Op-ed: Why systems thinking is needed for rural healthcare solar projects

From the newsletter

To ensure the success of rural healthcare solar projects, we must adopt systems thinking, viewing them as interconnected and interdependent, says Energy consultant Keziah Khalinditsa in today's opinion article. She points out that many project failures stem from a lack of a clear post-construction plan, including trained technicians and strategies to create demand.

• Ms. Khalinditsa hold a masters in agricultural engineering and has worked in the energy sector for over 10 years. Her experience includes a role at Abt Associates as a Senior Project Specialist, leading healthcare electrification projects in Uganda and Kenya.

• Healthcare electrification is one area that lags in access levels in Africa. According to research by SEforALL, only 28% of healthcare facilities have access to reliable electricity, contributing to poor health outcomes in the region.

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By Keziah Khalinditsa

There’s a wave sweeping through Africa right now. A wave of hope, money, and solar panels. Donors, development agencies, governments, everyone wants to solarise health facilities. And how can you not applaud that? After all, who wouldn’t want to see a mother giving birth under clean, safe lighting instead of a kerosene lamp in a rural, public dispensary? Or a vaccine fridge running reliably uninterrupted during power blackouts?

But I have to say this, with all the clarity and honesty I can summon, these well-intentioned solar initiatives risk falling far short of their potential unless we take a systems thinking approach.

I’ve been to rural health facilities where solar panels were installed with the best of intentions, and two years later, they lie idle, covered with dust, batteries dead, no one sure who’s responsible for fixing them. I’ve spoken to frustrated health workers who go days without power despite having a donated solar system. I’ve seen dispensaries connected to the grid with power outages that last for hours, sometimes days, and much worse, they have unpaid electricity bills that run several months.

So, before we rush in with more solar panels and another round of pilot projects, let’s slow down and ask: what’s really going on?

1. Yes, the first step is access, but that’s not the whole story

We must ensure every health facility has power. If the grid can’t reach them, then off-grid solar must step in. But that’s only step one. Without power, nothing else works. But power alone doesn’t solve all problems.

2. Quality and maintenance matter, but they’re not the only gaps

We’ve seen solar solutions fail not because the idea was flawed, but because the execution lacked quality and foresight. We need:

• High-quality systems with long-life batteries, not the cheapest ones that break down in 18 months.

• Ongoing maintenance contracts, not one-time handovers.

• Local technicians trained and accountable.

Still, even with great maintenance, systems fail when the real barrier is ownership.

3. Who owns this system?

This is the most important question, and the one least often answered. In most rural public hospitals, ownership is fragmented. The facility expects the county to handle it. The county says the NGO brought it in. The donor thinks it’s been handed over. The solar company isn’t paid for follow-up. And so, no one acts.

Meanwhile, the system dies.

4. The elephant in the room? Payment and budgeting

How do we expect facilities with nine months of unpaid electricity bills to suddenly start paying for solar maintenance? This isn’t about willingness; it’s about systemic budgeting failures. If solar is to work, we need to embed its cost, installation, maintenance, and replacements into county and national health budgets.

Solar won’t survive in a vacuum. It has to be integrated.

5. Energy is still seen as a luxury 

In many places, electricity is still treated as a luxury, something nice to have for lighting or charging phones. It’s rarely seen as mission-critical to healthcare delivery, at least in the small dispensaries that most want to donate solar to.

We must shift mindsets. Energy isn’t optional, it’s as vital as medicine, water, or staff. That mindset shift needs to happen from the Ministry of Health down to the community health worker.

6. What if we created demand on purpose?

Sometimes, the problem isn’t just lack of energy, it’s lack of energy demand. Some clinics barely use power because they don’t have lab equipment or refrigeration and so forth. So how can we design solar systems that also enable productive use, powering vaccine fridges, diagnostic tools, even income-generating services?

That’s how we build resilient, scalable systems that don’t just survive, but grow.

So, what must happen?

If we want solar to succeed in healthcare, we must:

• Map the whole system, from financing and policy to facility-level workflows.

• Involve all stakeholders, from donors to counties to EPCs to nurses and community workers.

• Design for accountability, clear ownership, and clear maintenance structures.

• Align budgets, energy expansion should be in the same spreadsheet as drugs and staff salaries.

• Support demand creation and integrate energy into service delivery.

If we don’t, we’ll keep installing solar systems that die young.

A Working Example - Makueni County’s Level 5 Hospital

Take Makueni County’s referral hospital, a Level 5 public facility that is making solar work. Not as a donation, not as a side project, but as a core part of its operations. The county government is paying for the system itself and worked in partnership with WRI among other partners to make this a reality. The whole county was mapped during an exercise carried out to create the county energy plan (CEP) and decisions made based on data and not just vision. As a result, they’ll save millions in energy costs annually and improve service reliability dramatically.

This model shows us what’s possible when systems thinking is applied: strong political will, quality technology, ownership embedded at the right level, and proper budgeting. If development partners want to make a lasting difference, let them support models like these, in partnership with the counties and all the stakeholders involved in the communities they want to serve.

Solar power is not a panacea, but it holds immense potential as an enabler for better healthcare in Africa. However, this potential will only be realised when we move beyond treating solar as a standalone product and embrace it as an integral part of a larger, well-designed system. Only then can we truly power healthcare facilities across the continent.