SDA-RF-AT-3.9.pdf
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Panel Discussion: Impact and Scope for Energy
Interventions in Primary Health Care
The healthcare priorities and energy requirements of a PHC would depend on a number of geographic, demographic and operational
parameters specific to the region. SELCO Foundation has worked closely with Karuna Trust, Swasthya Swaraj, Center for North
Eastern Studies, Tribal Health Initiative and other health and technology partners to understand the typology of health centers and
implemented energy and efficiency solutions designed to improve healthcare delivery. This panel focused on the learning from these
projects and the scope and requirements for further work
Panelists: Dr. Sr Aquinas (Swasthya Swaraj) and Mr. Ashok Rao (CNES), Mr. Venkatnarayan Chekuri (Karuna Trust)
Moderated by: Ms. Huda Jaffer (SELCO Foundation)
114
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FOUNDATION
Panel Discussion: Impact and Scope for Energy
Interventions in Primary Health Care
I'OUNDAI IOS'
Impact
B
Improved, reliable service delivery: Earlier, anxiety prevailed while dealing with
patients after 6pm, since power disruptions were very unpredictable. Post the
Future Scope
■
energy intervention, there has been a dramatic improvement in service delivery.
need to be a part of primary health care as it is the first point of contact for most of
Emergency cases post 6 pm are handled at the primary level with a cut down on
our population. To reduce the burden on secondary health care, a lot of services need
referrals. This also reduces the out of pocket expenditure for the poor.
H
New service additions: There are services now being offered which were not
seen as a possibility at primary levels. Diagnostic, curative and even auxiliary
to brought down to the primary level.
■
be a part of budgeting and planning due to the high dependency else the quality of
enabled technology based interventions, better supply chain management and
better delivery of doorstep services like mobile dental clinics.
services come down. In health care, reliability is more important than cost, as the lives
of the poor are at stake. Energy audits needs to be done at every primary health
Improved staff retention: Earlier, retaining of staff was difficult as ANMs often
center and budgeted for accordingly
have to stay in un-electrified sub centers which was difficult with high levels of
insecurity. Young doctors on boat clinics did not have time to study once it was
■
dark. Reliable electricity availability is giving them a dignified living and working
can be built with small food processing units to promote better nutrition through
locally grown foods. This can also act as a supplementary and complementary model
for lactating mothers.
Saving cost and human resources: There is a huge saving with respect to cost
and man power as health workers earlier had to travel long distances to procure
diesel and repair generators. In Boat clinics, they also had to travel frequently to
get vaccines and blood in ice boxes. Solar refrigerators have made it possible to
store these at the point of care itself, while also monitoring the temperature
remotely for better maintenance.
Focus on nutrition, safe drinking water: Forty percent of the diseases at a rural level
are water borne and they can be avoided with precaution. A sustainable ecosystem
environment, causing reduction in attrition.
■
Budgeting for reliable energy as a part of healthcare delivery: Most modern and
digital medical equipment are energy dependent and energy intensive. Energy has to
critical services like purification of water made easier. Constant supply of power has
■
Re-thinking primary services: Earlier even x-rays used to be considered as a secondary
service. Good diagnostics, obstetrics, skilled health workers, emergency services all
■
Planning for future needs: Energy requirements are never static and are ever
changing. What might be priority today might not be tomorrow. Planning needs to be
done accordingly and energy solutions need to be designed for it to be made available
on a more widespread scale.
Panel Discussion: Financing, Policy and Partnerships for
Scaling Energy-health Initiatives
FOUNDATION
Primary Health Centers are the backbone of public health system in India. There is a growing recognition of the need for reliable
electricity to deliver better health services at PHCs. Several States, with the help of National Health Mission, have deployed solar
back-up systems in over 600 PHCs cumulatively. On the other hand, private healthcare and energy practitioners have been partnering
to optimize sustainable energy solutions specifically to the health needs of the region. Cross learnings from these pilot initiatives can
help develop a roadmap for bridging the energy gaps in the public health system. What financing mechanisms, policy pathways and
partnerships are necessary to scale these initiatives?
Panelists: Prof. Muraleedharan (IIT Madras), Mr. Sanjeev Jain (CREDA), Ms. Kanika Gulati (GE)
Moderated by: Mr. Vivek Shastry (SELCO Foundation)
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Panel Discussion: Financing, Policy and Partnerships for
Scaling Energy-health Initiatives
•NUAIION
Technology Considerations
■ Design for rural contexts: When equipment's are being
designed, factors to keep in mind would be affordability,
reliability, ruggedness, efficiency to suit the Indian rural
context. Additional points to bear would be ease of
availability of parts and replacements which could be
accessible at a local level
■
■
Focus on long term ownership: In the public sector,
tenders, commodification, cost of acquisition is focused
on and not cost of long term ownership. The linkage of
providing the entire solution with ecosystem support
goes a long way. Staff training for new medical
equipment should be a part of the procurement process.
Benchmarking design and efficiency: Many States are
deploying standardized systems for PHCs, as there are
no existing benchmarks for efficient equipments and
context specific design guidelines. These guidelines
need to be developed.
Financing Channels
■ Public
Private Partnerships: In
cases where
government health centers are managed in
partnership with private NGOs, the partner NGOs
can raise the financing required for efficient
medical equipments. The cost of the decentralized
energy intervention can also be repaid over time
through the monetary savings from alternate
energy sources.
■ Financing through Banks: Private banks have
financing
schemes for expensive
medical
equipment. This scheme could also be leveraged to
finance efficient equipment together with
decentralized energy as one package. However,
such financing is availed mostly by private
hospitals, as NGOs or Government facilities may
not want to take on debt.
■ Energy in Infrastructure budget: Tamil Nadu has
■ Strengthening service networks: Maintenance needs
have to be addressed with having plant operators,
cluster technicians for routine checks, basic training for
health center staff, additional servicing staff for
equipments in remote areas, having spares being kept at
the district level etc.
set the example by allocating a certain amount for
solar energy within the infrastructure budget for
new sub centers. Provision for procuring higher
efficiency equipment can also be made through a
similar process.
Policy Pathways
■ Strengthening Sub-Centers: Sub centers are the first point
of care for the poor. Evidence from Tamil Nadu shows
significant increase in footfall at sub centers after
infrastructure upgrades. Introducing more decentralized
services with reliable electricity can further improve this
and reduce the load on secondary and tertiary care.
■ State Nodal Agencies: In Chattisgarh, the State Nodal
Agency for Renewable Energy has taken the lead to
provide standardized decentralized energy systems to
over 500 PHCs. The agency designed the system, pooled in
financial resources , as well as coordinated the installation
and maintenance through its own network of technicians.
■ Pooling local development funds: For scaling solutions
effectively, it is important to involve State nodal agencies
from the energy as well as health departments. In tribal or
backward areas, local development and welfare funds can
also be pooled in.
■ Evidence based recommendations: The outcomes of
various pilot interventions should be documented in the
form of patient footfall, reduced referrals to tertiary care,
improvement in infant mortality etc. This evidence can
justify the need to scale up initiatives. Academic
institutions should be close partners in this process.
4
Next Steps
SELCO
H
Design guidelines for different healthcare typologies: The variation and future
needs of healthcare and related energy implications for delivering healthcare in
different contexts need to be documented to facilitate replication.
■
Maternal and Infant Care: Reducing maternal and infant mortality is very critical
at the primary care level. The entire package of efficient equipment with reliable
energy for delivering effective care need to be evaluated in different contexts.
a
Cold-chain: Effective cold chain solutions are needed for community health
workers at the village level. Health workers currently need to go to the PHCs to
procure vaccinations which takes a lot of their time and money.
B
Efficient secondary care: There is a need to bring in basic secondary care
equipment down to the primary level. These include efficient medical grade
oxygen concentrators and imaging equipment such as X-Ray and Ultrasound.
■
Point of care devices: The energy and health link can be used to give people
mental and physical support. With maintenance kits with glucometers, blood
pressure and heart monitors at a door step level can be appropriate use of
technology acting as a preventive measure
■ Academic partnerships: Academic institutions can play an important role in
monitoring and evaluation of various initiatives, and to generate fresh ideas to
decentralize healthcare for the poor.
■
Policy advocacy: A stronger representation from health practitioners is needed
and strengthening of their voices will help in scaling up such initiatives. It is
crucial to sensitize the government about the criticality of energy access at every
level of health delivery.
4
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Participants
SELCO
FOUNDATION
Name
Organization
Name
Organization
Name
Organization
Amit Akkihal
Logistimo
Dr. Smriti Chawla
PATH
Sunil Mani
CEEW
Anup Sarmah
Karuna Trust (NE)
Dr. Sr. Aquinas
Swasthya Swaraj
Dr. Ramchander
IIT Bombay
Anwar Khan
Karma Healthcare
Dr. Sujeet Ranjan
Piramal Swasthya
Suhail Shaikh
IIT Bombay
Arun Agarwal
Janitri
Fazle llahi
ENVO
Susmita Bhattacharjee
Pushan
Ashok Rao
C-NES
Jaishanker N
Godrej
Venkat Chekuri
Karuna Trust
Deepa
PHFI
Kanika Gulati
GE
Mallari Kulkarni
Dell Healthcare
Dr. Giridharan Babu
PHFI
Pr. V Muraleedharan
IITM-CTAP
Rajeev B. R.
SOCHARA
Dr. Kishore Murthy
St. Johns
Prafulla
PHFI
Bharath S.
GRAM Bazzar
Dr. Balasubramanya
SVYM
Praveen B
WIPRO Cares
Mohan S.
CCSDANC
Dr. H. Sudarshan
Karuna Trust
Raghavendra
Biosense
Srihari
AIRA
Dr. Manikandan
Philips BoP
Rajita Kurup
OXFAM
Avinash
AIRA
Dr. Prince Matthew
MSF
Sanjeev Jain
CREDA
Dr. K Balasubramanyam
ACCUSTER
Dr. Ravikant Singh
Doctors For You
Sasmita Patnaik
CEEW
Varun
ACCUSTER
Dr. Siddhartha
MIT Manipal
Sharath Chandangoudar
Logistimo
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