June 22, 2020

Policy in the Pandemic: The Power to Fight Pandemics—Electric Power

Nicholas Institute for Environmental Policy Solutions

By Rob Fetter and Jonathan Phillips

Last month's UN-sponsored report on tracking Sustainable Development Goal 7—ensuring modern, sustainable, reliable, and affordable energy for all—brought some good news: the number of people without access to electricity fell from 1.2 billion in 2010 to 789 million in 2018. There are glaring holes in this progress, however, and the COVID-19 pandemic is laying them bare.

Electricity enables health systems to detect, prevent, and treat infectious diseases, but nearly a quarter of health clinics in sub-Saharan Africa lack power. Only 28 percent actually have reliable supplies. Meanwhile, Africa’s nascent off-grid renewables sector is at risk of dying on the vine. Herein lies a critical opportunity—one that some governments and development partners are recognizing—to make health facility electrification a central pillar of both near-term COVID response and longer-term efforts aimed at economic recovery and enhanced resiliency.

Fighting COVID is exponentially harder without electricity
Some African countries have demonstrated remarkably successful responses to COVID-19, leveraging institutions and assets built during previous polio and Ebola outbreaks. However, virtually all diagnostic tests for active COVID-19 infection require electricity. Patients who need treatment with ventilators or oxygen masks must be placed in clinics with reliable power; outages for even a few minutes can be life-threatening. Electricity powers sanitization and cleaning equipment that are necessary to prevent the spread of infection among patients and medical workers.

Electricity facilitates testing and communication—problems with diagnosis and reporting can quickly lead to regional and national emergencies if outbreaks spin out of control. Health care workers prefer living in villages with access to electricity, and report fear and frustration when forced to perform delicate procedures in the dark. Unreliable power is a common cause of medical equipment failure. And most vaccines require continuous refrigeration, so powering a cold chain will be critical to delivering a COVID-19 vaccine when it becomes available.

Off-grid systems should be in every pandemic fighter’s playbook
Extending electrical grids to thousands of clinics in rural communities will take years if not decades. Fortunately, massive declines in solar and battery costs combined with the advent of remote management systems have created a vibrant off-grid energy sector that can deploy quickly. In Nigeria, the Rural Electrification Agency and private firms constructed four solar minigrids at hospitals treating COVID-19 patients in just two weeks. These systems can reliably accommodate the needs of hundreds of patients, and they will outlast the pandemic, with operational lifespans pushing 20 years if they are properly maintained.

Now may be the ideal time to commit resources to power off-grid health facilities for another reason: the off-grid sector is facing unprecedented financial pressure, as the economic crisis is making it difficult for African energy customers to pay their bills. Nearly 370,000 jobs are at risk sector-wide.

Governments and donors are recognizing the opportunity to put this slack capacity to work to build resilient health care systems. A recent funding announcement from USAID/Power Africa led to over 360 proposals from off-grid energy firms seeking to provide electricity to health facilities. The World Bank and its partners are redirecting energy programming to incorporate health facility needs. And a number of donors, national governments, and NGOs have mobilized to provide technical and financial support.

Meeting short- and long-run healthcare needs requires systemic planning across sectors and better data. As frightening as it is that 10 countries in Africa have no ventilators, this is just one symptom of the institutional and infrastructure gaps that existed well before the present crisis.

In many cases, authorities simply lack information about which clinics suffer from electricity deficits. Such data are absent in some countries and nearly a decade old in others. The Energy Access Project at Duke is running a survey in Uganda to collect up-to-date information on connections, reliability, and willingness-to-pay for better access, but far more work is needed. A review of nearly 80,000 papers on energy access identified fewer than twenty that discuss how energy services enhance health care. With competing demands in low-income countries, a strong evidence base is needed to galvanize high-level policy and financial support and break down silos across the energy and health sectors.

COVID-19 has exposed the interrelated nature of crisis response and recovery. In Africa, where many challenges lead back to energy access, gaps in basic infrastructure like electricity create serious vulnerabilities. Remedying electricity access in health facilities in response to COVID-19 brings us a step closer to ending the vicious cycle of panic and neglect in preventing deadly diseases.

Rob Fetter is a senior policy associate with the Energy Access Project at Duke. Jonathan Phillips is director of the Energy Access Project at Duke.

NOTE: This piece was adapted from a post featured earlier this month on the Brookings Institution's Future Development blog. Read the full post here.

The Big Questions

To continue the conversation on this week's topic, here are a few questions for further consideration and study:

  1. Given limited resources, how should governments prioritize electricity access for different facility locations (e.g., rural or urban) and different health system needs, such as pandemic response, maternal care, or surgery?
  2. How can governments, donors, and NGOs support electricity access at health facilities that is environmentally sustainable?
  3. How can better data be leveraged to help governments and donors make the best policy and investment decisions?

What to Know for This Week

  • Ocean-linked economic activity, called the ocean economy or sometimes “the blue economy,” has certainly not been immune to the global economic downturn, particularly given that some of the largest components include offshore oil and gas, maritime and coastal tourism, maritime transport (e.g. shipping), and seafood production. Preliminary indications of ocean economic slowdown from the UN Conference on Trade and Development note that:
    • Maritime and coastal tourism has been particularly hard hit (notably cruise tourism). Roughly half of all tourists reportedly choose a coastal destination for their vacations, and international tourist arrivals are projected to decline by at least 20–30 percent in 2020.
    • Container shipping lines lost about 4 percent of volume in the first quarter of 2020 compared to the same period in 2019.
    • Seafood supply chains have been disrupted, notably with flight cancellations, declining demand from restaurants and hotels, etc. However, demand for frozen, canned, and pre-packaged seafood has grown as households seek non-perishable items.
  • As lockdowns related to COVID-19 have eased, daily global carbon emissions have rebounded to within 5 percent of 2019 mean levels, according to data published by the Integrated Carbon Observation System. The data supplement a May study from the same authors in the journal Nature Climate Change that found daily global emissions declining by as much as 17 percent during the height of lockdowns in early April. About half the total change was attributable to reduced use of surface transportation.
  • Colorado-based Extraction Oil & Gas Inc. attributed reduced energy demand during the COVID-19 pandemic and an ongoing pricing war between Russia and OPEC to its filing for Chapter 11 protection last week, reports Law360. Other energy producers have declared bankruptcy in recent weeks citing the same factors.
  • Five leading foundations recently announced that they will increase their programmatic spending—partly financed by issuing debt—to aid organizations they support during the COVID-19 pandemic, according to a New York Times story. More than half of the Nicholas Institute’s operating budget comes in the form of foundation grants. Many foundations have said they will relax deadlines and restrictions on how grants are applied to specific expenses, in order to accommodate the effects of rapidly changing conditions. Some funders have indicated they will reduce their grant budgets in the year ahead or will fund only ongoing work, not new projects or ideas.
  • Duke +Data Science is offering an eight-week seminar series for Duke students, faculty, and staff on data science methods with direct applications to the COVID-19 pandemic. Learn from experts about the state-of-the-art in these 1-hour virtual sessions. Register here.


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