Purpose & Background
South Africa is experiencing a prolonged electricity crisis where challenges in power supply cannot meet demand across the country. To manage this, South Africa’s national electrical utility Eskom has enacted planned rolling black-outs, known as “load shedding.” During load shedding, Eskom shuts down electricity flowing into a certain geographic area, and to almost all of its infrastructure, including hospitals and health facilities that have not received exemption. Only a selection of tertiary hospitals and other critical infrastructure in each province currently are exempted from load shedding. This severely and negatively impacts access to health services, especially for vulnerable populations who rely on smaller Primary and Community Health Centers for care. These periods of load shedding increased in frequency and duration in 2022 and 2023 and have become a major source of concern for many stakeholders, including the South African National Department of Health (NDoH), the USAID/Southern Africa Regional Mission’s Bilateral Health Office (BHO), and South African non-profit organizations (NPOs) that support healthcare delivery, many of which implement health programs funded by USAID. Planned and unplanned power cuts to health facilities that are otherwise connected to the electrical grid and reliant on electricity to operate computer systems, diagnostics, treatment, refrigeration, etc. result in health clinic delays and closures, which reduces client health outcomes. This also reduces the effectiveness of public health investments, including those made by USAID.
Renewable energy solutions already exist in the South African private market. Existing market actors offer a growing variety of technologies and solutions that could help to mitigate or eliminate the impact of power outages on public health facilities owned and operated by NDoH. Currently many health facilities rely on government-provided generators and diesel for alternative power supplies, however this coverage cannot support all health facilities simultaneously.
The purpose of this RFA is to solicit proposals for innovative energy solutions to mitigate or eliminate the impact of power outages at five public health clinics in Ehlanzeni District of Mpumalanga Province. This pilot will test private sector-led approaches to alternative and innovative energy solutions for health clinics.
Activity Synopsis
The Local Market Catalyst for Health (LMC4H) activity aims to strengthen collaboration between the public and private sectors in South Africa to address electricity shortages at health clinics. The activity will test market-based, innovative energy solutions to meet local health clinics’ power requirements, inform a business/financing model for scaling solutions, and ultimately lead to improved patient care and health outcomes.
LMC4H Stakeholders
This activity is being conducted with the approval and guidance of the South African National Department of Health and the Mpumalanga Department of Health (DoH), who will assume ultimate ownership of and responsibility for the installed solutions. A Steering Committee is guiding the implementation of this activity, and is composed of representatives from the Mpumalanga DoH, USAID/Southern Africa Regional Mission’s Bilateral Health Office (BHO), the ATI program, and selected health non-profit organizations. ATI is implementing this RFA and the activity on behalf of this Steering Committee.
All grantee work will be overseen by a Project Management Team (PMT) from USAID’s Africa Trade and Investment activity, along with representation from both USAID’s Bilateral Health Office (BHO) in South Africa and USAID’s Center for Innovation and Impact (CII) based in Washington, D.C. The USAID BHO will maintain regular engagement with the selected partner and facilitate ongoing engagement between the selected partner and the Government of South Africa partners, including but not limited to, National, Provincial, and District Departments of Health.
Objectives and Activities
ATI seeks South Africa-based private sector energy solution providers (“Applicant” or “Applicants”) to submit technical and cost applications to achieve the following three objectives: (1) Analyze the energy ecosystems at five Mpumalanga-based public health clinics[1]; (2) Use results from those analyses to inform the procurement and installation of on-site technical solutions that mitigate the negative impacts of power outages; and (3) Implement thorough, sustainable systems for operations and maintenance (O&M) of the technical solutions. In all cases, ATI will give preference to applicants that demonstrate prior experience successfully delivering activities similar to those described below.
Objective 1: Technical analysis. The Applicant will conduct a rapid assessment of the energy ecosystems at each of the five clinics to ensure that technical solutions (e.g. solar PV[2], battery storage) are designed per clinic-specific needs. This rapid assessment should build on the information provided in Attachment 1 and any information gathered during site visits as part of this RFA process. Areas of inquiry could include but should not be limited to clinic utility bills, interviews with facility personnel, historic load shedding schedules, energy consumption patterns of clinic personnel and patients, the current states of clinic internal wiring, energy-consuming clinic equipment (e.g. autoclaves, computers, fluid pumps, etc.); and factors that could indirectly impact power system operation and general clinic energy security (e.g. road access, clinic security protocols, connectivity, the structural integrity of clinic buildings, etc.). Applicants should work with stakeholders to differentiate between energy consuming equipment / infrastructure that is more critical to clinic patient service delivery and that which is deemed less critical to patient service delivery. ATI, USAID, and the Mpumalanga Department of Health and Ehlanzeni District Department of Health intend to facilitate technical analysis at the five clinics.
Objective 2: Procurement and installation The Applicant will be responsible for designing, procuring, installing, and commissioning on-site energy solutions at each of the five clinics and per clinic-specific contexts. Applicants must propose solutions rooted in renewable energy-based generation and, where necessary, renewable energy-based storage (e.g. solar PV[3] and solar PV-fed batteries). ATI encourages the successful applicant to propose extensible solutions that can accommodate different portfolios of energy-consuming clinic equipment and clinic infrastructure based on different power outage scenarios (e.g. critical vs non-critical clinic equipment and infrastructure; various outage scenarios). Whereas the cost of the energy solutions will be covered by this grant, the cost of installation will not be covered by this grant. Applicants must cover the cost of installation as leverage or a contribution toward the activity’s overall success. ATI, USAID, and the Mpumalanga Department of Health and Ehlanzeni District Department of Health intend to facilitate system installation at the five clinics.
Objective 3: Operation and maintenance (O&M). The Applicant will be responsible for developing and implementing – prior to system commissioning – holistic O&M plans covering all five health facilities. And while ATI recognizes that Applicants will need to gather information during the Technical Analysis and Installation Phases to finalize O&M plans, ATI will give strong preference to applicants that demonstrate in their applications a preexisting and nuanced understanding of relevant O&M activities and associated costs. To that end, Applicants should include in their submission packages a preliminary structure for O&M inclusive of two key tenets: (1) Qualitative descriptions of key O&M design principles (e.g. community engagement, security considerations, clinic staff training) as well as (2) incorporating O&M activities in the budget including both fixed costs (e.g. labor, maintenance, insurance, etc.) and variable costs (e.g. repair, replacement, consumables, etc). Applicants should explore but should not feel limited to exploring the following topic areas in their O&M proposal:
- Separation of O&M responsibilities by stakeholder (Applicant[4], clinic staff, Department of Health, etc.)
- Security and safety plans that reduce risk of equipment theft and prioritize clinician and patient well-being
- Remote monitoring support costs
- Community engagement and awareness activities that increase the extent to which local community members are invested in system continuity[5]
- Public sector engagement (e.g. training officials at the District and/or Provincial DoH to ensure knowledge transfer on standard operations, use, and maintenance of remote monitoring the alternative power solutions)
- A preliminary framework for technical Key Performance Indicators (e.g. yield, degradation, performance ratio, etc.) and for health-focused impact indicators (e.g., improved service delivery).
Objective 4: Recommendations for scaling. A central goal of this project is to extract learnings – operational, financial, social – that private sector service providers can draw on, alongside public sector stakeholders, to develop province- and national-level public clinic electrification programs. To that end, between six and twelve months post-commissioning, the successful Applicant will be responsible for delivering a report on pilot-derived insights that can contribute to a “pathway to scale.” Topic areas for the report should include but not be limited to:
- Between 6-12-month retrospective: General analysis of system performance and description of community impact of the 5-clinic pilot solutions and insights on the viability of equipment typologies for further use in public health facilities to overcome power outages
- Business/financing model: Overview of business and financing models that can expand uptake of private sector-led renewable power solutions at public health facilities including:
- Recommendation of which costs could reasonably be borne by the public sector
- Estimated costs (CAPEX and OPEX) required to support different expansion scenarios (e.g. provincial, national)
- Preliminary thoughts on additional geographies well-suited for similar activities
- Suggestions for procurement structures and contract types that have the potential to accelerate uptake of private sector-led clinic electrification solutions
- Partnerships: Identification of organizations that have the potential to enhance similar clinic electrification activities (e.g., development banks, finance institutions, trade organizations, etc.)
- Risks and mitigations: Identification of risks associated with private sector-led scale-up along with required mitigations to ensure long-term success
[1] The current list of public health clinics for this proposal includes Cathyville, Figtree, Cottondale, Manzini, and Elandsfontein. Attachment 1 includes 1-page profiles for each clinic based on preliminary on-site reviews conducted in November and December 2023. This list of clinics is subject to change based on input from the Government of South Africa counterparts
[2] If proposing solar PV, preference will be given to a PVGreenCard certified installer or an equivalent accredited installer. Installer must have structural integrity assessments done by a certified structural engineer (Engineering Council of South Africa Professional Registered Engineer/Technologist).
[3] If proposing solar PV, preference will be given to a PVGreenCard certified installer or an equivalent accredited installer. Installer must have structural integrity assessments done by a certified structural engineer (Engineering Council of South Africa Professional Registered Engineer/Technologist).
[4] The grant is designed to cover O&M activities for the first year of system operation.
[5] Applicants are encouraged to include in their application their relevant experience helping build local ownership of energy solutions and an outline of how they will support the Government and clinics in such efforts.