Decentralised renewable energy (DRE) through solar plays a catalytic role in enabling healthcare delivery at the last mile. Various programs have been implemented across the world to meet the need for energy at last mile health facilities through decentralised solar energy systems. However, programs often focus on investing in the capital expenditure required to set up DRE, without accounting for operational expenditure required to keep it running over the long term. This crucial investment remains left out - resulting in limited ownership within public institutions cascading into limited support post-warranty with undefined processes for maintenance and limited or no monetary allocation for resolution of issues. Consequently, systems have high downtime, and therefore the quality of healthcare suffers due to limited access to energy. Millions of dollars invested in development are failing to deliver lasting impact—not due to poor system design or implementation, but because of a systematic failure to finance Operations & Maintenance (O&M). 

With partnerships across 12 states in India, this report attempts to reflect on the learnings from the Energy for Health program in building ownership to sustain health-energy interventions at scale. The following document delves into the specific challenges surrounding financing for O&M and discusses certain strategies which have emerged from the ground and succeeded in unlocking finances for O&M in different contexts in India.