Fact sheet No 132: Solar Energy and Rural Health Care - September 1996
Health and energy are interdependent factors which largely determine the progress of rural development. The 38 countries in the world with the highest under-5 mortality rates also have the highest proportion of rural populations (73%), and the combined rural populations of developing countries will exceed 500 million by the end of the decade. An energy strategy for rural areas will be critical in achieving lasting health improvements.
Health interventions, especially primary health care (PHC) services, have been shown in recent decades to greatly improve child survival, enhance educational performance and increase agricultural productivity. At the same time, PHC facilities and clinics require only very limited amounts of energy to operate. Developing a reliable and affordable source of energy that is well suited to meeting the low demand of PHC activities remains a challenge, but WHO believes solar energy can play an important role in improving health energy infrastructure if integrated with a broader array of end uses.
Refrigeration and lighting
There are currently two main applications of solar energy which directly support health care activities in developing countries - vaccine refrigeration and, to a lesser extent, lighting of health care centres. The technology of photovoltaic refrigerators is mature and fully commercialized with more than 5,000 now in use worldwide, the majority of them in African countries. Among the most active countries:
• As of 1993, all 54 health centres in the Gambia had replaced gas and kerosene refrigerators with solar units, and some centres had also been equipped with solar lighting systems and water heaters.
Performance versus cost
Provided that systems are correctly designed and installed and that users are trained, solar refrigerators have a high level of technical reliability during the first several years after installation. According to WHO comparative surveys, the average mean time between failures (MTBF) for solar refrigerators in Uganda was 2.6 years, and in Gambia almost 4 years. Both ratings were much better than for kerosene refrigerators, and somewhat better than for gas-powered units.
The same surveys indicated, however, that in terms of investment and recurring costs, solar refrigerators did not compete with gas-powered units. In Uganda, the total annualized cost of solar refrigerators over a 10-year cycle was found to be US$940 - close to twice that of gas refrigerators - and was even higher for solar units in Gambia. A review of kerosene and solar refrigerators in Indonesia found a similar pattern. The high costs of solar-operated units are due mainly to the need to bring very skilled technicians to remote areas to install the systems and to repair them. Even if the failure rate is low, the technology is so new that maintenance in remote areas remains difficult and costly.
In the present context, therefore, WHO recommends that implementation programmes which focus exclusively on solar vaccine refrigeration be avoided. The only conditions under which solar refrigerators are likely to be justified are: 1) no other fuel supply is available; 2) other fuel supplies are unreliable and shortages are likely to disrupt immunization activities; and 3) a private fuel distribution system or one managed by the national EPI cannot be envisaged.
Because the maintenance costs of solar equipment cannot be borne by immunization programmes alone, a more integrated approach will enable a smoother introduction of the technology into rural areas and contribute to establishing a local maintenance infrastructure. Solar energy can meet the needs of many other sectors of primary health care, and improve the living environment of the rural population by providing access to such services as television, video, communications and light.
The availability of small quantities of solar electricity can also be the basis for income-generating activities such as battery charging, lighting systems rental and TV/video for entertainment, thus contributing to meeting recurring costs of the health energy infrastructure.
In addition, solar energy also has a potentially important role in powering rural water supply in developing countries. The 1993 World Solar Summit in Paris identified household water supply, water pumping for clinics and health centres and water treatment in hospitals, inter alia, as areas where energy is critical to health. This is particularly true in rural areas, where often the poorest communities are located and mains supply of electricity is nonexistent. Information presented at the Summit clearly demonstrated the economic advantages of solar over diesel energy where climatic conditions are appropriate, advantages which increased with rising water demand.
WHO takes the view that, with the introduction of new vaccines and the global increase in large-scale immunization activities, continued development and use of solar refrigeration is indispensable. The reliability and relatively large storage volume of solar refrigerators allows for longer storage of vaccines at the periphery. Vaccines can be passed more rapidly down through the distribution system, relieving pressure on higher level storage facilities and enabling vaccines to be stored closer to the point of use. These benefits are sufficiently important to outweigh the differences in the cost of purchase and maintenance, presuming the cost burden can be shared with other applications sharing the same photovoltaic power source and a local maintenance infrastructure, public or private, can be established.
For more information please contact Health Communications and Public Relations, WHO Geneva, Tel (4122) 791 3221 or fax 791 4858; or Michel Zaffran, Expanded Programme on Immunization, Tel 791 4373 or fax 791 4193.
All WHO press releases, fact sheets and features can be obtained on Internet on the WHO home page http://www.who.ch//
© WHO/OMS, 1998
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