Improving Access to Reliable Energy for Primary Healthcare Centres in Nigeria

Over time Primary Health Care Centres (PHCs) across Nigeria have been characterized by infrastructural decay, loss of health inventory, unavailable medical equipment, poor staffing and working conditions. In most PHCs, vaccines are either unavailable or cannot be properly stored. Lack of clean potable water is another major challenge. Medical staffs are forced to source for water from local vendors without knowing the source or quality of such water. Where boreholes exist, many are either broken down or are not powered.

In addition, several PHCs are unable to render services beyond 5 pm due to lack of power to provide illumination at night. Medical personnel therefore rely on rechargeable lamps, kerosene lanterns, or petrol powered generators for night emergencies.

Most PHCs are located in rural communities and poor settlements; out of visibility of Government and elected representatives. Ironically, the annual budget for the construction and rehabilitation of both new and existing PHCs run into millions, if not billions of Naira; with costs ranging from ₦12million to ₦30million [depending on the PHC model; Type 1 or 2], yet the PHCs remain in deplorable conditions, with inconsistent power supply at the heart of the problem.

The study explores the energy situation in Primary Health Care Centres (PHCs) in Nigeria, using 60 PHCs in the Federal Capital Territory, Abuja as a case study. 57% of the surveyed PHCs are on-grid, while 43% are off-grid. Evidence from this study shows that on average a Primary Health Care Centre spends between ₦3,500 and ₦19,000 monthly paying electricity bills from the grid, which provides power for an average of 4 hours or less a day. To augment the poor grid supply, the PHCs turn to petrol powered generator sets, which they run for an average of 6 hours or more a day. The average monthly cost for this is between ₦20,000 and ₦29,000 on fueling (excluding maintenance and repairs).

This averages between ₦23, 500 – ₦48, 000 a month; and between ₦282,000 and ₦576,000 a year; to access electricity for 10 hours using unreliable grid electricity and polluting petrol generator sets. This still does not cover the required standard of 24-hours uninterrupted clean electricity supply all health centres (regardless of size, location or ownership) are expected to have. These electricity expenses are usually transferred to low- income patients through health charges and personal out-of-pocket payments by the staffs. Sometimes, this additional cost is also borne by donor organizations, NGOs and philanthropists.

The central finding of this study is that access to reliable electricity is critical for the efficient running of Primary Health Care Centres (PHCs). This can speedily be delivered to PHCs through off-grid Solar PV (which the study has proven to be more economical and reliable). Therefore, there is a need to prioritize the energy needs of PHCs to encourage the provision of 24-hour services, since Nigeria’s electricity grid remains constrained and limited. The study recommends the mainstreaming of standard off-grid renewable energy through Solar PV for lighting, heating and cooling in the design, construction and rehabilitation of all PHCs in Nigeria.

Finally, while there is a pressing need to increase the budget allocation to the health sector, specifically to Primary Health Care Development Agencies/Boards, there is also the very urgent need to push for and inculcate the practice of transparency, accountability, better planning and better management of resources in the entire process.

Caution needs to be taken as regards building new PHCs without proper provision to ensure their functionality. Central to their functionality should be the MANDATORY provision of off-grid clean reliable energy to power the facility and equipment in the PHCs.