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The Challenge in Rwanda

rwanda - map
Map of Rwanda and its neighbors.

Over three-quarters of Rwanda's population live in rural areas, where they have extremely poor access to electricity and other modern forms of energy. This lack of access was greatly exacerbated by the 1993-94 conflict, which destroyed much of the infrastructure and reduced human capacity in the energy and health sectors. Of the over 400 health facilities in Rwanda, as many as a quarter are un-electrified. As PEPFAR/Rwanda clinical implementing partners now work in over 300 facilities around the country, they are greatly impacted by the country's electricity situation. Even for those facilities connected to the grid, electricity is expensive (over US$0.20 per kWh) and may be inadequate to meet total demand.

PEPFAR provides budgets to its implementing partners to enable health facilities to fuel or sometimes purchase new energy equipment (particularly generators and solar pv systems). PEPFAR/Rwanda invited the USAID Energy Team to conduct an assessment of the energy situation in Rwandan health facilities and ascertain implementing partners- concerns in February 2007.


Key Findings

The assessment team discovered that lack of electricity was a key constraint to program implementation by clinical partners. In practice, the five implementing partners were using very different strategies to install energy systems, with varying levels of success. The assessment revealed that up to 40 percent of distributed power systems are not functioning well. As health experts, PEPFAR partners generally lack the ability to internally plan for and specify energy systems. This inability is exacerbated by the fact that Rwandan energy service organizations (especially solar energy companies) have a low level of capacity to provide innovative modern energy solutions. Their products are expensive, and there is limited capacity to design and deliver efficient energy systems for larger health institutions in particular. Government capacity in this area is also limited, and there are no government specifications for solar equipment.



rwanda - solar batteries

A technician at a health clinic in Rwanda stands near multiple solar battery packs. (Photo:  This email address is being protected from spambots. You need JavaScript enabled to view it. )

In response to these findings, PEPFAR/Rwanda began working with the USAID Energy Team to provide centralized technical assistance (TA) to the implementing partners. The assistance strategy had two main tenets:

  1. build local capacity, in order to provide a corps of local energy experts who could work with the implementing partners; and
  2. build networks between the implementing partners so that they could share lessons learned; and build links to government agencies and other donors, in order to leverage resources and develop a coherent approach to health sector energy needs.

As part of the TA program, in August 2007 Energy Team consultants identified and trained six Rwandan technicians how to conduct health center energy audits and write-up audit reports. Some preliminary training on solar system design was also provided. Full audits were conducted on four health centers (partner sites of four of the five implementing partners). Energy audits were selected as the first area of training, since no one in the country (including government ministries) had accurate data on what equipment already existed in the health facilities, nor what their energy demand was. The USAID assessments revealed that some off-grid facilities already possessed multiple pv systems, while others had none. The lack of uniformity made it impossible to develop generic energy equipment procurement packages and necessitated energy audits to gain a realistic picture of the situation on the ground.

PEPFAR/Rwanda staff and Energy Team consultants shared the audit tool developed for the training and the audit findings with government agencies and other donors. These consultations led to collaboration between PEPFAR and BTC (the Belgian donor agency) to provide similar audit training to staff of the Atelier Central de Maintenance (ACM), the Ministry of Health's maintenance unit, in May 2008. ACM is tasked with maintenance of all health center equipment. Following the training, BTC engaged ACM and two of the local experts trained by USAID to conduct energy audits of nearly 100 additional health centers, in anticipation of funding from Belgium and the EU.


Next Steps

The Government of Rwanda has now formed an inter-agency task force to design an integrated approach to health-center electrification. The task force consists of representatives from the ministries of Health and Infrastructure, as well as PEPFAR partners and key donors (US government, BTC, World Bank, etc). PEPFAR/Rwanda is coordinating with the task force to decide where to focus future TA activities.