Investments in this strategy aim to improve energy alternatives for healthcare facilities to reduce energy costs, increase reliability of power, provide lighting at night, allow for proper sterilization and refrigeration, and improve both quality of care and staff morale. The sections below include an overview of the strategy for achieving desired goals, supporting evidence, core metrics that help measure performance toward goals, and a curated list of resources to support collecting, reporting on, and using data for decision-making.

What

Dimensions of Impact: WHAT

Investors interested in deploying this strategy should consider the scale of the addressable problem, what positive outcomes might be, and how important the change would be to the people (or planet) experiencing it.

Key questions in this dimension include:

What is the problem the investment is trying to address? For the people experiencing the problem, how important is this change?

Healthcare facilities without access to reliable grid electricity may rely on expensive and unreliable gas or diesel generators for power. Lack of access to power makes it challenging for such facilities to deliver proper medical care or maintain staff. Emerging clean energy alternatives for health facilities can:

  • reduce energy costs and increase reliability (1);
  • provide lighting at night to facilitate around-the-clock medical treatment, especially in emergencies (1);
  • allow proper sterilization of medical equipment and facilitate meeting hygienic standards (3);
  • allow proper refrigeration of blood, drugs, and vaccines (3);
  • increase use of medical and office equipment (4);
  • improve quality of care by offering healthcare staff additional access to information; and
  • improve the morale, motivation, recruitment, and retention of high-quality staff (1).

What is the scale of the problem?

Lack of reliable electricity keeps more than one billion people in emerging-market countries worldwide from access to adequate healthcare. In India, 46% of healthcare facilities lack electricity, affecting around 580 million people (2). Over 30% of all healthcare facilities in sub-Saharan Africa, serving approximately 255 million people, lack access to electricity. According to another study surveying 11 countries in sub-Saharan Africa, only 28% of healthcare facilities surveyed with any access to electricity had reliable access (3). As a result, unreliable electricity and poor maintenance led to the waste of nearly half of vaccine doses delivered to emerging-market countries (3).

Who

Dimensions of Impact: WHO

Investors interested in deploying this strategy should consider whom they want to target, as almost every strategy has a host of potential beneficiaries. While some investors may target women of color living in a particular rural area, others may set targets more broadly, e.g., women. Investors interested in targeting particular populations should focus on strategies that have been shown to benefit those populations.

Key questions in this dimension include:

Who/What is helped through this strategy?

This strategy has many potential end beneficiaries, subject to investor preferences. However, the following groups are more often targeted:

Women: A lack of reliable electricity particularly affects women, who may give birth after dark. Additionally, one study in Uganda found that 82% of patients at surveyed health centers were female, largely because women primarily take responsibility for bringing children in for treatment or immunization (1).

Children: Lack of reliable cold storage for vaccines predominately affects children, who are the main vaccine recipients (1).

Doctors and Staff: Access to reliable electricity not only allows doctors and their teams to do their jobs more effectively but also makes particular healthcare facilities more attractive to high-quality staff. For staff living on-site, electricity also increases their morale and motivation by allowing them to charge their cell phones and engage in leisure activities after dark (1).

What are the geographic attributes of those who benefit?

Healthcare facilities that lack access to reliable electricity are predominately in rural areas of emerging-market countries, especially in Asia and sub-Saharan Africa (2).

Contribution

Dimensions of Impact: CONTRIBUTION

Investors considering investing in a company or portfolio aligned with this strategy should consider whether the effect they want to have compares to what is likely to happen anyway. Is the investment's contribution ‘likely better’ or ‘likely worse’ than what is likely to occur anyway across What, How much and Who?

Key questions in this dimension include:

Is the investment’s contribution ‘likely better’ or ‘likely worse’ than what is likely to occur anyway across What, How Much and Who?

Increasing access to clean, sustainable sources of energy and light that have comparatively better quality than those currently on the market would likely make an investment’s impact better for healthcare centers and their patients than what would likely occur without it. Investments in this strategy can have especially strong impact because healthcare facilities often require larger power generators and batteries than typical residential structures, often presenting a good application for rooftop solar or micro-grids. However, the product must be physically, financially, and intellectually accessible to the facility, which can raise particular challenges for rural, remote health centers. The extent to which this strategy can address healthcare facilities’ need for access to reliable electricity depends on the specific investee business and the product they are bringing to market.

How Much

Dimensions of Impact: HOW MUCH

Investors deploying capital into investments aligned with this strategy should think about how significant the investment's effect might be. What is likely to be the change's breadth, depth, and duration?

Key questions in this dimension include:

How many can receive the outcome through this strategy?

The potential breadth of impact is dependent on the number of health facilities currently relying on fossil fuels for generators, with faulty grid access, or without power at all. A recent study of 11 major sub-Saharan African countries found that roughly one in four health facilities had no access to electricity, and only about one-third of hospitals had reliable access to electricity (5). Possible improvement may be greater for those healthcare centers currently lacking access to power entirely.

How much change can beneficiaries experience through this strategy?

The amount of change end beneficiaries derive from this strategy depends on the extent to which the delivered product can effectively power or light the hospital. Example outcomes from investments in this area include the following:

  • In Sierra Leone, a pilot study of a clinic-based, solar-powered system providing lighting and power for oxygen concentrators found a significant reduction in infant mortality from 3.7% to 1.8% (6).
  • A Vietnam-based field test of a new solar refrigerator—used to store vaccines—found that the equipment provided extremely stable temperatures within an optimal range, even during cloudy periods (7).

Illustrative Investment

Impact investors could replicate a model used by hospitals to finance new investments in North America and Europe, in which hospitals become partners in “power-purchase agreements.” In these agreements, utilities or other investors pay to construct and operate on-site renewable energy. The health facility receives a guaranteed, fixed-rate supply of energy, selling any surplus to the utility. For off-grid situations in emerging markets, NGOs have replicated this model with microenterprises on a much smaller scale: clinics receive a solar system and use a small amount of the generated power to charge the community’s cell phones. Fees collected from the charging service cover maintenance costs, including replacement of light bulbs and batteries, ensuring long-term operational sustainability.

Draw on Evidence

This mapped evidence shows what outcomes and impacts this strategy can have, based on academic and field research.

NESTA: 3
Impacts of Rural Electrification in Rwanda

Bensch, Gunther, Jochen Kluve, and Jörg Peters. “Impacts of Rural Electrification in Rwanda.” Journal of Development Effectiveness 3, no. 4 (2011): 567-588.

NESTA: 3
Access To Energy In Rwanda: Impact Evaluation Of Activities Supported By The Dutch Promoting Renewable Energy Programme

Dutch Ministry of Foreign Affairs. 2014. Access To Energy In Rwanda: Impact Evaluation Of Activities Supported By The Dutch Promoting Renewable Energy Programme. IOB Evaluation No. 396.

NESTA: 2
Welfare Impacts of Rural Electrification: Evidence from Vietnam

Barnes, Douglas French, Shahidur R. Khandker, Minh Huu Nguyen, and Hussain A. Samad. Welfare Impacts of Rural Electrification: Evidence from Vietnam. No. 5057. The World Bank, 2009.

NESTA: 1
Accelerating Access to Electricity in Africa with Off-Grid Solar: The Impact of Solar Household Solutions

Harrison, K., A. Scott, and R. Hogarth. “Accelerating Access to Electricity in Africa with Off-Grid Solar: The Impact of Solar Household Solutions.” Overseas Development Institute ODI Report (2016): 9.

NESTA: 2
Connective Power: Solar Electrificaion and Social Change in Kenya

Jacobson, Arne. “Connective Power: Solar Electrification and Social Change in Kenya.” World Development 35, no. 1 (2007): 144-162.

NESTA: 1
Energy, Gender, and Development: What Are the Linkages? Where Is the Evidence?

Köhlin, Gunnar, Erin O. Sills, Subhrendu K. Pattanayak, and Christopher Wilfong. “Energy, Gender and Development: What Are the Linkages? Where Is the Evidence?.” Where Is the Evidence (2011).

NESTA: 2
Impact Assessment of the Solar Electrification of Micro Enterprises, Households and the Development of the Rural Solar Market

Harsdorff, Marek, and Patricia Bamanyaki. “Impact Assessment of the Solar Electrification of Micro Enterprises, Households and the Development of the Rural Solar Market.” In Research Report. PREEP (Promotion of Renewable Energy and Energy Efficiency Programme) and GTZ (Gesellschaft für Technische Zusammenarbeit), 2009.

NESTA: 2
Impact Assessment of the Solar Electrification of Health Centers

Harsdorff, Marek, and Patricia Bamanyaki. “Impact Assessment of the Solar Electrification of Health Centers.” Kampala, Uganda: GIZ (2009).

NESTA: n/a
Rural Lighting in Kenya (forthcoming)

Innovations for Poverty Action. 2017. Rural Lighting In Kenya. Accessed July 12.

Each resource is assigned a rating of rigor according to the NESTA Standards of Evidence.

Define Metrics

Core Metrics

This starter set of core metrics — chosen from the IRIS catalog with the input of impact investors who work in this area — indicate performance toward objectives within this strategy. They can help with setting targets, tracking performance, and managing toward success.

Additional Metrics

While the above core metrics provide a starter set of measurements that can show outcomes of a portfolio targeted toward this goal, the additional metrics below — or others from the IRIS catalog — can provide more nuance and depth to understanding your impact.