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Institutional Support

Health sector institutions - from the MOH to the health facilities - are organized, staffed, and trained to deliver medical services. These institutions are typically not well equipped to deal with the myriad of issues which are a pre-requisite for the effective and safe operation of health facility energy systems. Consequently, health facility retrofit programs should include efforts to work with all levels of health sector institutions to improve their capacity to address these issues.

 

Institutional Configurations

A variety of public sector and private sector configurations exist for integrating renewable energy into health facility electrification. There are advantages and disadvantages to each.

Management and Implementation by Government

In this institutional configuration, the government ministry of health carries out all aspects of the planning, system design, installation, maintenance, and repair of RE systems.

Advantages:

  • National health programs have an established infrastructure of planning, management, technical, and logistical support to rural health centers. This existing infrastructure may be adapted to support RE systems.
  • Programs on a national scale may be large enough to have sufficient critical mass to develop and support a service infrastructure.

Disadvantages:

  • Government bureaucracies are often inefficient in providing services. Bureaucratic processes are usually slow, particularly when involving purchases and travel expenses for installation, maintenance and repair.
  • Technical staffs are often insufficient in numbers to accommodate the needs of all regions of the country.
  • Ministry of health technicians, may be familiar with the health care systems, but will need training in the installation, maintenance, and repair of RE systems. They often lack the proper tools and resources.

Management by Government and Implementation by Private Contractor

In this institutional configuration, the government ministry plans the program to utilize RE, and issues requests for bids to provide equipment and services. Private contractors provide equipment along with installation services. The contractor may provide maintenance and repair services under a service agreement. Alternatively, the ministry of health may accept those responsibilities once the installation is complete and accepted.

Advantages:

  • Private contractors in the business of selling and installing renewable energy systems are usually equipped with the knowledge, skills, and tools to provide the required services as needed on a contractual basis.
  • A ministry of health may be better prepared to establish the scope of work and manage implementation than to actually perform the work with its own personnel.

Disadvantages:

  • If no clear specifications exist for procurement of equipment, bidders propose systems with varying specifications. This makes it difficult to evaluate and select from proposals with unequal attributes.
  • Many bureaucratic purchasing processes automatically select the lowest bidder without regard for significant differences in the relative quality of proposals submitted.
  • There is often a lack of Standards of Acceptance for quality of installation in the field. Deficient installations have a high rate of failure, pose a threat to reliability to health care services, and result in higher costs for maintenance and repair.
  • Private contractors are not always competent to install systems professionally in the field. They often are in need of technical training.
  • Private contractors are unfamiliar with the specific needs of health care systems.
  • Training of the system users is often forgotten or incomplete.

Management and Implementation by Non-Governmental Organizations

Many non-governmental organizations (NGOs) provide health care services in rural communities. In this configuration, the NGO procures, owns, operates, maintains, and repairs the system on its own.

Advantages:

  • NGOs are often run by committed and motivated individuals who operate efficiently and effectively on limited budgets. Decision-making and project implementation is generally less bureaucratic than a government process.
  • NGOs generally have strong community relationships. As a result, they may be more readily able to generate community support and participation as well as collaborate with other service sectors such as education, agriculture, and enterprise.

Disadvantages:

  • NGOs generally operate programs for a limited number of establishments which they operate and maintain themselves. This scale of program does not lend itself to significant support of a commercial service infrastructure.
  • NGOs typically do not have the specialized technical knowledge or skills to implement RE technologies without technical assistance.
  • Small NGOs often have cash flow problems.

 

Institutional Considerations

Institutional aspects of policy, planning, management, financing, service infrastructure, community participation, and user interface are critical to the successful use of any chosen technology. While focusing mostly on various institutional, organizational, and social issues that should be addressed prior to initiating a larges scale project, much of this information is applicable to smaller scale projects as well.

Policy and Commitment

A national policy framework is key to the integration of RE into health clinic electrification. Without an established policy at the highest level and commitment at every other level, efforts to implement RE technologies run a high risk of failure. Many health professionals responsible for allocation of limited financial and human resources for public health programs see RE technologies as costly, experimental technologies with a history of failures. They may be unaware of the benefits of successful applications. Promotion of RE development should be accompanied by the removal of barriers such as import duties and subsidies for fossil fuel power. Partnerships offer the ability to share resources, costs and benefits. Collaboration with other community sectors such as education and agriculture is beneficial to the mission of public health programs. Similar needs such as light for education and safe community water supply can share the same service and share its costs. Collaboration between public and private entities should seek to support public health with private commercial services.

Decision-Making and Management

In some instances RE systems failed to prove reliable. These experiences have often left the perception that RE is more costly and requires special skills and knowledge. Without quality standards and proper service these failures will be repeated. The selection and procurement of quality systems and service must be based upon standards of acceptance and quality control. Adequate resources for logistics, servicing, and maintenance must be allocated.

Higher quality service is the strongest argument for integrating RE into health care. Cost analysis is usually based upon the initial cost. LCC analysis can be a favorable argument for renewable energy choices but is not a determinant.

Service Infrastructure

Although the technologies are mature, there lacks a well-developed, reliable service industry to install, maintain, and repair systems in the field. This infrastructure can be developed more cost effectively through partnerships with other human service sectors to share costs. System designers and field technicians must receive regular training and information to retain current knowledge and skills. There must be enough pay for their services to keep them available and prepared. Spare parts must be available. The system users must be aware of the proper operation and care for the system. Training must be adequate and regular.

Financing and Income Generation

Availability of financing for purchase of equipment will put the benefits of RE technologies within the reach of those that need them most. National governments and international donors have provided significant capital funds for clinic electrification with marginal results. The lack of operating funds for maintenance and repair soon renders the equipment unusable. There are numerous examples of revolving credit funds to support productive use enterprises and enable individuals to purchase solar lighting systems as a means of rural electrification. The principles of these successes should be applied to community-based health facilities and enterprises. Strategies to generate income at the local level can enable recovery of the loan funds and provide operating funds to maintain the equipment.

Community and Culture

Dynamics within the community play an important role in making or breaking the success of a project. The community and its individuals may support, ignore, abandon, or even subvert the system. Systems and services provided must be in the appropriate language and level of education to be understood.


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