Powering Health

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Guyana

Map of Guyana and its neighbors.

The USG PEPFAR program is a multi-country, multi-billion dollar initiative to prevent and treat HIV AIDS in developing countries (www.pepfar.gov). The PEPFAR program in Guyana has found the effectiveness, sustainability, and reach of prevention, care and treatment programs are directly compromised by the lack of reliable power at health facilities.

The Challenge in Guyana

The acquisition of reliable and affordable power poses a challenge to many health facilities in developing countries, especially those in remote rural areas. This is the case in Guyana where the PEPFAR program and the Ministry of Health (MOH) requested USAID assistance in assessing options for improving energy services in health facilities.

The PEPFAR blood safety team has been working with the Ministry of Health (MOH)/National Blood Transfusion Service (NBTS) on a variety of regional blood collection centers and blood banks including construction of a new blood bank on the grounds of the New Amsterdam Regional Hospital. The blood banks have critical refrigeration needs as well as air-conditioning requirements. The PEPFAR team is also working with the MOH and other local partners to improve service delivery at the Georgetown Public Hospital, regional clinics, and other prevention of mother to child transmission (PMTCT) sites throughout Guyana. These facilities require high-quality power for the operation of sensitive laboratory equipment, climate control for the storage of HIV rapid test kits, and refrigeration for pediatric anti-retroviral drugs (ARV’s) and a variety of testing reagents. PEPFAR is also supporting the construction of several major infrastructure projects, including a reference laboratory that will be located on the grounds of the Georgetown Public Hospital and a supply chain management warehouse in Georgetown.

In November 2006, The USAID Energy Team supported a two week assessment of Health Facility infrastructure needs in Guyana. The team interviewed stakeholders in the health and energy sectors and visited a representative sample of eight health facilities to assess their energy supply conditions. The focus of the assessment was to identify options that would improve the energy reliability and quality at grid-connected facilities, expand the reach and quality of health services in the unelectrified/quasi-electrified interior regions of the country, and reduce the energy costs of power intensive health facility infrastructure under construction across the country.

The Team’s key findings and recommendations for improving energy service at these facilities and others currently in design or under construction, are presented below.

Findings and Recommendations

Solar power contributes to the electrification system at the Mahdia district hospital in Guyana. (Photo: Jeff Haeni)

Currently, full service district hospitals located on the coast suffer from expensive, unreliable, and poor quality power. District hospitals located in the interior face similar problems compounded by the fact that the power is intermittent, of worse quality, and from a variety of expensive sources. Hinterland health centers often have no energy at all, limiting the reach of cold chain dependent immunization programs and prevention of mother to child transmission (PMTCT) services. The lack of electricity in many interior regions of the country limits the distribution of certain cold chain dependent ARV drugs and HIV rapid test kits. Power anomalies cause damage to laboratory equipment and jeopardize the accuracy of sensitive laboratory tests. Finally, the expensive cost of electricity in Guyana makes the long-term operating costs of power intensive health care facilities currently under construction significant.

Improving Energy Reliability and Quality at Grid-Connected Facilities

Many non-solar based investments, such as back-up generators, power conditioning units, and un-interruptible power supplies would likely take top priority when considering cost-effective options for improving the power supply at grid-connected health facilities such as New Amsterdam and Georgetown public hospital. In addition, self-generation of power is a cost effective approach that should be considered by nearly all health facilities in Guyana. The poor quality and reliability of grid power should be a major consideration in the design of all new facilities – such as the blood bank at New Amsterdam, and the reference lab in Georgetown. Inadequate attention to this problem could seriously jeopardize the sustainability and operation of the facility.

Expanding the Reach and Quality of Health Services in the Unelectrified/Quasi-Electrified Interior Regions of the Country

Investment in a power supply which could provide refrigeration for off-grid health facilities could help expand the provision of vaccination programs and HIV/AIDS testing services throughout Guyana. Solar power is an economic option to be seriously considered for any health facilities that are not connected to the GPL grid (or reliable grid such as Linden Electric). Hospitals located in Regions I, VII, VIII, and IX, provide the greatest overlap between PEPFAR programmatic priorities and solar suitable facilities. An investment in solar/diesel hybrid systems for these hospitals likely represents the most cost effective solution to meet the energy needs of these critical facilities which serve as the focal point of regional health care delivery. The similar energy needs of small health posts lend themselves to “off-the-shelf” solar systems with design standards determined by the Ministry of Health. PEPFAR investment in the solar electrification of an interior regional hospital, coupled with the establishment of a PV training program, design standards, and maintenance protocols, would build the overall solar technical capacity in Guyana and translate into improved sustainability of all PV systems currently being installed at hinterland health facilities in Guyana.

Reducing the Energy Costs of Power Intensive Health Facility Infrastructure

The donor community, local stakeholders, and Ministry of Health (MOH) should seriously consider the power demands of all new infrastructure projects in the health sector. Consideration of energy savings techniques, such as natural lighting and cooling, should be a pre-requisite to facility construction. Facilities that are built to Western standards without the corresponding reliability and quality of Western energy services have proven to be problematic. Upfront investment in renewable technologies is a viable option for donors to offset the long-term energy costs of health facilities. The current cost of power from GPL makes “grid-tied” solar systems economic with a 50% subsidy of capital costs.

Ensuring the Sustainability of Solar Electrification

Guyana has a poor track record concerning the sustainability of past health facility solar electrification efforts resulting from poor system design, improper maintenance protocols and lack of dedicated maintenance funds. Investment in solar solutions for any facility is only advisable if a corresponding training and maintenance program is initiated. Proper solar system design is essential and components need consistent maintenance from appropriately trained personnel. Since the health care facilities do not collect fees, maintenance funds must be established upfront and be dedicated only to solar system repair. Mixing maintenance funds with general operating budgets has proven to be an ineffective model.

Response

In response to these findings the Guyana PEPFAR program requested funding in their FY ’08 to implement an health facility infrastructure improvement program. This program will begin in Sept. 2008.