为卢旺达的医疗保健提供动力：医疗保健设施的市场评估和路线图

Market Assessment and Roadmap forHealthcareFacilities Acknowledgements ThisdocumentwasdevelopedbySustainableEnergyforAll(SEforALL)andEnGreen,aspartofatwo-yearprogrammefundedbyPowerAfrica.TheteamandauthorsincludeLuc Severi,Tom Rwahama,Rahul Srinivasan and Marilena Lazopoulou(SEforALL);Valeria Gambino,Francesco Roncallo,Carlo Tacconelli and ClementIduhayeNdagije(EnGreen). Wewouldliketoacknowledgethespecificsupport,contributionsandpeerreviewbykeypartnersandstakeholders,includingDr.CorneilleNtihaboseandhisteamfromtheRwanda's Ministry of Health(MoH),Ministry of Infrastructure(MININFRA)-responsiblefor Energy,the Rwanda Energy Group Limited(REG)and its twosubsidiaries,theEnergyUtilityCorporationLimited(EUCL)andEnergyDevelopmentCorporationLimited(EDCL),UNDPandallstakeholders(IPs,NGOs,privatesector)workingonpoweringsocialinfrastructureinRwanda. CurrentSituation of Healthcare System andFacility Electrification in Rwanda Executive Summary Rwanda’s healthand energysector at a glance HealthSector EnergySector 2,139TotalHFs inRwanda 72% 61% 26%or 326 Populationwith access toelectricity:•47% connected to the grid•14% via off-grid systems HF with basic water services Share and absolute valueofhealthcarepostswithout a connection to thegrid 100% 30/1,000 203/100,000 Share of tertiaryandupper level HFswith gridconnection and fuelbackupsystems Infant mortalityAverage global: 28Average SSA: 50 Maternal mortality rateAverage global: 211AverageSSA: 533 Sizingtheaccessgap–The marketopportunitycoverssolarPVsystemswith differentaccess status MajorityofHFsareon-grid Opportunity:moving from diesel-based back-up systems torenewablesshouldbeexploredthroughcost-benefitanalysis. Aboutone-thirdofoff-gridHFsarepoweredbySolar-PVsystems,includingstandaloneandmini-gridsystems Opportunity:System repowering forimproving reliabilityandtypeofhealthcareservicescouldbeexplored*. Majorityofoff-gridHFsarepoweredbydieselgenset Opportunity:moving from fossil fuel-based systems torenewablesisanopportunityforsustainableHFE. MinorityofHFsareun-electrified Opportunity:achieving 100%HFs with access to reliableelectricitysupply. Current energy demand and expenditure of healthcare facilities **Theexhangerateusedis$0.00092/RWF (as per February 2023) Executive Summary Proposed solutions and costs for healthcare centres andhealthcare posts Various healthcare sector financing strategies can be explored Performance contract system (IMIHIGO) Traditionally,Imihigowasaculturalpracticewhereanindividualwouldsettargetsorgoalstobeachievedwithinaspecificperiodoftime.Theterminologyiscurrentlyusedtorefertoaperformance-basedmanagementtool,whichisabletostrengthenstrategicplanning,manageandimproveservicedeliveryinthelocalgovernmentsystem. Inamorepracticalway,anyinstitutionisrequiredto signaperformancecontractyearlywith itssupervisingbodyoutliningthekeyresultsandtargetsitwillbeexpectedtoachieveovertheyear. Investment ticket size for off-grid PV for HP is $1.5 million $1.5 million InvestmentticketsizeofstandalonePVforoff-gridHP Notes:•Datainclude public and privateHPs •Out of the 11 existing mini-grids, 7 are operational as per EDCL Assumptions:•Each existing mini-grids electrifies an off-grid HP, for a total of 11 HPs •Ticketsize includesall EPC contract costs; it does not include soft costs (e.g.,projectdevelopment and management,financing and legal costs, complementary activities such as capacitybuilding, etc.) Investment ticket size for grid-connected back-up power for HC & HP is $8.5 million $8.5 million Investment ticket size of battery backup for grid-connected HC & HP There in noone-model-fits-all solution •Impact ofprivatedelivery model is higher than others thanksto theWEF nexus and PUE approach, however the potential market sizeonly targets off-gridhealthcare posts. •Publicandnot-for-profitdelivery models target off-gridHPsandon-grid HPs/HCs. •The impact anot-for-profitdelivery modelhasis higher thanthepublic one since, unlike the public entity: •Anot-for-profitentitycan raise additional funds for the initialinvestmentsand O&M of the facilities. •Given that thenot-for-profitentity should be already engagedin healthcare services (pre-condition), there might be synergiesbetween health and energy projects. •Thenot-for-profitentitycan supervise theO&Minthe start-upphase,given(i) its vocation for training courses and capacitybuilding and (ii) its presence in the HFsalready deliveringhealthcare services. •Publicandnot-for-profitdelivery models can be shifted into aback-up system once the grid arrives. •Privatedelivery models cannot be sustainable if shifted into a back-up systemonce the grid arrives. Executive Summary Threedeliverymodelsare proposed for Rwanda Thepublicdeliverymodel(ortraditionalownershipmodel):whereapublicentityprovidesgrantfundingandcommissionsanNGOorprivatecompanytodesign,purchaseandinstallsolarPVsystemsattheHF.TheO&Misoutsourcedaswell.Theassetisownedby thepublicinstitutionoragency.Thisisonlyappl