New Delhi: To strengthen rural health infrastructure to deal with COVID-19, especially with the increased load from the influx of migrants returning from cities, the Indian government should solarise over 39,000 unelectrified health sub-centres--the first point of contact for over 200 million people with the primary healthcare system, industry leaders wrote in an open letter on April 30, 2020.

“India needs to spend as little as Rs 28.06 ($0.37) per person to rapidly install reliable, clean energy solutions to end energy poverty for rural clinics,” 17 leaders from top think-tanks, renewable energy companies, industry groups and healthcare services said in a set of recommendations to the government.

These 39,000 unelectrified health sub-centres serve 230 million people in rural India, or about 15% of the country’s population.

Referring to a 2017 study on solarising sub-centres in Chhattisgarh by the Delhi-based think-tank Council on Energy, Environment and Water (CEEW), the letter said that the addition of rooftop solar and batteries resulted in better healthcare outcomes--especially for maternal and neonatal health--by protecting sensitive medical equipment. It also saved money.

With less than a year before the end of Phase-3 (2018-2021) of the Indian government’s Off-Grid and Decentralised Solar PV Applications to take off-grid solar power to currently unelectrified areas in March 2021, “now is the time to seize the moment to ensure that the nation once and for all ensure universal rural healthcare”, the letter said.

Four recommendations

The letter recommended that the government’s Off-Grid and Decentralised Solar PV Applications programme should adopt the learnings from Chhattisgarh to accelerate the use of renewable energy to power all unelectrified primary health centres (PHCs) and sub-centres at a national scale.

For this, the government needs to allocate dedicated capital from the national budget. Given a per sub-centre benchmark cost of Rs 74 per watt for solar PV system with three-hour storage, India can electrify all sub-centres for as little as Rs 600 crore ($85 million)--no more than 0.6% of the 2020-21 energy and healthcare budget, said the letter.

The state-level National Health Mission (NHM) and renewable energy agencies should be deployed to implement the programme. A budget must also be set aside for ongoing operations and maintenance to ensure the solar systems work beyond the current five-year warranty periods, it said.

As the final recommendation, the letter suggested fostering innovation in the medical equipment sector. Most medical equipment available on the market today is highly inefficient in terms of power usage, increasing the financial burden on rural clinics, the letter said, adding that manufacturers must be incentivised to develop more efficient, ruggedised appliances suitable for rural healthcare services.

How solar power improved Chhattisgarh’s sub-centres

  • Solar provided a reliable power backup to PHCs in the state, especially during peak load hours and after sundown. This showed that it could potentially be a primary mode of power supply.
  • About 90% of the solar-powered PHCs reported cost savings from using solar photovoltaic systems over diesel generators. Diesel power costs Rs 24-26 per kilowatt-hour (1 unit) of electricity, while solar plus battery costs about 46% less at Rs 12-14 per unit.
  • One-fourth of power-deficit PHCs relied exclusively on solar as a backup to run cold-chain equipment for storing vaccines and drugs and newborn care equipment.
  • Higher comfort due to better lighting and running of fans increased patients’ willingness to get admitted.
  • Solar-powered PHCs admitted over 50% more patients and conducted twice the number of child deliveries in a month compared to power-deficit PHCs without a solar system.

Source: Council on Energy, Environment and Water, 2017

(Tripathi is an IndiaSpend reporting fellow.)