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Haiti: Improving Energy Service at 20 Health Facilities

Case - haiti map

Map of Haiti and its neighbors.

The quality of grid power in Haiti is ranks among the worst in the world. Many health facilities receive only a few hours of power per day, with prolonged outages of up to a month not uncommon in some locations. The lack of reliable electricity in health facilities across the country complicates the storage of cold chain dependent blood, laboratory reagents and HIV rapid test kits. Power anomalies cause damage to laboratory equipment and jeopardize the accuracy of sensitive laboratory tests. In addition, a significant portion of many health facilities operating budget was used for the purchase of diesel fuel to power generators during frequent power outages. Reducing this expense would allow these facilities to use these funds for other priority needs.



Under the aegis of the PEPFAR program, USAID's energy assessment team visited 20 health facilities in Haiti to assess energy supply conditions. The team investigated options for improving the energy reliability and quality at grid-connected facilities and for off-grid facilities in the Central Plains. This case study presents the team's observations and recommendations for improving energy service at these facilities.



The assessment found that, with a few notable exceptions, public health facilities in Haiti did not have the technical capacity, funding, and/or managerial discipline to effectively install, operate and maintain energy systems. The team recommended that PEPFAR should consider supporting national and perhaps regional level engineers/electricians to help improve the energy infrastructure at health facilities around the country.

The ability of health facilities to mitigate the impact of unreliable power and manage on-site energy systems was directly related to a facility's management capacity. The team recommended that a select group of facilities with motivated and competent management that did not have the funding or capacity to solve their energy challenges should be considered priority candidates for support. Facilities with incompetent management should generally be avoided until management is strengthened, and facilities which are in need of incremental investments to improve functioning energy systems could be considered a second priority.

Many of the larger hospitals had a majority of the technology required to mitigate the effect of the unreliable and poor quality grid power. However, few hospitals had the technical ability, or financial resources, to integrate the various components into a well function system. The team recommended that with a reasonable investment, PEPFAR would be well positioned to "connect the dots" at these facilities and greatly improve their energy systems. At many of the larger facilities such support would likely involve training of the on-site electrician, re-wiring, integration of UPS systems, and installation of automatic transfer switches.

PEPFAR has shown great foresight by providing point of use UPS systems and inverters and battery bank systems to improve the power supply at ARV labs in Haiti. The approach is technically sound and if implemented correctly will be an effective way to reduce laboratory equipment damage and improve testing results. Although the batteries and inverters are not complex technology, several steps must be followed to improve the success of this program. This assessment found that just 50% of the systems in the field were functioning properly. The team recommended that the success rate of the inverter program could be drastically improved with a few low cost steps:

  1. Load Analysis: Before a system is provided to a health facility a load analysis should be conducted. With the correct training, a load analysis could be completed by CDC personnel or by a nationally based (e.g. reference lab) electrical engineer. The load analysis will help inform PEPFAR about the proper size system to provide, and will identify appropriate loads which should be connected to the inverter. A proper load analysis can help maximize the loads supported by the inverter and minimize battery failure resulting from excessive discharge.
  2. Installation and Operation Support and Guidance: Few, if any, of the systems were installed for optimal performance. In addition, some of the supplied systems were not installed because the hospital claimed it had insufficient funds. Given these observations it is recommended that PEPFAR insure professional installation and provide training to local users on proper operating procedures. An inverter and battery operations manual should also be produced in French/Creole.
  3. Trained Support Network: The proper design, installation, and maintenance of these systems can be achieved by establishing a trained support network. A national level engineer should be responsible for the installation of all systems and for providing operational training to local users. PEPFAR should immediately support the establishment of such a network and a training program. The training program could be targeted at local users, CDC regional logistics officers, and an engineer employed by the national reference lab or National Plan.

The use of propane/electric hybrid refrigerators seemed to be an effective approach to deal with the intermittent power supply found throughout Haiti. The assessment found refrigerators operating on both electric and propane supply. Operation of the refrigerator on propane was an effective way to keep contents cold during extended power outages, and electric operation was observed in many clinics because of the logistical challenge in obtaining propane. The team recommended that PEPFAR consider investing in more robust hybrid refrigerators even if they are not locally available.

The multitude of energy challenges facing health facilities in Haiti require a diversity of technological solutions. The assessment found no reason to preclude any specific technology from consideration when designing a solution to a given facility. Several solar systems were observed that had been operational for many years. Based on the experiences of the WHO EPI program, the location of the health facility appears to be one of the primary determinants in the sustainability of the solar systems. Solar systems in major population centers were often stolen, while systems in places like Port Salut and Jeremy have had no reported problem with theft. The team recommended that grid power will almost always be the most economic option for charging back-up battery systems. In cases where no grid power is available, or extended grid outages require prolonged generator operation, solar installations should be considered on a case-by-case bases for battery charging. Several theft resistant measures can also be employed to help secure the solar panels. These strategies were not being utilized in the installations reviewed in this assessment.

The team observed that the ubiquitous use of battery based back-up systems in health facilities in Haiti requires that careful consideration be given to the energy demands of all donor provided equipment. The team recommended that the donor community, local stakeholders, and MOH, 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 and use of energy efficient appliances, should be a pre-requisite to facility construction.