6 Steps to Powering Health

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Installation of photovoltaic panels on the roof of a health clinic in Kigali, Rwanda. (Photo: Walt Ratterman)

Powering Health promotes a step-wise approach to planning for and implementing improvements to health facility power supply.

Over the years, significant effort and funds have been dedicated to providing energy services to health facilities – with a particular focus on expanding the vaccination cold chain. Unfortunately, many of these efforts have proven not to be sustainable over the long term. Fulfilling the energy needs of such facilities over the long term requires careful preparation, a comittment to maintenance and dedicated funding. Powering Health has a six-step approach to understanding a health facility’s energy needs and designing an energy system to meet those needs in a cost effective way.

This page explains the approach step-by-step and offers specific resources found on Powering Health that support the activies of each.


1. Analyze Energy Demand & Supply 

Before investing in any energy technologies, a health facility must first understand its current energy needs and supplies. An initial energy audit is a critical component to ensure proper system design and operation and in most cases should be carried out by a trained energy professional. Here are representative health facility load calculations, an online load calculation tool, as well as a detailed audit manual and spreadsheet.

Load Analysis: A Critical Component of an Energy Audit

A basic electric load assessment involves creating a table showing power ratings of all electrical devices in the facility along with an estimate of the number of hours each device will operate on a daily basis. This results in an assessment of the watt-hours used by the facility per day, which is used to assess the size of the energy system needed. Here are a range of sample health facilities as well as energy consumption estimates for commonly used equipment.

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Load Analysis and Example Calculations

A fundamental part of energy management, and the first step in improving a health facility energy system, is an electrical load inventory.  An electrical load inventory is a listing of all electricity-consuming equipment in a facility, everything from light bulbs to expensive lab equipment to cell phone chargers.

Online Load Calculation Tool

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Load Calculation and System Optimization

This online software tool is designed to assist health care providers in designing appropriate power systems for their rural health clinics. The software is designed to evaluate hybrid power systems that include generators, utility power grids, batteries and photovoltaic arrays. The software uses the optimization program tool called HOMER to determine the most cost effective options for delivering continuous electrical energy to the health facility.

Full Energy Audit

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Energy Audit

A spreadsheet tool and guide designed to be an overall off-grid energy information package to help energy experts and procurement officers collect and analyze information, plan PV and generator systems in off-grid health centers, and develop specifications and bidding documents.


2. Account for Change 

Once a facility has analyzed the energy requirements of its day-to-day operations, it must also determine whether the energy demands are likely to change in the near term. Health facility managers must think strategically in consultation with stakeholders, about the possibility that energy demands may increase due to the addition of patients, extended operating hours, or new services.

Ultimately, all stakeholders will have to agree on a target energy load for the facility which will feed into the system design process. The target load will directly impact the cost of the energy system. Loads will often be separated into critical and non-critical categories, with critical loads receiving continuous power from a battery based system and non-critical loads receiving power when a local grid or generator is operational. The addition of loads to a battery based system is one of the most common causes of system failure. Once an energy system has been designed around a given set of agreed upon loads, the loads cannot be increased without modification of the system (addition of batteries, solar panels, etc).

When considering future equipment procurement, take energy efficiency into account as this will result in a lower overall facility load, translating to a smaller, lower-cost energy system.


Energy Efficiency

Incorporating energy efficiency measures for health facilities will help to reduce future challenges associated with off-grid clinics or those with unreliable grid power supply.

Use the online HOMER tool to estimate the effect that different load configurations will have on the lifetime cost of the system. If the capital, operating, or maintenance costs of a system exceed the likely available budget than the system will need to be redesigned to support a smaller number of critical loads. The purchase of a system whose operating and maintenance costs exceed the available budget of the clinic will quickly result in system failure.


3. Investigate Viability of Local Service Providers 

Health facilities are in the business of providing quality health services, not operating energy systems, and if reliable power can be purchased for a reasonable price from an outside source it is typically worth pursuing. Before investing in any on-site technology, certain options should be investigated.The following options should be investigated before on-site investments in technology are made:

Grid Connected Facilities:

  • Improving the quality of grid-power via a dedicated feeder line, new transformers, etc.

Off-Grid Facilities:

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Grid Extension

Grid Extensions connects the facility to the local utility grid. If available, grid power is typically the most cost effective power supply, although the cost of extending lines to rural facilities can be prohibitively expensive. The quality of grid power in developing countries is often poor, so on-site technologies are often required regardless of whether a facility is connected to the grid or not.

  • Mini Grid – If grid extension is not a cost effective option, a mini-grid serving a health facility and local community may be a viable solution.

Unfortunately, improving the quality and reliability of grid power in developing countries often requires significant institutional reforms and capital expenditures which are long term endeavors and are outside the manageable interest of a given health sector support program. Mini-grids based on traditional fuels (and some renewable technologies) often provide intermittent power which is insufficient to meet a health facility’s needs. In these cases a health facility must rely on on-site power generation, storage, and conditioning technologies to ensure continuous and high quality power supplies.


4. Explore On-Site Technology Options 

After determining the health facility's typical daily energy needs, accounting for change, and investigating options for purchase of power from local service providers, it is time to evaluate the on-site energy technologies needed to meet the facility's energy needs. Selecting the best technology option requires the consideration of a number of factors.

These factors need to be considered:

  • Lifecycle costs of different technology options
  • Reliability and quality of local grid (if applicable)
  • Local renewable energy resources (wind, solar, biomass)
  • Local cost and availability of conventional energy resources (diesel, propane, gasoline)
  • Local availability of systems, parts, service companies, and technicians
  • Government policies and incentives
  • System reliability requirements
  • Technical capacity and funds for system maintenance and replacement
  • Special considerations or desired operational characteristics - i.e., noise, emissions, etc.
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Technology Options

Health facilities have a number of technology options available to supply reliable electricity, including Photovoltaic (PV), Wind, Reciprocating Engines (generators), Hybrid Systems, and Grid Extension. 


5. Design, Procure, and Install the Energy System 

Implementing your energy system will include a number of steps including designing the system, preparing bid packages and technical specifications, procurement, and finally, installation.

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Design and Installation

Proper system design and installation are the first steps required for sustainable on-site health facility energy systems. Off-grid energy system design is quite complex and should typically be done by a trained professional. This page does not attempt to teach the user how to do a design and installation, but rather covers some general principles and lessons learned.

Preparing Bid Packages

A "bid package" is prepared to ensure that the group procuring energy equipment is clear about the equipment and services it expects to purchase and the suppliers of equipment and services know exactly what they are expected to supply and the manner in which they are expected to supply the goods and services.

The bid package is a source of information for tendering companies and should provide them with a complete set of information to prepare their bids. The more complete a bid document is, the more likely that suppliers of equipment will provide equipment and services that meets the needs of the job and works for a long time.


Standards and Technical Specifications

Properly drafted specifications and standards can allow each energy system to be tailored to meet the needs of the facility while still ensuring best practice design and installation protocols are followed.

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Example Bid Documents: Publications - Technical Materials

Find solicitations for bids used by the Improving Health Facility Infrastructure (IHFI) project.  These bidding documents contain technical specifications, standard bidding procedures and contracting language used in the procurment of batteries, inverters, photovoltaics and other energy system components.

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Technical Drawings

 These schematics provide technical installation drawings for inverter/battery power backup systems at health clinics in Haiti. 


6. Make Investments Sustainable 

Without the correct people and support systems in place, no amount of investment in energy systems and technologies will adequately address the health sector's energy crisis."

The sustainability of any on-site technologies at health facilities requires proper operations, maintenance, and energy management which can only be achieved with proper institutional support structures, funding and training. These issues are discussed in more detail below:

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Training Material

Training health care staff on energy management practices is a vital component to successful health facility electrification efforts.  Find a number of presentations and other resources used in training programs for battery, inverter and generator maintenance.

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Maintenance Logs and Checklists

There are two critical components needed for effective system maintenance: training and funding. While significant progress has been made in including training programs with facility retrofit efforts, funding for replacement parts remains a serious constraint to system sustainability. Maintenance logs and task checklists should be maintained for all on-site energy supply equipment.

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Energy Management

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.

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Theft Prevention

High value technology in developing countries is an automatic target for theft. Several techniques have proven effective in mitigating the likelihood of system theft including full-time guards, anti-theft mounting systems and cages, and proper system maintenance.


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.

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