Category: Health

How Rwanda’s clinics have gone off-grid and onto renewable energy


By Bruce Krogh, Carnegie Mellon University and Taha Selim Ustun

Rwanda is located in the poorest region in the world, sub-Saharan Africa. Despite this, it is making advances with off-grid renewable energy solutions for rural areas that could be a model for similar economies.

Rwanda has harnessed its endowment with enormous, untapped renewable energy generation potential to address the problem of how to get energy into remote parts of the country.

The approach being taken accepts that extending the electricity grid to remote areas is fraught with problems. It is expensive, transport costs are high, and accessibility is difficult. In sub-Saharan Africa, grid-extension costs $23,000 per kilometre.

A project to get clinics in remote areas of Rwanda onto reliable sources of renewable energy has recently been stepped up a notch with the introduction of technology that smooths distribution.

Small-scale generation for remote areas

Off-grid electrical systems, where power is derived from renewable energy, have the potential in Rwanda for taking advantage of several types of small-scale generation.

This has become more feasible with the development of new technologies that have revolutionised the possibilities for making these systems highly resilient and economically sustainable. Examples include smart meters with wireless communication and sophisticated technology for fine-grained monitoring and control.

Rwanda is taking advantage of developments such as this to crack the problem of getting electricity to remote clinics.

Uninterrupted access to electricity is a key requirement for improving care in health facilities. But access to either grid or off-grid electricity is still one of the grand challenges for rural health centres in the region. One-quarter of health facilities are not connected to any source of electricity. On average, three-quarters of facilities have no reliable source of electricity. This leads to a poor health care service delivery.

83% of Rwanda’s population live in rural areas. This makes healthcare in these areas all the more important. And ensuring that healthcare centres have power is vital.

To overcome this obstacle decentralised power sources such as PV systems are becoming popular in rural areas because of their cost effectiveness compared to grid extensions. PV systems basically convert solar energy to direct current electricity using semi-conducting materials. But these have not proved adequate in matching supply with demand because:

  • Health centres operate on a first-come first-serve basis. If health centres continue to use connected electronic devices without proper management, the chances of blackouts will increase and patients will suffer.
  • Unused energy from fewer patients than expected also presents a problem as energy is wasted. Making batteries available to store energy can be a way to ensure less is wasted, help avoid shortages and manage excess demands. But this option is expensive.

The graph below shows the ad-hoc scheduling of energy services in PV-power health clinics. Between t0-t1, the power demand exceeds available solar power. The t1-t2 window sees no load. This results in some services not being delivered, unnecessary use of batteries, and hence a shorter life-time, and less orderly operation.

Existing ways scheduling show overutilisation and underutilisation of the energy generated by solar systems.
Click to enlarge

Smart scheduling has done the trick

Smart scheduling is used to match consumption of active services with the available solar power. This results in minimum use of batteries or other energy sources.

The idea lying behind is as follows: the central controller estimates daily solar profile of the PV panels by pulling solar radiation information from online servers. Then when a physician wants to undertake an operation that requires electricity he sends a request to the central controller. This request includes power consumption and the duration of the operation.

In our prototype, the final decision lies with the system. Different services have different priorities. So, a surgery room may be given the highest priority during system planning. If an emergency occurs and a surgery room is fed into the system, it will be given the highest priority.

But human intervention is possible. The central controller is a photo voltaic (PV) inside the clinic. This means that a clinic administrator or the highest ranking physician can tap into the system, remove some services from the list and add some others.

The central controller checks the available solar power and the loads that are already being served. If there is sufficient excess energy, the request is confirmed and the energy is delivered. If there is not sufficient energy the controller schedules the request to when there will be enough energy. This may happen due to solar radiation, hence the generation, increasing or a service that was already receiving energy load being terminated.

In this way, facilities are used in a smart way and solar generation is used as it is generated.

Copied from The Conversation.


Rwanda Pioneers Use of Non-Surgical Circumcision Method


27. 11. 2013

Minister Agnes Binagwaho and other health officials at the launch of prepex at Kanombe Military Hospital

Rwanda has become the first country to launch a nationwide scale-up of non-surgical adult male circumcision method (Prepex) to reduce the rate of HIV infections

Adult men will be able to access the Voluntary Medical Male Circumcision (VMMC) services which now targets over 700.000 adults (between 15-49 years) in the scale up program.

The non-surgical method was launched on November 26, 2013 in Kigali by Rwanda’s Minister of Health, Dr. Agnes Binagwaho.

The method was developed by Tzameret Fuerst, who are medical experts and co-founders of Prepex. It was first tried in Rwanda and has also been fully approved by the world health organization after a three year clinical and rigorous evaluation process.

Though the country’s HIV prevalence is at a low rate (3percent), the Minister of Health Dr. Agnes Binagwaho says that the method is timely and will enable the country to have a grip on the scourge by preventing more infections and enabling the infected ones to get assistance.

“This method is the first of its kind that will scale up the VMMC services and curb the rate of HIV infection in Rwanda. We will deploy it along other existing methods of prevention coupled with behavioral change initiatives,” Dr. Agnes Binagwaho said.

The minister also stated that though Rwanda has been the first country to use the method, the problem of HIV/Aids is a crosscutting issue that calls for the involvement of everyone.

She said that Rwandans have showed a lot of interest in the Prepex method despite the fact that the country is limited by resources to meet the demand.

According to the Minister, government will open up more health centers, mobilize and train more human resource to provide the services at all community levels, and also solicit the funds needed to actualize the set goals of promoting male circumcision.

Studies have showed that voluntary medical male circumcision reduces risks of heterosexually acquired HIV/AIDS infections by roughly 60 percent. In 2007, international health experts announced plans to circumcise 80 percent of male adults (20 million men) in 14 countries in south and eastern Africa- which are hit hardest by HIV.

Prepex becomes the first device for adult circumcision to receive WHO approval and according to US Global AIDS coordinator Ambassador, Eric Goosby – it is believed to be “a method that will truly save lives”.

The UNAIDS estimates that the circumcision effort would prevent 3.4 million HIV infections and it will need about $16.5 billion for the goal to be achieved.



[Today, many scientific advances have been made in HIV treatment, there are laws to protect people living with HIV and we understand so much more about the condition. But despite this, people do not know the facts about how to protect themselves and others from HIV, and stigma and discrimination remain a reality for many people living with HIV. World AIDS Day is important as it reminds the public and Government that HIV has not gone away – there is still a vital need to raise money, increase awareness, fight prejudice and improve education.] (Source:

Rwanda Inaugurates Butaro Ambulatory Cancer Center to Provide Comprehensive Outpatient Care


21. August

Photo: The New Times (09/07/2013)

Kigali — With the rise of non-communicable diseases like cancer, a state of the art cancer referral centre, the Butaro Cancer Centre of Excellence, was established in Butaro Hospital, Northern Province, in July 2012, to provide comprehensive care to cancer patients in Rwanda and the region. Part of the Centre now includes the Butaro Ambulatory Cancer Center (BACC), inaugurated yesterday.

BACC will provide outpatient care including chemotherapy infusion services, clinical consultation, education sessions, and multidisciplinary counseling for patients and their families. The Centre is an important part of Rwanda’s five-year plan to institute cancer prevention, screening and treatment on a national level.

“The establishment of the Butaro Ambulatory Cancer Center is an indication of government’s commitment to providing universal access for cancer treatment,” Dr Agnes Binagwaho Minister of Health speaking at the inauguration.

Dr. Paul Farmer, Co-founder of Partners in Health (PIH/IMB), which has partnered with the Ministry of Health to treat cancer in rural Rwanda since 2006, said that to reduce cancer related deaths it is important to integrate prevention, diagnosis and treatment. “The Butaro Ambulatory Cancer Center, inaugurated today will make it possible to attain this,” Dr. Paul Farmer Co-founder of Partners in Health.

Adelphine Musabyeyezu, 34, a cancer survivor from Rusizi District, who completed chemotherapy treatment at the Centre said, “I received timely treatment at the Butaro Cancer Center. I encourage my fellow women to opt for early detection as the best option.”

Since its inauguration on July 18, 2012, the Cancer Center has delivered high-quality cancer care that was previously inaccessible to those who needed it most. Over 1,000 new patients from every district in Rwanda and several neighboring countries have been registered in the oncology program since it opened.

Other registered successes include the development of endorsed national protocols for cancer care, the expansion of Butaro’s pathology lab to a national referral facility and the implementation of an electronic medical record system to support national registry inputs.

The inauguration was hosted by Burera District, the Ministry of Health, the Rwandan Biomedical Center (RBC), and Partners In Health/Inshuti Mu Buzima (PIH/IMB), in partnership with the Cummings Foundation, Dana Farber/Brigham and Women’s Cancer Center, Boston Children’s Hospital, and Harvard Medical School.

Related article:

President Clinton visits Rwanda (The New Times, 05/08/13)

Photo: Tami Hultman

Former US President Bill Clinton arrived in Rwanda last evening for a two-day visit during which he will tour several projects under the Clinton Health Access Initiative (CHAI) and Clinton Global Initiative project. [read more…]