Renewable Energy for Improved Healthcare Delivery in Nigeria

By Juliana Okoro

Access to energy is a prerequisite for quality health care and it is fundamental to the achievement of universal health care coverage and the Sustainable Development Goals. Yet, about one in four health facilities in Sub-Saharan Africa lack access to electricity, and three in four facilities lack reliable power. The lack of sufficient and reliable power is jeopardizing the well-being of hundreds of millions of people, especially women and children, who often bear the brunt of inadequate primary healthcare services. According to Dr Julie Yemi-Jonathan. O, Country Manager, We Care Solar, “without a reliable source of electricity, nighttime deliveries are most of the time, attended in near darkness, cancelled or conducted by flashlight, and the outcomes are often tragic.”

Off-grid renewable energy solutions present a key opportunity to provide clean, reliable and cost-effective electricity to rural health centers, which can dramatically transform the quality of healthcare services provided to rural communities.

Harnessing the enormous potential of renewable energy to improve energy access for primary healthcare facilities requires combined action from the health and energy sectors. To this end, the Nigeria Energy Conference, which took place between 20 - 22 September 2022, brought together key energy and health sector stakeholders, including policy-makers, practitioners, financial institutions, development partners, and NGOs that can play a role in enhancing electricity access for primary healthcare facilities.

During a panel session at the conference, eHealth Africa facilitated a discussion about sustainable energy for improved healthcare delivery in Nigeria. The panelists discussed what needs to be done to ensure that Primary Health Centers (PHCs) have access to energy for better health outcomes. Acknowledging the challenges most PHCs face, the panelists elaborated more on how the lack of electricity in primary health centres has led to more medical emergencies and increased mortality rates.

The panel discussion sparked the much-needed, cross-sector thinking around how to deliver energy to health facilities, especially in resource-constrained environments. A resounding takeaway was that distributed solar power and energy-efficient devices hold great potential for creating stronger and more resilient health systems in Africa and beyond.

We Care Solar's deployment of solar suitcases to Primary healthcare centers has had a tremendous impact on reducing child mortality and maternal mortality rates. According to the company’s representative on the panel, “a lot of our health facilities do not have access to a reliable power supply. We have seen cases where surgeries are turned down because of a lack of power. Sometimes surgical operations are suddenly interrupted, leading to the death of the patient, due to power failure”. This she said, “prompted We Care Solar to develop the Solar Suitcase”. 

Another speaker, Mohammed Bello, a project manager at eHealth Africa, identified solar energy as the reliable solution to these challenges. He highlighted some projects implemented by eHealth Africa with support from partners and stakeholders to ensure health facilities across the country have access to a reliable power supply. According to him, eHealth Africa is working with the Nigerian Energy sector and Integration Consulting firm, which are critical players on issues concerning energy.

The panel speakers and moderator after the session hosted by eHealth Africa at the Nigeria Energy Conference 2022

Key lessons from the panel session hosted by eHealth Africa at the Nigeria Energy Conference 2022:

• There is a dire need to increase renewable energy access in primary health centres, especially those in remote areas.

• The use of solar panels as an alternative source of electricity in primary health centers will help mitigate the energy challenges faced by primary health centers.

• Health facilities should be a top priority in electrification plans for both national governments and development partners. Off-grid renewables offer rapidly deployable, reliable, cost-effective solutions.

• In order to address the energy access needs of healthcare facilities, the energy and health sectors must work together. This should happen at all levels, from strategy and planning to policies, budgeting, procurement and implementation.

• Innovation has to be encouraged and promoted, as in the case of the solar-powered suitcases by We Care Solar. Also, in the design of robust, low maintenance, efficient, user-friendly medical devices suited for remote off-grid areas.

• Energy-efficient medical devices, combined with off-grid renewable energy and telecommunications, can expand the services offered by primary health centres in under-served communities. This also reduces the need for patients to travel to larger, more distant facilities.

• There are funding opportunities from donors as long as the organization involved can provide evidence of work done in this field.

Conducting successful Remote Energy Survey in security/network challenged environment

By Mohammed Bello, Tope Falodun and Busayo Fashoto

Remote Assessment of Energy Gaps in Selected Health Facilities: Identifying Potential for Alternative Energy Sources (Part 2)

Energy access is needed to maintain health, especially during pandemics. A prompt emergency response also depends on reliable energy access; health facilities have two main energy requirements: electricity for health services and medical equipment and thermal requirements related to sterilization, space and water heating, and incineration. However, lack of energy access poses additional challenges for the provision of emergency care services and the functioning of intensive care units.  When basic energy services are unavailable, essential components of emergency responses become compromised, including night-time care, refrigeration to keep samples, sterilization facilities, or electricity to power simple medical devices.

This expanded phase was implemented in Nasarawa states and is also part of the Nigerian Energy Support Programme (NESP), a technical assistance program co-funded by the European Union and the German Government and implemented by the Deutsche Gesellschaft fürInternationaleZusammenarbeit (GIZ) GmbH in collaboration with the Federal Ministry of Power (FMP), in partnership with eHealth Africa. It was conducted in close cooperation with geospatial data experts from INTEGRATION energy and environment. Still part of the effort of the NigeriaSE4ALL to bring you the most up-to-date, ground-truthed, electrification data available in Nigeria.

Following the successful first phase remote survey of 291 health facilities in Kano and Osun states in September 2020, INTegration contracted eHA to conduct a second phase of the remote survey in 300 Health facilities (HFs) of Nasarawa state.  This next project phase analyzes the energy status of communities in Nasarawa state.

In recent times Online surveys have been the most popular way of conducting survey research as opposed to the traditional face-to-face surveys widely used before now.  Although the face-to-face survey gives you more advantages in capturing additional emotional and behavioral clues, online surveys are cheaper.  The migration in recent times to remote surveys is a result of the migration of many organizations to digital solutions. This type of survey is less expensive and gives you some of the elements obtainable in the traditional face-to-face survey, such as the accuracy and efficiency of the data gathered.  It is also reliable in security-challenged environments. This result cannot be achieved without the expertise of agents trained to perform all the aforementioned.  At eHealth Africa (eHA), we have specially trained helpdesk agents specifically for these purposes.  In addition, our specially trained GIS and program delivery staff for the same purpose. They work collaboratively with stakeholders/beneficiaries to get accurate and efficient data based on planned activities.  The methodology and learnings from the first successful survey led to the successful planning of activities to conduct the grid supply quality in this second phase.

The following activities led to the success of the second phase survey in the 13 LGAs in Nassarawa State;

• Engagement with the state Team; Trained program staff to conduct a high-level stakeholder engagement with the state to introduce the project to the state team, get their buy-in, and discuss necessary data needed for the successful survey implementation.

•  Identification of Health Facility OICs Lead; following the high-level engagement is the identification of the health facilities officers in charge leads.  These are chairpersons of each LGAs OICs responsible for all OICs under their jurisdiction.  They assist in reaching out to the OICs to pre-inform the OICs of the implementation commencement and are relevant in following up with the OICs where the latter are unreachable.

• Health facility data gathering, verification/validation, communication with the LGA leads for HFs list sharing. HFs were then sorted, and some HFs not included on the list were verified following validation of all the selected HFs.

•  Training helpdesk agents for a successful survey;  The eHA helpdesk agents experts were trained on the survey tools and how to administer them. This includes what to look out for, understanding the tools, and further probing where necessary.

•  Conducting remote Survey; We completed the survey within three weeks of the project implementation with the helpdesk team working collaboratively with the GIS and program team to ensure the activity's success.

•  Continuous communication/collaboration with the state team;  The program team continued to communicate with the state team regularly to escalate issues encountered and collaboratively sought solutions to such problems.

Challenges:

There is no activity without its peculiar challenges; however, the excellent collaboration between the program team and the LGA/State team enabled the team to proffer solutions to address challenges such as unreachable OICs, wrong numbers of OICs, wrong OICs in actual HFs, non-network communities, etc.

Despite the challenges mentioned above, the lessons from the first phase of the project and other similar projects gave room for the team to be prepared for risks and challenges ahead of implementation.  This led to about 85% HFs data gathered at the end of the first two weeks, with only the unreachable HFs due to the earlier listed factors.  Communication platforms include Whatsapp chat, voice calls, SMS messages, etc. Intensive follow-up and the positive relationship between the team and the state team assisted greatly in successfully implementing the survey. At the end of the 3rd week, the group gathered the entire 300 HFs data, including geo-coordinate for HFs initially without geo-coordinates.  You are assured of the cost efficiency, especially considering Nigeria's current insecurity challenges.

The Program Partners

Partners’ role towards renewable energy accessibility in rural communities: A case study of 12 selected states in Nigeria

By Mohammed Bello and Tope Falodun

The focus on renewable energy in recent years has been on the rise, this is largely due to the bedeviling problems surrounding nonrenewable energy sources. It has been ascertained that the world will face severe problems related to the depletion of traditional (non-renewable) energy resources (Kahia et al., 2016) as a result of the exhaustive nature of the resources viz a viz growing population and industrial activities. Apart from the finite availability of this energy type, it has environmental issues, the increasing magnitude of global energy consumption and its rapid growth have severe environmental implications (Irandoust, 2016), It is now well established that oil and coal exploitation have ultimately led to forest destruction, biodiversity extinction and natural disasters. (Kahia et al., 2016) the consumption of this energy type also increases carbon dioxide emissions. These emissions are considered the main cause of global warming (Ben et al., 2017). These necessitate the surge of suitable energy for the environment and are inexhaustible.  

Renewable energy forms a key milestone in Africa for social and economic development.  The lack of access to electricity by most people - “600 million in Africa'', and one of the targets of the Sustainable Development Goals (SDG) No. 7 is to expand infrastructure and upgrade technology for supplying modern and sustainable energy services for all in developing countries, brought about the need to improve access to electricity. A common method to assess latent electricity consumption already being applied in Nigeria bringing in existing knowledge from various disciplines to the  Nigerian and West-African context and sharing results and tools openly with all stakeholders from questionnaires and interviews with relevant stakeholders forming partnership with several local (Covenant University, Obafemi Awolowo University,  Université Abdou Moumouni - WASCAL program,  PowerGen Renewable Energy, Creeds Energy,  Clean Technology Hub, Rural Electrification Agency, the Government of Nigeria) and international (Technical University Berlin, Wuppertal Institut,  MicroEnergy International,  Fosera) for the PeopleSuN,  a highly inter- and transdisciplinary project which seeks  to improve on this status quo, having Reiner Lemoine Institut (RLI) an independent non-profit research institution  whose mission is to find paths to a sustainable energy supply based on 100% renewable energy  sources partnering with the Funders - ‘PeopleSuN project funded under “CLIENT II - International  Partnerships for Sustainable Innovation'' in the Framework Program Research for Sustainable  Development towards goal number seven (7) engaged the expertise of eHeath Africa (eHA) a non-governmental organization focused on improving health systems with core technical expertise in Health Delivery Systems, Public Health Emergency Management Systems, Disease Surveillance Systems, Laboratory & Diagnostic Systems, Nutrition, and Food Security Systems, and sustaining program interventions with a mission to build stronger health systems through the design and implementation of data-driven solutions that respond to local needs and provide underserved communities with tools to lead healthier lives.

Scope

eHA as the consultant was ‘responsible for the turn-key implementation of detailed energy surveys of  households and enterprises across 247 non-urban enumeration areas of three geo-political zones in Nigeria’ involving a total of 12 states as follows; 

• Kaduna, Kano, Katsina, and Zamfara within the North-Western zone

• FCT, Nassarawa, Niger, and the Kogi states within the North-Central zone

Akwa-Ibom, Delta, Edo, and the Rivers states within the South-South zone.

Fig 1. Map showing implemented states

Methodology/ Implementation Approach

The methodology used in collecting the data was using a customized Kobo Collect smartphone and a conjoint laminated sheet. eHA conducted detailed energy surveys in Households and Enterprises within these zones.

Field Data Collector administering Household survey in one of the EAs at Malumfashi LGA of Katsina State

From the outset of the survey, one of eHA’s innovative data-driven products, Planfeld was leveraged for planning and monitoring of the survey field activity. A total of 60 enumerators and 12 State supervisors were engaged in the quantitative survey activity. 3,952 Households and 1,235 Enterprises were targeted and data collection started on August 7, 2021. A team comprising 2 enumerators (mostly paired male and female) worked in an EA to cover 16 households and 5 enterprises in each EA. They were to cover 1 EA daily including travel time. Teams set out daily to cover EAs as planned and moved into new EAs to continue coverage, with plans to complete unfinished ones the following day. Gatekeepers, including community leaders and local authorities, were consulted before enumerators’ visits and commencement of activity at the LGA and community levels.

Fig 3. Table showing targeted enumerating areas (EAs)

Data Quality Control and Quality Assurance procedure

To ensure accurate and reliable results from the fieldwork, three categories of validation were used. Attribute validation control, Lineage validation, and spatial validation. All these validations serve as data quality control (QC) for the survey. These controls were checked at three (3) levels of data quality.

Fig 4: Quality Assurance procedure

Three levels of controls:

• Field Enumerator checks: Field enumerators ensured that all Quality Control (QC) checks were completed.

• Supervisor checks: Supervisors ensured that all the enumerators met their daily target, also ensured that all QC checks were passed. The supervisor ‘approved’ the forms from the Kobo toolbox platform after validation

• Data Analyst checks: The Data Analyst runs the quality control check on the forms and is sure that all validations were done. Then the data was released to the partners to ensure the data was valuable, complete, and precise.

The 3 cycles of data validation continue until a desirable result was met.

Data Process and Analysis

The workflow of the data process started from the Open Data Kit (ODK) forms development. We produced the forms in 3 different languages, English, Nigerian Pidgin, and Hausa. This was followed by the deployment of survey tools on the KoBo ToolBox platform. The two survey components- Household and Enterprise- possessed a questionnaire file each. The survey platform was then ready for submissions from the field which were made by the enumerators. After the data collection, the data cleaning exercise commenced which marked the end of data process activities as required by the partner.

Fig 5. A map depicting all implementing states with points collected overlayed

Results

The data were collected in a total of 3,961 Households and 1,232 Enterprises across the 12 states, with 9 EAs that were not visited due to insecurity amongst other issues.

Challenges

There were various challenges encountered during the implementation exercise across the 12 states. Insecurity cuts across the states as some secured areas before implementation became insecure while others are uniquely specific, these challenges are not limited to the following;

• Enumerators' inability to complete targeted H/H and  Ent in specific EAs as a result of security attack while conducting the survey.  The states affected are Akwa-Ibom, Katsina, and Kaduna.

• Torrential rain in Akwa-Ibom, Delta, Edo Rivers, and FCT led to obstruction to daily implementation with re-visit plans rescheduled.

• The bulkiness of the survey led to the refusal to consent or complete the questionnaire in some households across the implemented states.

Lessons Learned

• Communities were reluctant to willingly cooperate with enumerators without the presence of a known local guide at the initial stage. This was later resolved by the collaboration of supervisors and the enumerators who worked hard to engage and onboard local guides, despite the lack of payment factored for local guides.  Provision of incentives (payment)  for local guides should be considered and budgeted for in surveys to get the buy-in of communities.

• Secure enumerating areas (EAs) before implementation become highly insecure after commencement.  information from the security situation reports by the Security Adviser is shared with the team daily in addition to pre-training/instruction to source valid information about the environment locally before moving out daily.

• In this case, the client is the one to provide EAs to be implemented by a consultant, adequate EAs as backup is to be provided for the exchange of inaccessible ones due to whatever reasons. Alternatively, pre-agreement of additional EAs is to be provided by the consultant and agreed upon before the implementation planning phase.

The Program Partners