Energy management is as much about human behavior and management as it is about technology. The actions of your staff will have a major impact on the amount of energy your health center consumes. In many instances, energy equipment and supply decisions may occur outside the health care facility. For example, a national government agency or donor may provide a diesel or solar system to meet the needs of a rural facility, often without input from you or your clinic staff. Energy use and management decisions, on the other hand, take place at the facility level, and therefore the long-term success of the energy system is one of your responsibilities.

Energy management determines not only how much power, electricity, or current you have available to run your facility, but also how you use that power. Energy management will help you to:

Maximize the lifespan of energy systems, through proper operation, use, and maintenance.
Ensure that energy is available when needed.
Keep energy costs as low as possible so more money is available for medicines and other important medical necessities at your facility.

A sound energy management program is implemented using the following five steps:

Step 1: Identify and Prioritize Your Facility’s Energy Needs

An energy management scheme begins by identifying and prioritizing the energy needs of your facility. This includes preparing a list of connected load for all electric appliances and devices within the health facility including the medical center, staff residences and other service areas. The next step is to categorize connected load into three components:

Critical load: Appliances or energy-consuming facility services that must be running at all times. Interruption or loss of power for critical loads can impose dangers to patient lives, a vaccine refrigerator for example.
Essential load: Refers to appliances/devices that are important as power is available for example task lights in the operation rooms.
Non-essential load: Refers to appliances/devices that are helpful but not essential. A fan for patient comfort, for example.

Once a comprehensive list of all the electric appliances and devices are developed, identify the rated power (e.g. a 60 Watts bulb) for each connected load. Also, list the number of hours each appliance/device operates in a day. Multiply the rated power of the device with the number of hours it operates in a day. This gives the daily energy requirement of an appliance. For example, one 60 Watt bulb operates for 5 hours every day, meaning its daily electricity consumption is 1 x 60 Watts x 5 hours = 300 Watt-hours per day. Add up the energy consumption for all the identified devices and appliances in the facility to determine the energy load of your health clinic.

Sanitas Clinic: The Staff Measures Their Energy Use

The Sanitas head nurse and two nursing assistants make a list of all the equipment that uses energy in their facility and staff quarters, and try to find out how much power each piece of equipment consumes. In some cases, they find the power consumption listed on a label on the bottom or side of the device; in other cases, they have to make a few phone calls. The district health office is able to give them some information; the service provider who installed their solar system is also helpful at estimating how much energy certain types of equipment will consume. Finally, the staff sits down and estimates how many hours each piece of equipment is used. They put all of this information into a table. To get the total energy consumed at the clinic each day (column E), they multiply columns B, C and D. The staff also prioritizes the importance of various appliances according to critical, important, and non-critical facility needs.

A	B	C	D	E (BCD)	F
Energy Consuming Device	Number of Devices	Power Consumption (Watts)	Hours Used Per Day	Energy Consumed Per Day (Watt-hrs)	Device Priority
Blood bank refrigerator	1	70	24	1,680	*Essential*
Blood chemistry analyzer	1	50	2	100	Essential
CFL light bulbs, clinic (indoor)	8	18	8	1,152	Essential
CFL light bulbs, staff quarters (indoor)	5	18	4	360	Non-Critical
CFL light bulbs (outdoor)	4	26	8	832	Essential
Clothes iron for bedding, sheets, towels, clothes, etc.	1	1,000	1	1,000	Non-Critical
Examination lamp (CFL)	1	18	4	72	Essential
Laptop computer	1	35	8	280	Essential
Microscope	1	30	3	90	Essential
Operating table lights	2	100	3	600	*Essential*
Phone charger	1	20	6	120	Non-Critical
Radio/Cassette Player	1	60	18	1,080	Non-Critical
Vaccine refrigerator/freezer	1	60	24	1,440	CRITICAL
Total Load (in Watt-hours consumed per day)			8,806 or 8.8 kWh
Future Loads
Electronic Centrifuge Machine	1	575	2	1,150	Essential

Read more about Step 1 in Powering Health: Energy Management in Your Health Facility.

Step 2: Know Your Energy Systems: Balance Energy Demand and Supply

Rural (or off-grid) health facilities often generate their own energy for lighting, critical medical equipment, refrigeration, office and communications functions, and other purposes. Therefore, understanding the total amount of power available to you is very important develop a proper energy management plan.

On-site electricity generation can come from different sources such as solar power, wind turbines, mini-hydro, diesel/gasoline generator, propane/kerosene-based lighting sources, batteries, hybrid systems etc. It is important to know the power supply capacity of the energy generating source. For example, for diesel and renewable energy systems, power ratings are typically found on the energy producing equipment. The power rating tells you what the equipment’s electricity generating capacity is. You can calculate the amount of energy that the equipment produces in a day by multiplying the capacity by the number of hours that the equipment generates electricity.

For renewable energy systems (e.g., solar, wind, hydropower), equipment is typically rated in Watts or kilowatts. For example, if a facility has five PV panels, each rated at 100 Watts, then the PV capacity would be 500 Watts (100 x 5) or 0.5 kilowatts. If the facility usually gets full sunlight for about four hours per day, then that system produces a maximum of 2,000 Watt-hours per day (500 x 4), or 2.0 kilowatt-hours (kWh) per day. To enhance renewable energy system availability, batteries are often added to store energy produced and make it available when the renewable energy resource is not available, e.g., when the sun is not shining or wind is not blowing. The storage capacity of batteries is typically provided in amp hours (Ah). When multiplied by the batteries nominal voltage (e.g. two, six, or twelve volts), this gives the storage capacity of the battery in kilowatt-hours. For example, a 200 Ah, 12 V battery can store up to 2,400 Watt-hours, or 2.4 kilowatt-hours of energy.

Knowing the total amount of power available, the power needs of your facility, and the critical load priorities, you are able to more effectively manage energy consumption and have the power needed to satisfy facility demand. This information will help to prioritize limited energy resources available, and identify any extra capacity left for running existing appliances for longer durations in a the day and whether the system has sufficient capacity to add new equipment.

Sanitas Clinic: Managing Energy Supply

Sanitas clinic has a total load of 8,806 kilowatt-hours per day. This includes 7,366 kilowatt-hours per day to meet general energy needs, and 1,440 kilowatt-hours per day for the clinic’s critical load—the vaccine refrigerator.

Sanitas currently operates two solar power systems:

A dedicated solar panel and battery to meet the needs of the 1,440 kWh/day consumption level of the vaccine refrigerator.
The main solar power system generates 7500 kWh/day to meet bulk of the clinic’s energy needs. Because the daily energy demand is 7366 kWh/day, the clinic has a very small margin of error—in other words, there is very little room for making mistakes in executing the energy management plan.

With this energy system, the clinic cannot support any more energy usage than it currently consumes, so overloading the system is a real concern. For example, if the staff uses the radio/cassette player one day for 24 hours, or leaves the laptop turned on overnight, the energy usage will exceed the systems capacity to generate electricity. This would likely cause the batteries to discharge that the system will not work for several days or even a full week until the batteries get charged again.

Recently, the district health office has contacted the clinic with an offer for an electronic centrifuge machine to replace their manual one. The electronic version requires 575 watts. It will be a challenge to operate the machine unless non-critical loads are shed off or new generation capacity added.

Read more about Step 2 in Powering Health: Energy Management in Your Health Facility.

Step 3: Establish Your Energy Management Team

With knowledge of the facility’s energy needs and supply availability, the next step is to formulate an energy team to establish and implement sound energy management practices. This involves the following:

Make a facility commitment to effectively manage energy use

Implementing an energy management program requires commitment by the highest level at the facility, someone who can demonstrate leadership and show the staff that this effort has strong internal support. Ideally, the program should also have the regional/national policy support that encourages sound energy management practices for country’s health care facilities.

Form a dedicated energy team to deliver results

Sound energy management relies first and foremost on people. Building local capacity at the facility level and among other key stakeholders will be important to the successful operation of facility energy systems. All of the health facility staff members should gain a good understanding of the facility energy management plan, and for contributing to its execution and ultimate success. The facility manager should form an energy management team to ensure that the facility’s energy system meets health care needs on a day-to-day basis. The number of team members will vary depending on the facility’s size.

Ensure the team has the training and tools to do the job

The medical staff will be the primary users of the equipment and so it is important that they are represented on the energy management team. A training program will help ensure that staff members have the skills and knowledge to manage and use the energy system. Your energy service provider is a good point of contact for helping to design the program and conduct the training.

Different levels of training are appropriate for different members of the health care facility staff:

Understanding the energy system for all staff
Energy use monitoring for the facility energy monitor
Operation and maintenance training for the facility energy technician.

Case Study: Solar-Energy System—Training Lessons Learned

Micobee Health Clinic is a small clinic located in a remote interior area of Guyana. The clinic serves 360 residents and 300 miners from a small village, with one part-time health worker on staff (the same person also staffs a nearby clinic with no electricity). A small photovoltaic system was installed to power a communication radio, an indoor light, and an outdoor security light.

When the photovoltaic system was installed at the clinic, the local health worker was not given any training on the system, and was told not to touch the batteries because the regional health office decided that since he had not been properly trained, he might damage the system by using trial and error methods to resolve problems. He did not monitor the system or log any type of energy use. No maintenance contract with the local service provider was in place.

When the USAID Energy Team visited the clinic, the electrolyte level was critically low in many of the batteries. Distilled water, which is used to refill the batteries, is not locally available. The health worker did not know how to refill the batteries to the appropriate water level, and was unable to maintain the system without some basic knowledge of system maintenance and operation. This example provides a clear reason why simple training—and including health facility staff as part of the energy team—can go a long way toward prolonging the life of an energy system.

Step 4: Operate and Maintain Your Energy System

Sound operation and maintenance (O&M) practices are essential to ensure that your energy system performs as expected. Proper implementation of the O&M plan has proven to be one of the most challenging aspects of health facility energy system improvement programs. Insufficient O&M funding, training, and load enforcement often lead to system failure in short order. Alternatively, if a proper O&M plan is implemented, benefits will include:

Keeping system in good working order
Guaranteeing that the system is working properly
Ensuring optimal equipment performance
Detecting potential problems before they arise and making necessary corrections
Reducing potential for premature system failure
Extending the life of the system
Saving money for your facility.

All health care facilities, both large and small, should develop a basic O&M plan for their energy system. This should be based in part on the manuals provided with your energy equipment. O&M plan preparation should be led by the facility energy technician, with assistance provided by the equipment service provider as needed. An effective O&M plan includes the following:

Labeling and wiring of critical and non-critical equipment
Identifying and conducting routine O&M activities
Creating an inventory of spare parts
Addressing theft prevention
Setting up a dedicated budget for energy system O&M costs
Preparing for the worst-case scenario.

Task	Frequency	Responsible Staff Member
The Energy System
Monitoring and log keeping of system use	Daily	Facility Technician
Training in emergency shutdown procedures	Periodic	Facility Manager and Energy Technician
Maintaining a spare parts inventory	Daily	Energy Technician
Lighting
Check electrical connections	Weekly	Energy Technician
Clean lamps to maintain brightness levels	Weekly	Energy Technician
Replace burned out lamps and ballasts	As needed	Energy Technician
Medical end use equipment
Clean equipment, and check for worn insulation on electrical wires and loose electrical connections	Weekly	Facility Medical Staff
Follow manufacturer’s maintenance recommendations	Daily	Facility Medical Staff
Check that power quality is sufficient. If power quality deteriorates, it may be necessary to invest in power conditioning equipment	Monthly	Energy Technician
Batteries (may be part of a back-up system)
Check electrical connections	Weekly	Energy Technician
Check for corrosion and clean terminals	Weekly	Energy Technician
Check water levels and top up (for lead acid battery types only)	Weekly	Energy Technician
Ensure that batteries are fully charged on a regular basis	Weekly	Energy Technician
Replace the battery bank	Typically every 2-5 years (lead acid) and 5-10 years for (sealed gel) if well maintained	Energy Service Provider
Manage hazardous materials storage and disposal: recycling of spent batteries, managing electrolyte spills for lead-acid batteries	As needed	Energy Technician and Energy Service Provider
Generators
Maintain fuel and lubricating oil levels	Weekly	Energy Technician
Change oil and oil filter	See manufacturer’s recommendations	Energy Technician or Energy Service Provider
Routine servicing: check and tighten bolts, replace fuel filter	Periodic	Energy Technician
Conduct minor and major overhauls at regular intervals	Periodic	Energy Technician or Energy Service Provider
Manage hazardous materials storage: diesel fuel, motor oil; and used motor oil disposal*	As needed	Energy Technician
Photovoltaic panels
Clean solar panels with water and a soft cloth—do this task with care in the morning or evening; solar panels and rooftops will be extremely hot during peak sun hours.	Daily during the dry season; monthly in less dusty areas/seasons	Energy Technician
Check system wiring for loose connections/corrosions.	Weekly	Energy Technician
Check all fuses and circuit breakers	Weekly	Energy Technician
For systems equipped with adjustable mounting racks, the array must be seasonally adjusted	Quarterly	Energy Technician
Check the array for shading from growing trees or new buildings; the solar panel will not work properly if it is in the shade. Trees may need to be removed or in the case of a larger building, the solar panel relocated. Also look for dirt and debris.	Quarterly	Energy Technician
Battery charge controller (may be part of a back-up system)
Check electrical connections	Weekly	Energy Technician
Inverters (may be part of a back-up system)
Check Settings	Weekly	Energy Technician
Check electrical connections	Weekly	Energy Technician
Replace	Typically every 5-7 years	Energy Service Provider

Sanitas Clinic Establishes an O&M Plan

Sanitas Clinic has had its solar energy system for about a year. It was installed by a solar engineer whose business headquarters are in the nearest large town. The Ministry of Health overseeing the clinic made sure that the engineer signed a contract with the Ministry agreeing to perform periodic maintenance checks as well as respond to service calls as needed, for a five-year period. For this service the Ministry of Health pays the engineer a flat sum; unexpected service calls are billed as they occur, and these are handled by the district government health office.

When the system was installed, the engineer sat down with the head nurse and the office manager assigned to be the clinic’s energy technician, and together they prepared a list of tasks for the technician to carry out on a regular basis. They also prepared daily logs for the technician to fill out; he keeps these handy for when the engineer makes a routine visit.

The O&M routine for the clinic’s energy technician is as follows:

Daily recording of system battery voltage—this helps compare energy production with energy use.
Monthly cleaning of solar modules and control equipment—this ensures it is free of dust and other environmental debris for optimum efficiency.
Ensure visits by the external engineer every 4–8 weeks to:

Collect and review battery voltage charts
Advise staff if systems are being overused or misused
Help with an energy-saving strategy
Check functionality of the energy system
Fix any problems found and identify any potential or expected problems
Verify that the technician is properly cleaning the systems and keeping a daily log
Update the training of the clinic staff at least once per year, and/or when turnover occurs.

Checking the spare parts inventory every 4-6 weeks and notifying the engineer and local/national health office or organization when additional parts need to be ordered.
Checking and tightening all wire connections every year—poor connections are a leading cause of decreasing system performance over the long term.

In addition, the head nurse has established a monthly “check-in” phone call with her superiors in the Ministry of Health to discuss any energy issues that arose during the period, including budgetary and new equipment needs. Her constant communication with her superiors has had an added benefit: she has elevated the visibility of her clinic and her successful Energy Management Team, so when visiting donors and dignitaries want to see a health clinic, they are brought to visit Sanitas. The clinic staff enjoys the heightened attention by the dignitaries, and this attention has led to increased funding for the clinic as well.

Read more about Step 4 in Powering Health: Energy Management in Your Health Facility.

Step 5: Improve Your Energy Use

Once you understand your facility’s energy demand, you can start to consider ways to reduce the demand without reducing the quality of services provided by the equipment. Reducing demand reduces the cost of fuel and of operating and maintaining the system, and also may make it possible to add equipment to your facility to improve the health services you provide. You can control and reduce energy demand in three ways: Energy monitoring, purchasing energy efficient appliances, equipment and lighting, and managing staff behavior.

Energy Monitoring

Sound maintenance and upkeep practices begin with energy monitoring, which is a function of daily behavior as well as having the right materials on hand. Monitoring energy use can help increase energy efficiency, lower costs, and lead to effective long-term budgeting. Periodic energy monitoring includes measuring electric power consumption (when measuring equipment is available), and identifying hours of the day when equipment is in use. Monitoring makes such inefficiencies apparent, and strategies can then be devised to minimize energy consumption. These include:

Installing alarms that notify staff when to turn off equipment due to low power availability.
Displaying lists of non-approved appliances that are not allowed on premises.
Instructing staff to turn off equipment when not in use.
Scheduling energy-intensive tasks for times when energy supply is adequate.
Eliminating phantom loads by disconnecting power cords or using switched power strips for equipment that operates in stand-by mode.
Ensuring that clinic staff are educated on and invested in the continued operation of the system. This may include designing the system to allow for personal use such as cell phone charging or staff quarters.

Purchasing Energy Efficient Appliances, Equipment and Lighting

Energy efficient appliances and lighting use less energy to provide the same level of service or operation as less efficient models. Reducing energy consumption reduces expenditures on fuel and electricity, for a more cost-effective energy system. For example replacing incandescent light bulbs with compact florescent light bulbs or new LED lamps.

Managing Staff Behavior

Staff behavior is key to conserving energy. There are many ways to reduce electricity usage without compromising the quality of health services that you provide by taking simple steps such as remembering to turn off appliances when they are not in use. Why use more power than you need to, especially when it is there only to help patients and is already in short supply?

Read more about Step 5 in Powering Health: Energy Management in Your Health Facility.

Additional Resources

A worksheet for logging maitenance activities.

Manitenance Logs and Checklists

Maintenance logs and task checklists should be maintained for all on-site energy supply equipment.

United States Agency for International Development: U.S. AID from the American People

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.

Thumbnail image of Powering Health: Energy Management in Your Health Facility cover

Powering Health: Energy Management in Your Health Facility – English (PDF 1.9MB), French (PDF 1.1MB), Spanish (PDF 1.1MB)

A resource for health professionals seeking to make better use of limited energy supplies. This guide assumes your health care facility already has electricity access, but presumes that more effective management of this limited resource will improve your ability to provide routine, quality health services on demand.

Get Adobe Acrobat Reader...

View our Privacy Policy
Contact the Webmaster
Last updated: September 28, 2011

The information provided on this Web site is not official U.S. Government
information and does not represent the views or positions of the
U.S. Agency for International Development or the U.S. Government.