EXPERT PONDER IF SOUTH AFRICA PUBLIC HOSPITAL SHOULD GO SOLAR

For businesses and households that can afford it, solar panels and batteries offer a way to keep the lights on during South Africa’s ongoing bouts of load shedding. Such technologies may also offer a solution for healthcare facilities, where a reliable energy supply can be a matter of life and death.

The problem of reliable energy at health facilities goes much wider than South Africa’s current load shedding woes. More than one in ten health facilities in Sub-Saharan Africa lack any electricity access and power is unreliable for a full half of facilities in the region, a recently published report on the electrification of health facilities found.

A needs analysis by the World Bank, which is included in the report shows, “almost two-thirds (64%) of healthcare facilities in low and middle-income countries require some form of urgent intervention – for instance, either a new electricity connection or a backup power system – and some US$4.9 billion is urgently needed to bring them to a minimal standard of electrification”.

The report identifies solar energy as a potential solution.

The situation in SA

During a briefing by the deputy health minister, Dr. Sibongiseni Dhlomo to the National Council of Provinces in February, MPs heard that the department provided Eskom with a list of 213 hospitals to be considered for possible exemption. Dhlomo said that “about 67% of these are supplied by municipalities whilst about 33% are supplied by Eskom. Of the 213 hospitals, 76 have been exempted (26 directly supplied by Eskom and 50 by municipalities).

More than one in ten health facilities in Sub-Saharan Africa lack any electricity access and power is unreliable for a full half of facilities in the region – WHO

There are 400 hospitals and over 3800 clinics in the public health sector.

Many of these health facilities, for now, depending on backup diesel generators when load shedding kicks in, but with longer periods of load-shedding, the increased use of generators comes with a hefty price tag for health facilities. In Gauteng, for example, health facilities by August last year had spent R42.5 million on diesel for generators – almost double the amount spent in the same period in 2021, the Health MEC said in response to a question in the Gauteng legislature.

Elsewhere, in the North West, health spokesperson Tebogo Lekgethwane says the Mahikeng Provincial Hospital, which is currently not among the hospitals exempt from load-shedding – spends nearly R800 000 a month on diesel and servicing backup generators. “Sometimes the health facility runs short of capital to procure diesel,” says Lekgethwane.

Mahikeng Provincial Hospital, which is currently not among the hospitals exempt from load-shedding – spends nearly R800 000 a month on diesel and servicing backup generators. – Tebogo Lekgethwane

Added to the cost issue, however, is concern that persistent power surges also reduce the lifespan of specialized equipment like CT Scans, radiology, and theatre equipment.

President of the South African Society of Anaesthesiologists (SASA), Dr. Caroline Corbett tells Spotlight that the equipment they use is taking a knock as a result of power surges. “There has been a decay in our medical equipment because of power surges. Anesthesia is extremely dependent on power. All our monitoring and intervention equipment requires some sort of power. As a result of load-shedding, we have seen an increase of equipment requiring servicing ahead of their service plans,” she says. “Devices have been short-circuiting and batteries decaying because we are running them flat where previously they were using a stable electricity connection.”

There has been a decay in our medical equipment because of power surges. – Dr. Caroline Corbett, SASA

Loadshedding has also made the existing backlogs in surgeries more pronounced, Corbett says, adding that it has also caused a huge strain on budgets in both the private and public sectors because hospitals and private clinics have had to invest in alternative sources of energy when the power goes out.

It is anticipated that the recent move to declare South Africa’s electricity crisis a National State of Disaster could facilitate the exemption of more hospitals from load-shedding and make available the necessary funds for mitigation plans. These plans can, however, take many forms – from installing the cables and equipment needed to exempt more facilities, to simply procuring more diesel – and potentially investing in solar energy.

The promise of solar?

Northwest University’s School of Mechanical Engineering lecturer, Cornelius (CP) Kloppers says diesel generators are very expensive to run and maintain in a health setting. He says it would be much more cost effective to use solar energy in the long term compared to diesel generators. However, the initial capital is a barrier to entry for using solar power in hospitals.

“Solar has high input costs, but thereafter it is free energy. It’s very reliable, and it is a green technology. Solar panels have an expected life cycle of 25 years,” says Kloppers.

Using solar at a hospital is not as simple as a house, says Petrus Swanepoel, Infrastructure Sustainability Manager at Mediclinic (a private hospital group). He says there is ‘no one-size-fits-all’ approach. “Each case is different from hospital to hospital and very difficult to give a value. We currently have solar panels installed at 20 hospitals and we are busy with installations at six sites. By the end of March this year, we should have solar panels installed at 26 facilities,” he says.

Using solar at a hospital is not as simple as a house. – Petrus Swanepoel, Mediclinic

“One of the challenges of using solar is that it needs a lot of roof space,” he says. “Hospitals are amongst the top five energy-intensive industries. Lithium batteries are also very expensive.”

Of the current technologies, Swanepoel says solar is the best and cheapest renewable energy source. “Diesel generators are not sustainable and expensive to run as they need to be serviced and maintained whereas solar has little to no maintenance,” he says. “We identify our electricity as essential load and non-essential load. Essential load is what you would describe as your theatre, ICU, and ventilators. These are covered by a generator. The rest of the power is covered by our non-essential generator. Solar is only used to generate additional capacity alongside diesel generators. So if you are using solar and you generate 10 units of power, five will be coming from solar and the other five from your diesel generator.”

Swanepoel says the Southern African division of Mediclinic 2021 agreed with Energy Exchange of Southern Africa – a Nersa-accredited energy trader – to purchase renewable electricity in a deal worth R2.1 billion. He explains they are currently using two different funding models for their renewable energy procurement. There is a purchase to own and a power purchase agreement where a third party will finance the project and the hospital group will just purchase the power from them.

The plans for solar in the public sector

Whereas some hospital groups in the private sector are already using solar, processes move slower in the public sector.

During his briefing to the NCOP in February, Dhlomo said that the Council for Scientific and Industrial Research (CSIR) is currently conducting a due diligence exercise for the installation of solar panels at public health facilities as part of the department’s medium-term intervention. The CSIR is set to identify critical consumption for critical areas of each health facility. This, he says, will enable the department to compile “a comprehensive business case study to justify the required budget”. “It will also help identify critical areas within a health facility that require a backup service from solar energy,” MPs heard.

Lawrence Pratt, a solar energy researcher at the CSIR, tells Spotlight that they are currently awaiting a list from the National Department of Health with nine clinics and hospitals across the country where they will run a pilot project.

“It will be with that information that the department of health can make some decisions about priorities on where to invest in and what technology to go with,” he says.

Pratt says some of the work which the researchers at the CSIR will be doing involves determining how much energy and resources each health facility requires. “The key question that we’re going to try and help answer depends on the use case. One of the challenges that we face when we try and do this type of work is the lack of data. So, oftentimes our clients don’t know how much energy they use when they use it, and what their peak loads are. So part of the work will be developing a solution for each use case.”

Timeframes

Head of Facilities and Infrastructure Management at the National Department of Health, Ayanda Dakela says the due diligence exercise of the National Department of Health alongside the CSIR is inclusive of solar PV+ battery storage as backup for critical areas, which include hospitals, mortuaries, and emergency service stations (EMS) based on an estimated demand profile. The study is expected to be completed by April 2023.

The expected date for the roll-out of the solar energy program is June 2023, provided that there is enough budget allocated. The timelines also depend on the full cooperation of other stakeholders, like local government. Dakela says that the National Health Department will only be able to provide the media with the names of the nine facilities in April when the study is completed.

According to Dakela, the implementation approach will be clustered per province and will commence at the same time. The objective of this approach is to accelerate the program and finish it within the timeline of the National State of Disaster.

During a media briefing last Sunday, Health Minister Dr. Joe Phaahla said that when provinces submit business plans to be allocated a share of the Health Facilities Revitalisation conditional grant of about R7 billion, they will be required to outline infrastructure projects that “include independent power supply, especially in terms of solar supply, batteries, and any other tech”. “The key priorities in the 2023/2024 financial year must be additional energy supply separate from the grid,” he said.