Ventilators save lives, supporting the lungs to give the rest of the body a fighting chance. During the height of the Covid-19 pandemic, you could count on one hand the number of ventilators in some sub-Saharan African countries. In South Sudan, just four were available to its 11 million-strong population. Ten African countries had none. Across the entire continent, there were less than 2,000 ventilators for populations of hundreds of millions of people. Meanwhile, the UK had more than 30,000 available – the equivalent of about one for every 2,200 people – many more than were necessary.  

Even if Africa had enough ventilators to support its population, many of its health facilities would not have the electricity to power them. According to the World Health Organization, two-thirds of hospitals in sub-Saharan Africa do not have reliable electricity access. A quarter have no electricity at all. 

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Medical assistant Geofrey Makawa at Mtambii Health Clinic in Malawi. (Photo by Chris Gagnon via SolarAid)

Electricity is necessary for daily hospital operations, including vaccine storage and deployment. Without cooling facilities available in many parts of sub-Saharan Africa, it is commonplace for healthcare workers to pack vaccines into portable coolers and travel door to door, their runs limited by the time it takes for the ice to melt. Up to 25% of liquid and 50% of freeze-dried vaccines are wasted each year due to cold chain failure in Africa.

Solar-powered cooling exists, with some success in the Democratic Republic of Congo, where Gavi, the Vaccine Alliance has deployed more than 4,500 solar fridges in the past two years. However, Africa’s vaccination rate still stands at a mere 14% and a fifth wave of the virus has been forecasted – posing a risk not just to vulnerable local populations but to the world, should a new, more lethal variant surface.

Covid-19: a setback for electricity access 

Sub-Saharan Africa’s health crisis long pre-dates the pandemic. The region's healthcare system is underscored by unreliable and – in many places – non-existent electricity access.

Just before Covid hit, the number of people without access to electricity was shrinking steadily, with more than 40 million people gaining access to reliable electricity supplies between 2013 and 2019. When Sierra Leone emerged from the worst of its Ebola outbreak in 2015, the evident challenges of powerless health facilities fuelled an overhaul of the country’s electricity supply for healthcare. The government and the United Nations Office for Project Services, an operational arm of the UN, electrified the healthcare facilities of 94 local communities, with stand-alone solar mini-grid systems. Aside from the expected improvement in the quality of healthcare, those newly electrified facilities increased locals’ trust – visits from those seeking medical advice for disease and maternal healthcare rose by 26%.

It was hoped that Covid-19 would trigger a similar but grander-scale response. Solar panels and lithium-ion batteries have overtaken diesel generators as the most cost-effective mini-grid solution.

Yet, according to the International Energy Agency’s World Energy Outlook report for Africa in 2021, Covid-19 decreased, not increased, access to electricity. This was in part due to social distancing rules, which halted mini-grid installation fieldwork, and global supply chain disruptions, like that of the photovoltaic supply chain because of a lockdown-induced reduction of available transport.

“Almost every facet of operations was impacted [by the pandemic],” says John Keane, CEO of SolarAid, an organisation committed to providing healthcare facilities and schools with solar-powered devices and mini-grids, which are like microgrids but are off-grid, with a smaller capacity, typically up to 10kW. “We paused a lot of activities. We didn’t want to bring Covid to rural areas.”

Covid stories demonstrate solar success

Electricity generation by renewables is still rare across Africa. Those mini-grids that do exist, often powered by solar panels, have made a real difference to the quality of healthcare. On the most basic level, health facilities that have reliable access to electricity can stay open overnight. “Often if [healthcare facilities] have no electricity and there is a knock on the door during the night, there is a debate as to whether or not they should even open, because they would be [treating patients] in total darkness.” says Keane.

In December 2021, SolarAid installed solar panels at the St Paul’s Mission Rural Health Centre in rural Zambia. Sister Grace Mukupa, a healthcare worker at the clinic, describes what it was like before they had a reliable power supply. “When the power [went out], [we didn’t] have anything,” she says. “Maybe a woman was in labour, then [we would] have to find the means of helping that woman.”

SolarAid provided lights and medical equipment such as foetal dopplers [handheld ultrasound devices that use sound waves to listen to a fetal heartbeat] and pulse oximeters [non-invasive devices that use spectrophotometry to measure oxygen levels in the blood] that operate off a small solar mini-grid.

“We are using [the foetal doppler] in the maternity ward," says Sister Mukupa. "[By reducing contact with the mother] it is helping prevent the coronavirus and other infections – and the patients are happy, they [can] hear the heartbeat of the baby."

Reliable access to electricity reduces absenteeism among healthcare workers. Job satisfaction research of sub-Saharan healthcare workers found that power outages turned textbook health treatments such as inserting an IV line into frustrating obstacles. The same study noted that nurses and doctors expressed concerns for their own safety when handling blood samples and potentially contaminated fluids in darkness.

SolarAid and other organisations recognised the importance of empowering healthcare workers with electricity access during the pandemic. “Very quickly we were working with the ministries of health to distribute basic solar lights and charging equipment so health workers could keep their phones charged to communicate,” says Keane.

Too many cooks spoil the broth

Historically, the quality of electricity supply in places already connected to the grid in sub-Saharan Africa – such as urban areas, where connection rates can exceed 75% – is poor and highly variable. Various organisations have long lobbied for a decentralised and renewable approach.

Power Africa, launched by the US Agency for International Development, is one such organisation, having installed more than 1,329MW of clean electricity across the continent in 2021, 95% from renewable sources including solar mini-grids.

However, without a central coordinating body, policy or strategy, Keane explains that things get erratic. “You could get a health facility and it has had two or three different solar systems placed on it by different organisations," he says. "Half the systems don’t work anymore and there is total confusion.”

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At the UN General Assembly in September 2021, Power Africa and Sustainable Energy for All, a UN-founded NGO, along with 14 other organisations, endorsed the Multilateral Energy Compact for Health Facility Electrification. The Compact's purpose is to provide electricity to 25,000 health institutions in sub-Saharan Africa. Power Africa has a target of providing electricity to 10,000 clinics in the region by 2030.

According to a spokesperson for Power Africa, the Alliance for Health Facility Electrification is also being formed. This public-private collaboration hopes to offer reliable, inexpensive and sustainable power to health institutions by bringing together commercial companies, non-profit groups, foundations and other stakeholders.

Another issue lies within the technology itself: when solar installations are set up in rural areas, their operation and maintenance often falls by the wayside. SolarAid conducted a survey of 24 healthcare facilities in Malawi that had previously received solar mini-grids and found that 21 had malfunctioning or underperforming technology.

Keane argues that with the right kind of solar technology, operation and maintenance can be as simple as putting together flat-pack furniture. “There are so many solar home systems sold across the [African] continent," he says. "[…] These companies operate a pay-as-you-go hub. They could also serve and service health facilities. [It is a switch that] can happen overnight.”

Accelerating progress

At the current rate of growth, sub-Saharan Africa is set to miss the UN Sustainable Development Goal for universal energy access by 2030.

Yann Tanvez, upstream lead for mini-grids in Africa for the International Finance Corporation at the World Bank, explains that a lack of public and private investment stands in the way of health centre electrification.

“A challenge we are faced with is the reliability and confidence that health centres will pay," he says. "Typically, [health centres that are] managed by public authorities or regionally or nationally have a poor record of paying."

To boost funding and trust in healthcare electrification projects, he suggests the establishment of systems that guarantee payment for buyers and investors.

Scaling Mini-Grid is a World Bank Group initiative launched in November 2021 to address this issue. The project seeks to increase private investment in mini-grid projects by working with governments, private sector investors and donors to reduce investment risks and produce bankable projects.

Climate finance for grid investments in Africa was a topic of discussion at Glasgow’s COP26 conference last year. Under the Green Grid Initiative, which sought to obtain financing for renewable grids in developing regions, a report was put forward by the conference’s Energy Transition Council working group.  

With COP27 taking place in Egypt later this year, the hope is that climate finance for Africa will once again be brought centre stage.