share learnings and design training modules for program development of solar powering health centers in sub Saharan Africa.
As Misra adds, “A small silver lining during the pandemic was that decentralisation of health services was as important as access to healthcare. When health services were being hampered due to lack of energy, alternatives such as DREs were set up rapidly. Because of travel restrictions, and travel itself being the source of the virus being spread; there was an incentive to improve facilities and access at the last mile. All levels of governance are now looking at the energy gap and how it impacts access to healthcare. We are hoping to help wherever and in whatever capacity we can.”
The interventions made through the SELCAP program has resulted in savings on fuel that was needed to run the diesel-generators. Needless to say, the emissions too have reduced. The interventions have also led to timely immunisations using a well-functioning cold chain system, safer deliveries, critical care needed for newborns and better working conditions for doctors and nurses.
As Narayan says, “Access to electricity is absolutely essential for a healthcare system. In order for the system to reach the last possible person, it is crucial that efficiency of health centres are increased and that frankly, it works all the time. DRE is a great way to make this happen. Ultimately, if implemented effectively, it will lead to people trusting the system more. These include both health practitioners and the people who come to avail healthcare.”
The inception report for the ‘Sustainable Energy led Climation Action Program’ can be accessed here.
Contact: Rachita Misra, rachita@selcofoundation.org or write to info@selcofoundation.org
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