By Geoffrey Kamadi

In developed countries it is a routine procedure – injecting a mother who has just given birth with oxytocin to control her bleeding.

But at health clinics in Bungoma County, in rural western Kenya, this drug was unavailable until recently – because many clinics lacked a reliable electricity source to store the drug at the optimal 4-80C temperature range.

The result was that women died – as a result of uncontrolled bleeding in Bungoma County – one of the most poorly electrified regions in the country.

Even though solar-powered refrigeration has become critical in maternal healthcare provision in Bungoma County in particular, Kenya has seen a decline in solar powered refrigeration in general, relative to other appliances purchased.

The national maternal and infant mortality rates in Kenya stands at 0.4% and 0.2% respectively. In Bungoma however, these rates are way higher.

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

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.

Solar power to the rescue

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.

A solar powered heater at Chuwele Sub-country, Level 4 hospital, in Bungoma County. Photo by GEOFFREY KAMADI

Lack of reliable power in health facilities in remote regions of the developing world is an obvious cause of maternal mortality. But it has remained a backwater issue. SDG indicators of reduced maternal mortality are linked to women having access to a skilled caregiver and giving birth in a health clinic – with little consideration about whether the clinic has the power to deliver the most basic support for the birth of her child.

However, at least one new public private partnership is now connecting the dots.

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 neo-natal 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.

Emily Wamalwa, the Public Health Nurse in Kapchai sub-Country Bungoma County, demonstrating how a solar-powered child incubator works.

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

The clinics in the county were targeted because of simple fact-finding on the ground:

“Our maternal and peri-natal audits found out that the use of fridges [for oxytocin] were not in use because of lack of power,” says Ngeno.

Solar Energy Is Abundant in Bungoma 

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

But 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.

And 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. But it also shows the amount of carbon offset taking place that the solar system facilitates.

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.

Noreen Josephs, lab technologist standing besides the solar fridge used to store oxytocin

Energy expenditure savings, carbon offsets

And another level, these benefits are not limited only to provision of maternal and newborn healthcare. Rather, the use of solar power in these health facilities has 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 17,208kgs of carbon. And a total of $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 $13,600 in diesel purchases per year if  green energy solutions was adopted as the primary source of backup 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 several factors. This includes, “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.

Dr. Nzioka cites a DFID funded WASH (Water, Sanitation and Health) project in Ethiopia, where health facilities have been supported to build capacity to adapt to climate change to demonstrate the viability of climate related interventions in the health sector.

“The project has a very significant impact on health and in particular, those diseases most likely to be exacerbated by climate change,” he says.

This particular project targeted the development of national safeguards such as the National Framework for climate resilient in the health sector. This is in addition to the National Health Vulnerability and adaptation assessment (the first of its kind in the country) as well as the Health National Adaptation Plan.

The adoption of solar energy solutions in the healthcare sector in East Africa is consistent with the uptake of this source of renewable energy overall in the region, with Kenya leading the way, according to the Global Off-Grid Solar Market Report of July-December 2020.

This story was covered as part of the Clean Energy Wire (CLEW) fellowship.

Data analysis and visualizations by Annika McGinnis.