This story was originally published at Harvard Public Health.

Sign up here for Harvard Public Health, exploring what works, what doesn’t, and why.

On a muggy September morning, white clouds hang low over the green-and-white, two-room public health clinic in Mawtawar, a village in northeastern India. Inside, nurse midwife Bandashisha Diengdoh and a colleague are speaking to mothers and administering shots to children.

Another coworker pulls vials of vaccines packed in plastic bags out of a new, blue-and-gray portable vaccine carrier, plugged into the wall. Although there are frequent power cuts in the area, the carrier always stays cool, thanks to the clinic’s solar panels.

Before the panels were installed, someone almost always had to fetch doses from a bigger clinic nearby, and mothers and newborns didn’t always receive the inoculations that are supposed to be given at birth. Now, Diengdoh says, “almost all the babies get their vaccines after delivery”.

Bandashisha Diengdoh, a nurse midwife, consults with a patient at the health clinic in Mawtawar, a rural village in northeastern India. Credit: Menty Jamir, for Harvard Public Health.

A shiny solar panel, hidden from view on the building’s tin roof, has been a game-changer at the Mawtawar clinic. Installed earlier this year, the panel gives the clinic a supply of uninterrupted electricity. That’s true even here in Mawtawar, where it rains frequently.

The panel means the clinic can reliably vaccinate about 15 children each week. It means Diengdoh and her coworkers no longer have to deliver babies and stitch up wounds using flashlights, mobile phones, and candles, or turn patients away because they can’t sterilise tools or run medical equipment.

It also means Diengdoh has more consistent electricity in her staff quarters, where she lives with her family. That helps her rest better at the end of the day. “We feel relaxed,” she says.

Installed solar panels on a concrete roof in Lumshong, India. Solar panels installed on the roof of a health center in Lumshnong, a rural village not far from the border with Bangladesh. Credit: Menty Jamir, for Harvard Public Health.

Mawtawar is in Meghalaya, a mountainous, sub-tropical forested state in northeastern India. Its primary power source is hydroelectric energy. The clinic’s panels came through a partnership that began in 2020 between the Indian government and the Selco Foundation, a large solar nonprofit. Selco has so far installed panels at 277 of the state’s 643 health facilities.

The electricity challenges in Meghalaya are familiar around the world. Nearly one billion people in low-and middle-income countries depend on health care facilities without reliable electricity sources. Almost two-thirds of health care facilities in South Asia and sub-Saharan Africa lack steady access to power.

Unreliable power in many countries is preventing clinics from consistently delivering health care services at best-practice standards – and from expanding medical services on offer – according to the global nonprofit Sustainable Energy for All.

Solar is an increasingly cost-effective and popular option for addressing electricity challenges. The price of solar panels and lithium batteries has been falling since 2010, which in turn “has resulted in the sector embracing much larger power solutions for [health] clinics,” according to Luc Severi, program manager at Sustainable Energy for All.

A row of batteries that store solar power sit on a grey metal shelf in a room in a health clinic in northeastern India. The room has a green curtain on the doorway and various community photos and signs on the walls. Batteries store power generated by solar panels installed at a health clinic in Mawtawar. These batteries can supply reliable electricity to the health clinic's lights, fans, and some medical equipment. Credit: Menty Jamir, for Harvard Public Health.

Solar energy in use

In India, more than 1,300 health centers now have solar power systems through the Selco Foundation. Elsewhere, the United Nations Development Programme and its partners have helped bring solar power to 1,000 health facilities in 15 countries.

Sustainable Energy for All, which works closely with the United Nations, and its 22 partner organisations have plans to electrify 35,000 more clinics by 2026. The World Bank, meanwhile, aims to bring electricity to between 40,000 and 60,000 public facilities, including health care providers, by 2025.

Health staff vaccinate Ibansara Kharlyngka's daughter at Mawtawar's weekly clinic. Credit: Menty Jamir, for Harvard Public Health.

The World Health Organization has estimated that nearly $5 billion is needed immediately to bring some sources of electricity to health facilities in South Asia and sub-Saharan Africa, allowing them to at least provide essential services.

While the World Health Organization does not specify that solar power systems are required to electrify rural health facilities, experts say solar is increasingly the preferred solution. “In recent years, among all the power solutions that have been deployed to health facilities, solar is the dominant one,” says Severi.

A female healthcare worker lifts a container of vaccines out of a white deep freezeer at a health clinic in northeastern India. Edeisbun Dann is a community health officer at the health clinic in Lumshnong. She is conducting a regular check of the freezer inside the facility's cold chain room. The freezer is powered by solar energy. Credit: Menty Jamir, for Harvard Public Health.

Where they are installed, solar panels work wonders. Biolinda Poit, a staff nurse at a health clinic in Lumshnong, about 80 miles from Mawtawar, says that during the pandemic, every time the power went out clinic staff had to stop their usual work and rush to save the vaccines. “I was so angry,” she says. “We had to shift those vaccines to coolers. It was so hectic.”

For Brasida Damlong, sitting by the bed of her feverish five-year-old son, it’s a relief to have the turquoise window curtains billow as the fans overhead cool the air. The last time she was in the Marngar clinic, a year ago, there were no solar panels, and “At night, we had to use candles and the fan didn’t work,” she says. Damlong, a mother of eight, has to walk an hour from her village to the health center.

But installing solar panels is not a panacea. For example, solar doesn’t supply all of the needs at the Lumshnong clinic: Custodian Talang, a nurse midwife, says the electricity still goes out frequently in the on-site staff housing quarters, and the center’s solar panels can’t provide enough power for electricity-gobbling medical equipment, like high-voltage autoclaves for sterilising equipment, or even basic water pumps.

Biolinda Poit, a nurse midwife at the public health clinic in Lumshnong, treats a patient. Credit: Menty Jamir, for Harvard Public Health.

Trying to keep the system working smoothly is also an ongoing challenge including: a lack of funding for repairs, overloading the solar panels with too much equipment, and batteries dying with no way to replace them. Mountainous terrain prone to landslides in places like Meghalaya, especially, make reaching rural health centers difficult and slows down installation and maintenance of solar panels.

Current technology means that in the short-term, solar energy is likely to be a supplementary energy solution in most rural health centres, rather than a replacement for the main power grid or diesel generators. But Mohua Mukherjee, a senior research fellow at the Oxford Institute for Energy Studies, says a solar panel today can produce nearly twice as much power as the same panel in 2017, and advances in solar panel technology should continue.

A CCTV camera inside the health clinic in Kyrdem is powered by solar energy. Credit: Menty Jamir, for Harvard Public Health.

But solar panels with advanced technology cost way more – and at some point, costs like maintenance have to come out of each facility’s individual budget. “For public health clinics that are cash-strapped and lack access to affordable financing, it is likely that they will invest in the older and cheaper technologies rather than going directly for the latest and most expensive,” she says.

Solar technology could also help healthcare centers compensate for the effects of climate change on available sources of power, which can get knocked offline by extreme weather events such as floods and heat waves. For right now, in public health clinics around Meghalaya, clinicians are just grateful that when the power goes off, the lights don’t.

Villagers stop to fish on their way to the public health clinic in Marngar, a village in northeastern India. Credit: Menty Jamir, for Harvard Public Health.
The outskirts of Kyrdem, one of the villages in Meghalaya state where solar power is making a difference in public health. Credit: Menty Jamir, for Harvard Public Health.

Mebanialam Tang translated and provided additional reporting from Meghalaya.

Vandana K is an independent journalist based in New Delhi.

Menty Jamir is an independent Naga photo-artist based in New Delhi. She also belongs to 8:30, an emerging women artists’ collective in India.