HEALED BY THE SUN

Solar energy lights the way for quality rural health in East Africa during Covid-19

HEALED BY
THE SUN

Solar energy lights the way for quality rural health in East Africa during Covid-19

Like most urban dwellers in Uganda who rushed to villages at the start of Covid-19 lockdowns, Gloria Mucyunguzi had another crisis to contend with in the village: erratic power. 

Remote from the grid, every time the sun sets, Mucyunguzi’s marital village of Mburamaizi in Bihanga, Buhweju district gets shrouded in darkness. But she badly needed a healthcare facility with access to electricity to have her child immunized. 

Health facilities need electricity to power essential medical devices, refrigerate medicines, lights, and safely deliver babies in the operating rooms, among other purposes. For example, most vaccines are refrigerated at 35 and 46 degrees Fahrenheit to remain safe for use. 

“With suspended public transport, I could not take my child back to Mbarara city for immunization,” narrates Mucyunguzi. Her only option was to carry her child on the back and walk to any health center. But Nsika health center four — the health facility on the power grid nearest to her village, is situated about 16 kilometers away. To reach it, Mucyunguzi would have to climb over ten hills. But to her disbelief, she climbed only one hill and found a health facility — Bihanga health center III, powered by solar energy, that offered the services she needed. 

 
Outpatient department at Bihanga health center III in Bihanga sub-county, Buhweju district.

“We offer such services because of solar power,” narrates Osbert Ntumwa, the assistant in charge of Bihanga Health Center III that is off the power grid in Bihanga, Buhweju district.

Bihanga Health Center III is one of the health centers in Uganda that benefited from free solar systems, installation, and maintenance under the third phase of the energy for rural transformation project (ERT Project III). 

The project, funded by the government of Uganda and the World Bank at a tune of 28.6 billion Uganda shillings, is one of a slew of government and donor-funded projects across East Africa that have endeavored to bring solar energy to rural health centres located off the electricity grid. Though many of the projects began before the onset of the pandemic, they have seen cascading benefits during Covid-19 – as many urban dwellers moved back to villages, and movements were restricted, leaving people to resort to walking to their nearby rural health centres.

During the pandemic, solar power systems in these rural health facilities in Uganda, Kenya and Tanzania have been essential for keeping vaccines cold, providing light for mothers in labor, and supplying power for medical procedures such as laboratory tests, injections and blood transfusions.

This, despite major challenges posed to the off-grid solar energy sector as Covid-19 took a heavy toll on East African economies.

lighting rural health centers across uganda

Lack of access to affordable and reliable electricity deprives millions of rural people of quality healthcare in developing countries. The situation is worse across rural Africa, where electricity coverage stands at only 25 percent. 

In Uganda, electricity access in rural areas has greatly expanded in the past two decades, from only 3 percent in 2000 to 50 percent in 2020.

The Ugandan government visions that by 2040 every Ugandan should have access to power. And about 30 percent of this is expected to come from solar. Engineer Robert Nuwagaba, the ERT project manager, believes that in the next five years, all public health centers in the country will have solar power.

The energy for rural transformation project’s first phase started about 15 years ago with the West Nile region. Its third phase started about five years ago and has installed free solar systems at 329 public health centers in 24 districts, including Buhweju. (Uganda has 135 districts). Under this project, a health center 3 gets a solar system of about 980 watts; health center 4s receive 1500 watt systems, while health center 2s get suitable solar packages according to the health services they are offering and staff houses needing power.

Under the project’s third phase, “12 public health centers” in Buhweju district received free solar systems, according to Pius Manigaruhanga, the Assistant District Health Officer Buhweju, raising the district’s electricity coverage to “40 percent,” according to Melex Musinguzi, the district’s works committee chairperson.  Now residents of this hard-to-reach district are assured of better health services, according to Olive Koyekyenga, the woman MP of Buhweju district. 

 
A health worker extracts blood samples from patients at Bihanga health center 3.
A nurse attending to a patient at Bihanga health center 3 in Bihanga sub-county, Buhweju district.

“Women can now deliver babies under adequate solar light in health centers, unlike in the past when they would deliver under candlelight,” contends Koyekyenga. 

With solar-powered refrigerators, Bihanga health center III, like other health center 3s in the district, works as a Covid-19 vaccination center. 

Francis Mwijukye, the MP Buhweju constituency, describes this as a landmark, saying, “it has saved hundreds of people from traveling long distances to get a vaccination, some of whom would have given up because of long distances.”

Rehabilitating Solar Systems

Some of the solar systems at health facilities that were the first to benefit under this project in districts like Moyo, Madi, Gulu, and Amur, among others, have reduced their functionalities to 50-60 percent.  

Now a facility that is supposed to have solar power a whole night may have it for only five or six hours, and this is because batteries have reached their lifespan, according to Nuwagaba. 

He says they have requested close to 9 billion shillings (USD $2.6 million) from the finance ministry to functionalize solar systems at more than 980 health centers countrywide. 

“We had a five-year contract for maintenance of these solar systems. But, unfortunately, when the five years elapsed, they were left unattended to,” narrates Nuwagaba. He says it is now the headquarters or the regional workshop that attends to them, which is “overwhelming.” To overcome this challenge, the project wants to have more years of maintenance on new contracts from five to 10 or 15.  Also, the project is investing in remote monitoring of these systems to detect and solve technical challenges early in outlying areas where these systems are installed. 

But Wafula Wilson, the assistant commissioner in the energy ministry, says beneficiary health centers need to take the lead in finding solutions to challenges their solar systems face. “Health centers need to save money they have been spending on generators and electricity and use it to maintain their solar systems,” notes Wafula.

Some donors have been stepping in to help rehabilitate old solar systems and provide new systems for the most remote and vulnerable areas that struggle with financing.

In Moyo district, northeastern Uganda, three rural health centres that reach more than 7,000 people were installed in September with state-of-the-art power systems in a new project funded by the German development agency, GIZ.

The new solar panels perched on top of Ggabi health centre II, a health facility that was originally constructed by the community in 1999, after which it was given to the government.

Patrick Drama, the Moyo district energy focal person, said the district responded to a competitive call for proposals that was eligible to eight countries in Africa to win the bid. The main electricity grid, with power supplied from the dams on the Nile River in Jinja, reaches only a radius of about 5 kilometers along the main road in the district, leaving the majority of households and institutions without power. Out of the 15 health center IIs in Moyo, only three are on-grid, he said.

Many of the district’s health centers are located in mountainous rural communities along the South Sudan border, treating mobile populations of Ugandans, refugees, and South Sudanese nationals, according to Gard Oguma, the in-charge nurse at Afoji health center II, located just 3 kilometers from the border line. This mobile nature of the population affects vaccination, along with power shortages: When the gas-powered refrigerators run out of gas, vaccines spoil or have to be transported long distances to another health center, where patients may not be able to go.

According to a 2019 assessment by the Ministry of Local Government, Moyo district had an immunization coverage of just 54.6 percent, far below the national target of 90 percent. This includes childhood vaccines that target diseases such as polio, measles, yellow fever and hepatitis B. The in-charge nurses anticipate that the solar-powered refrigerators they will receive in March or April 2022 will change that. The fridges will also allow the health centres to start Covid-19 vaccinations, Oguma said.

Gbari health centre 2 is a one-hour drive from Moyo along mountainous roads. The health centre is the only facility for 3 villages.

Gbari health centre II in Metu subcounty is a one-hour drive from Moyo town through a mountainous terrain of forests and grasslands. After kilometers of wilderness, a small group of grass-thatched huts appear in the distance. Soon after, an old stone building emerges, hosting a new crop of solar panels that glitter in the midday sun. 

This health center is a bedrock in the community as the next closest facility is 12 kilometers away, costing 15-20,000 Uganda shillings to reach on a motorbike – a rate most people cannot afford, said Fiona Maliama, a midwife at the health facility.

She said the solar system has greatly improved service delivery.

“Those days when they would bring a mother for delivery… they even don’t have small torches, so they come in darkness and you as a health worker you need to bring your torch from home to come and help them in the night. After when the mother has delivered, you go with your torch and leave them in darkness,” Maliama said.

Midwife Fiona Maliama handling vaccines in the refrigerator at Gbari health centre 2.

“Those days when they would bring a mother for delivery… they come in darkness and you as a health worker you need to bring your torch from home to come and help them in the night. After when the mother has delivered, you go with your torch and leave them in darkness."

Fiona Maliama, Midwife at Gbari health centre 2 Tweet

Without light to see ahead, the scorpions and snakes that live in the old clinic’s walls would bite people as they walk in the night. Maliama said it also impacted the health of the newborns.

“In that darkness, even the baby may not be able to look for the breast of the mother. And in Uganda here it is mandatory that breastfeeding is supposed to be initiated within the first hour of delivery. If you don’t do that, the nutritional status of the baby will be affected just starting from that time,” the midwife said.

In the first month since the power was installed in September, Maliama conducted four deliveries in 30 days – many more than before, when she would conduct zero, one or two in a month. This means more people are choosing safe deliveries at the hands of health personnel, which is important to prevent complications like neonatal sepsis and maternal and perinatal deaths, she said. 

Fiona Maliama, a midwife at Gbari health centre 2, treats a mother and her three children.

The trend is the same for all types of health emergencies. In the past, people would fear coming at night, or they would be told to return in the morning – when often the sickness had worsened, Maliama said. But in October after the light had been installed, she was able to stabilize and transfer a mother with excessive bleeding in the middle of the night. In Afoji, the nurse Oguma said he has been able to respond to night calls including a child with convulsions and a patient with snake bites.

The health centers have already seen other benefits, including increased security at night, technology charging services for community members, and reliable power in the staff quarters, where existing small solar systems were rehabilitated. Communication has also improved since staff are able to charge their phones, radios and computers. This improves service delivery, since clinicians rely on their ability to call other hospitals and health facilities to refer and transfer patients in need, said Oguma. 

“We see the community get 24-hour services. We serve them without any problem,” he said. “There was great happiness when they heard the solar system is coming, and when it was installed, most of them came physically – they wanted to see if it was true if this solar system was there. And when they saw the light on, they were so grateful.”

Saving Maternal Lives in Bungoma County, Kenya

In addition, the MANI – QC programme is helping improve maternal health services in Nandi, Kericho, Mombasa and Kwale counties of Kenya.

Up to 2 million women and girls in Kenya, Malawi and Yemen have been enabled to access quality reproductive health services by Options.

“Healthcare providers are now able to provide emergency care for hypothermia, asphyxia and resuscitation as a result,” says Gladys Ngeno, the Kenyan based Projects Lead.

Emily Wamalwa, Sub-County Public Health Nurse, Kapchai Sub-County, explaining how a solar-powered child incubator functions.

The MANI project, which began in 2015 with the support of UKAID– the UK’s overseas aid programme – whose specific aim is the reduction of maternal and neonatal deaths, focusing on 15 counties with a high-burden of these deaths throughout Kenya. Bungoma County is one of them.

“Installation of solar panels improved care of patients as laboratory services now run for 24 hours,” observes Emily Wamalwa, the Public Health Nurse in Kapchai sub-Country of the larger Bungoma County. Wamalwa oversees several clinics under the MANI-QC The national maternal and infant mortality rates in Kenya stands at 0.4% and 0.2% respectively. In Bungoma County, rural western Kenya however, these rates are much higher.

The maternal mortality rate in the county is nearly nine times the national average at 3.4 percent, whereas at 3.1 percent, the infant mortality rate is more than 15 times this average.

One of the main reasons has been a lack of reliable electricity to store oxytocin, which is important to provide women after childbirth to control their bleeding. Without the drug, many mothers died. 

At least a quarter of Kenya’s health facilities have no access to electricity, according to a 2013 study led by WHO – a situation common to many of sub-Saharan Africa’s largest countries.

But recently, women in Bungoma have a better chance at surviving childbirth, thanks to a major solar power project, which now ensures uninterrupted power in 13 facilities in the county.

The project is known as Maternal and Newborn Improvement Quality Care (MANI – QC). It is overseen by an international development consultancy known as Options. The firm provides innovative solutions to health challenges around the world.

In addition, the MANI – QC programme is helping improve maternal health services in Nandi, Kericho, Mombasa and Kwale counties of Kenya.

Up to 2 million women and girls in Kenya, Malawi and Yemen have been enabled to access quality reproductive health services by Options.

“Healthcare providers are now able to provide emergency care for hypothermia, asphyxia and resuscitation as a result,” says Gladys Ngeno, the Kenyan based Projects Lead.

The MANI project, which began in 2015 with the support of UKAID– the UK’s overseas aid programme – whose specific aim is the reduction of maternal and neonatal deaths, focusing on 15 counties with a high-burden of these deaths throughout Kenya. Bungoma County is one of them.

“Installation of solar panels improved care of patients as laboratory services now run for 24 hours,” observes Emily Wamalwa, the Public Health Nurse in Kapchai sub-Country of the larger Bungoma County. Wamalwa oversees several clinics under the MANI-QC project.

She says that the initiative has seen a drastic drop in deaths at the clinics on average from 40% to less than 10%.

Solar Energy is Abundant in Bungoma

Sunsets over the Katsyoha- Kitomi central forest in Buhweju district.

Solar as a viable alternative energy source was chosen for Bungoma, given its humid nature and the plenty of sunlight it enjoys.

In order to determine the suitability of solar for these health facilities in the County, explains Ngeno, they had to evaluate the amount of radiation that hits the ground when the sun shines.

They achieved this through a global tool known as an irradiation map, which registered a score of between 4.5 – 5 of radiation in the county. What this meant is that the amount of heat generated by the sun during the day could last up to midnight in Bungoma.

After energy audits were conducted, a solar system had to be designed in line with the energy requirements of the 13 health facilities.

“Then we had to train the people on how to use and install the solar system,” explains Ngeno.

This also involved the use of a mobile App, which shows the system’s battery level and energy consumption at a given health facility. It also shows the amount of carbon offset taking place that the solar system facilitates.

Noreen Josephs, lab technologist standing by a solar powered fridge, supported by the MANI Project.

Since the installation of the solar system, these facilities are now able to carry out blood transfusion. Whereas only 6 facilities in the county had the capacity to conduct blood transfusion, this number has jumped to 14.

“Now we are able to manage health emergencies at the sub-county level,” observes Ngeno, adding that otherwise, such cases would be referred to larger facilities in neighbouring counties.

Before the project began, Bungoma County was listed among 14 other Kenyan counties that have a high burden of maternal and newborn deaths. It has since been removed from the list, a result directly attributable to the installation of solar systems.

Energy expenditure savings, carbon offsets

These benefits are not limited only to provision of maternal and newborn healthcare. The use of solar power in these health facilities has also resulted in financial savings in addition to a quantifiable reduction in carbon emissions.

Between January and June 2018 for example, the 13 facilities saved up to 17,208 kilograms of carbon. And a total of USD $5,408 was saved in six months, based on purchasing the equivalent amount of grid power, according to Ngeno (MANI-QC).

The same review found out that the Machakos Level 5 Hospital (in eastern Kenya) was able to reduce emissions by 44.1 tons of carbon dioxide. This translated to savings of up to USD $13,600 in diesel purchases per year if green energy solutions were adopted as the primary source of backup power.

Between January and June 2018, the 13 health facilities saved up to 17,208 kilograms of carbon. And a total of USD $5,408 was saved in six months, based on purchasing the equivalent amount of grid power.

“This study was focused on district hospitals providing comprehensive emergency obstetric and neonatal care services in Kenya and Ethiopia,” explained Dr. Solomon Nzioka at the Department of Public Health, Environment & Social Determinants of Health of the WHO, during a presentation at the 10th KEMRI Annual Scientific & Health (KASH) Conference in February of last year in Nairobi.

That a need for additional on-site energy generation exists is not in doubt, as demonstrated by the WHO study, according to Dr. Nzioka.

Overall, diesel generators that are also used in some of the county’s facilities are not reliable, owing to factors including “ongoing fuel maintenance costs…greenhouse gas emissions, non-renewable sources of fuel and switching delays,” said Nzioka.

Conversely, a better option than using diesel generators alone, concluded Nzioka, would be to equip healthcare facilities with battery inverter systems.  These can store energy from a solar panel or generator when it is operating – and then release it consistently later when there are needs.

He added that the use of renewable energy solutions could also open up opportunities to access financing related to climate change mitigation and clean energy investments.

Rural Tanzania: Why solar power mattered during the pandemic

In 2019, 38 percent of the population in Tanzania had access to electricity. For rural populations, that number was 19 percent. About 65 percent of Tanzania’s population lives in rural areas. These access gaps have also affected the health sector, especially in rural areas, evident in district health centers and hospitals. 

One of the worst affected villages is Chikunja in Masasi, Mtwara in southern Tanzania. Ndomondo Charles, the chairperson of this village, said power shortage in health facilities during the pandemic led to a lack of vital health services for Covid-19 patients. 

"When a patient needed a ventilator, he often missed when there was no power. That is why many of us are now resorting to solar power."

Ndomondo Charles, Chikunja village chairperson Tweet

Jerome Kisoki, a health expert, said electricity is vital in operating ventilators and other medical equipment in hospitals treating Covid-19 patients.  The failure to operate such equipment would mean patients are referred to far-to reach hospitals or left to die. 

Health facilities in rural areas in Tanzania are the primary first aid and treatment centers before patients can be referred to referral hospitals, according to Bugumba Magwa, a non-communicable diseases specialist. They are also vital in vaccination, especially for those who cannot travel to urban areas.

However, various companies and agencies have been distributing solar panels in hospitals and health centers in Tanzania to help mitigate the effects of the pandemic.  One of such organizations is Jumeme Institute, which connected 10 hospitals with solar power in Mwanza region districts in April 2020. 

Godliver Assey, director of another solar power company, Arti Energy, says solar energy enabled them to provide health services to the Covid-19 patients.  “We needed electricity for gas cylinders to operate,” Assey noted.

Since 2018, solar energy company PowerCorner, which constructs solar power mini-grids in various regions across Tanzania, has also started distributing electricity via a Pay-as-You-Go system to health facilities in Mtwara and Lindi regions, southeastern region.

This has further enhanced the operation of these facilities especially at night, according to Jackson Lipanga, Head of Marketing for the Southern Region of Tanzania, PowerCorner Company. 

“Initially they were not working at night because of lack of electricity, and they also did not have basic services as laboratories and vaccination services were not available, so many services were available in the district,” Lipanga said. “The health of these villagers has been strengthened and enhanced by this solar service.”

Since the project was started in 2018, the rural hospitals that were provided solar power services include Kitunda Health Centre and Sikonge Tabora Hospital in midwestern Tanzania, and Barikiwa Hospital, Liwale Lindi, JJ Dispensary, Nachingwea, Lindi, Matepwe Nachingwea Lindi Dispensary, Nakopi Clinic, Mtwara and Lufumbule Dispensary in the southwestern region.

Lipanga said during the pandemic, they worked closely with the hospital’s chief medical officers to ensure the electricity was not cut off at all times.

“Prices have not changed, but we have made sure that their electricity is effective. If the power goes out then through our chief physician and our agent, we make sure he reports the progress of the hospital, if the power goes out and we solve the problem quickly,” says Lipanga.

Lipanga also added that rural solar-powered TVs helped educate people about how to protect themselves from the Covid-19 virus.

Hilda Chikudi, a resident of Chikunja Village, Masasi said that before solar power was provided at Chikunja Dispensary, expectant mothers were forced to start their journey early to Masasi town two weeks before their due date for quality care at Nkomaindo Hospital. But now, they can give birth in the village.

“In the past if it was an emergency and you had to give birth here in the village at night, then the attendants would use phone flashlights to light up,” Chikudi said.

Dorothy Killewo, a chief physician at Kitunda Health Center in Sikonge District, midwestern Tanzania, said Tanzania Electric Supply Company (TANESCO) electricity has not yet reached Sikonge district, so solar power is a great help to them.

“At the moment, roads are being built; I see the issue of electricity is still complicated here, so solar power electricity has been very helpful in health centers,” she said.

Killewo said although the power is not stable, especially in the evening, at least blood storage refrigerators, vaccines, oxygen systems and other laboratory services are now operating efficiently.

Killewo said during Covid-19, solar panel prices went up and so far they have not changed, which has increased operating costs.

Most of the solar panels used in Tanzania are manufactured in China, one of the world’s foremost producers of energy technologies. 

The lockdowns resulting from the pandemic meant that solar panel productions and transportation from China to Tanzania had to be halted, according to Sussane Pendame, a health specialist at Konrad Adenauer Stiftung Institute of Germany. 

“A cut in supply of such panels meant that the prices for the few available had to go up,” stressed Pendame.

Towards Climate-Smart Health Care

With half of Ugandans living in areas served by the national hydroelectric power grid, hydropower remains the dominant energy source in the country and several other countries in sub-Saharan Africa. Fortunately, solar radiations are abundant in this world region, although governments haven’t utilized them maximally, especially in the health sector. 

While Uganda, Kenya, and Tanzania all saw a dip in off-grid solar lighting sales during the pandemic, Kenya’s sales have doubled in the past three years to be more than three times the sales of Uganda and Tanzania combined, according to the most recent Global Off-Grid Solar Market Report produced by GOGLA, the global association for the off-grid solar energy industry. Conversely, Uganda and Tanzania’s sales have not increased significantly.

Sales of off-grid solar-powered refrigerators, vital in providing health services such as keeping vaccines cold, also remain low and have actually been decreasing across the three countries.

Clean and sustainable energy use in the health sector minimizes air pollution, which surrounds health units that use diesel generators, according to Jeconeous Musingiwre, an environmental scientist and the southwestern region manager for the Uganda national environment watchdog, NEMA. It also “cuts costs that health centers would have incurred running on hydroelectric power,” Musingwire further noted. 

While Uganda is increasing its hydropower capacity with the Isimba dam that started generation in 2019 and the Karuma dam that is expected to be commissioned in 2022, demand for grid power is actually decreasing. Grid connections fell from 22 percent in 2017 to 19 percent in June 2020, while solar connections increased from 18 to 38 percent in the same three-year period. 

Since its inception in 2001, the Rural Electrification Agency has been tasked to take power into the rural areas. Drama, the Moyo district energy focal person, said that in recent years, the government’s “vision and understanding of energy has changed,” from a focus on supplying power for manufacturing industries to reaching the “end user” at household level. After 2015, decentralized energy departments were created in the ministry to manage power distribution in districts across the country. The government also mandated that all sub county headquarters be connected to the national grid, he said.

Sometimes extending the main grid into remote areas with poles and power lines ends up with higher service costs for rural communities, and increasing off-grid solar is a better option, Drama said. According to the Uganda National Survey Report 2019/20, the main reason households in West Nile were not using grid electricity was that the grid was not available or was too far from their households. For almost a fifth of households, the main reason was the expense of the initial connection.

In Uganda, grid connections fell from 22 percent in 2017 to 19 percent in June 2020, while solar connections increased from 18 to 38 percent in the same three-year period. 

Uganda National Household Survey Reports Tweet
A resident of Abeso village at his home, located in an isolated mountainous community a one-hour drive from Moyo town.

According to the Uganda National Survey Report 2018/19, 74 percent of government health facilities had a solar panel, an increase from 66 percent in 2016. Almost half (48 percent) of facilities had access to electricity, up from 31 percent three years earlier. 

Still, Covid-19 dealt a major blow to sales of off-grid solar power, especially as sellers and technicians struggled to move to rural locations during lockdowns. 

When the pandemic hit, solar lighting sales dropped significantly across Uganda, Kenya and Tanzania. From July-December 2020, sales started to recover, but they fell again in the period January-June 2021, according to the GOGLA report.

In Uganda during this period, sales fell again by 27 percent to their lowest level in the past three years, as the second wave of Covid-19 and the stringent lockdown imposed by the government affected the economy. Cash sales were the most affected across East Africa, implying consumers were facing more cash constraints. 

However, while use of solar home systems dropped during Covid as compared to before the pandemic, use of solar kits slightly increased, according to the Uganda National Survey Report 2019/20.

Project rollouts have also been affected. “We lost a full year,” narrates Nuwagaba, further disclosing that “a health center which was supposed to receive solar power in 2020 June, is most likely to receive solar in 2023 January.” 

The pandemic has forced some companies dealing in solar systems to get out of business, according to Nuwagaba, noting that “we are likely to see an increase in the prices of the equipment, but also it (the pandemic) has delayed us.”

A 2017 USAID analysis of the off-grid energy sector in Uganda identified several continuing challenges to the growth of the sector, including difficulty for small-scale solar operators to obtain loans, lack of finance for rural households to be able to purchase solar systems, lack of certifications for solar products and services, new and unclear tax policies, and a limited reach of trained technicians to perform repairs and maintenance in rural areas. 

The report recommended improving knowledge among government ministry officials, bank officials and telecommunications officials; increasing supply of solar home systems and improving distribution networks; and supporting both access to capital for solar companies and access to finance for solar buyers. 

In Kenya, last year the government reinstated an exemption to a VAT tax on off-grid solar products that had been reintroduced in 2020 and was blamed for negatively affecting the sector.

An Increase in Government Funds for Rural Health, But Not Yet Enough

The three Moyo health centres are a good start. However, many more rural health facilities in Uganda are in dire need of power, Drama said. The district’s original proposal included 7 vulnerable centres, but funding was only available for 3. Now, if more health centres want to acquire similar power systems, they must budget and purchase them themselves – a challenge due to limited government funding for rural health.

In the past three years, health has steadily increased as a percentage of the total local government budget, which has also expanded. In the 2019-2020 fiscal year, out of the 25.9 billion Uganda shillings budget for Moyo district, health was allocated 3.7 billion shillings (about 14 percent). This increased in the current 2021-2022 fiscal year, where out of 44.6 billion shillings, health was allocated 9.1 billion shillings (20 percent).

The budget to purchase solar batteries, inverters and other accessories across the district has also tripled in the past three years to 115.5 million shillings

But the solar systems are expensive. The three solar systems for the Moyo health centres, which were acquired from the Kampala-based company All in Trade Ltd., cost GIZ between around 27 and 30 million shillings each, and the three solar fridges were an additional 25,000 euros, or about 100.1 million shillings, according to Timotheus Torner, the GIZ development advisor in Moyo. 

The current local government budget for solar could therefore only purchase similar solar power systems for around two of the district’s 28 health facilities, without including maintenance and replacement costs. 

Patrick Drama, the Moyo district energy focal person, inside Afoji health centre II. Drama’s office wrote the proposal to GIZ that resulted in the installation of the three solar power systems.

The three solar systems and refrigerators cost around 60 million shillings ($17,000) each. The current Moyo district budget for solar purchases for all 28 health centres is only 115.5 million shillings.

Timotheus Torner - GIZ; Moyo District Budget FY 2021-2022 Tweet

“The biggest challenge that requires budgeting is after five years when you need to change the battery – does the health centre or district have the budget? It’s really a challenge, and I’m not sure if we have a solution for that,” Muceka of GIZ said.

“We can see this where some health centres have access to the grid but cannot pay, because they are a government health centre,” he added. “Government needs to allocate more money for health centres for electricity because it’s an essential service for medical services. There also needs to be more awareness at a district level, so during budgeting these things are not overlooked.”

Lighting the Way to Healthier Communities

Lighting the Way For Healthier Communities

Awareness, funding and the business climate for solar still need vast improvements to ensure universal electrification for rural health in East Africa. The pandemic as well has presented big challenges. But for the communities that have so far benefited, supplying renewable energy for rural health is a successful model that is addressing multiple SDGs at a go: from Climate Action to Good Health and Well-Being, with a direct impact on reducing maternal mortality

That is the case in remote Abeso village in northeastern Uganda. Since the first Covid-19 lockdown was installed in March 2020, the midwife in Abeso has never once left this village, due to the mountainous terrain, poor roads and lack of almost any phone network in the area.

Idrifua Joseph, nurse at Abeso health centre 2, charges his phone inside a plastic bottle tied to the wall above his bed. Due to the poor network on the border of Uganda and South Sudan, this is the only spot where he is able to receive SMS messages, but no calls.
Communication is key for improving health service delivery, Idrafua says.

Solar has since helped young mothers give birth safely. Three years ago, when then 17-year-old Baatio Agnes felt her first labor pains, she left her house and walked 6 kilometers to the nearest health facility to give birth to her first child. 

Last year, and pregnant again, Baatio was again planning for the long walk. This time, it would be 15 kilometers on mountainous roads to reach the nearest health centre III, the lowest level of health clinic in Uganda that has a maternity ward.

But night had fallen when she went into labor. In the darkness, Agnes was forced to move to her closest health center II, a more basic outpatient clinic where births are allowed only in cases of emergency. For years, this clinic had operated without any source of electricity – making night births difficult and dangerous as health workers relied on small torch lamps or candles to illuminate the mother and baby.

But this time, Agnes was in luck. With its new state-of-the-art solar power system, the Abeso health center supplied unwavering light through the long night of labor, until the moment when she welcomed her young son into this world. Today, her baby is three months old and healthy. 

Baatio Agnes with her one-month-old baby inside her house. She gave birth to her second child under the solar lights at Abeso health centre 2.

According to Robert Drichi, Agnes’ neighbor, the coming of the solar system has been a beacon of progress and relief in the community. He said the light recently saved one of his friends who was ensnared at night in a locally made trap for a wild animal. 

The nurse Oguma also told the story of a child with convulsions who arrived in the middle of the night – to find steady power and a team of staff ready to treat him. Solar, he said, is lighting the way for healthier communities. 

“That was around 2 a.m. From us to the hospital in Moyo is very far, but because of this, because the power service was there, there was light, staffs are there, and the fear of the staffs have come out, so they came and we served them. The child was discharged.”