Energy in Healthcare and Livelihoods

Holistic Decentralised Renewable Energy Solutions in Sittilingi, Tamil Nadu

Sustainable energy for Tribal area development

Health

Background

Sittilingi is a remote village which is situated 80 Km away from the district headquarter of Dharmapuri in Tamil Nadu. Sittilingi is surrounded by Avalur valleys from all the four sides which have 21 hamlets. The Sittilingi valley and the surrounding Kalvarayan and Sitteri Hills are inhabited primarily by tribal people, Malavasis or Hill People who eke out a living through sustenance or rain fed agriculture. About fifty thousand people live here.

As per census 2011, literacy rate of Sittilingi village is 61.28 % compared to 80.09 % of Tamil Nadu. Agriculture is the main source of livelihood for the villagers. Sittilingi has 53% population engaged in either main or marginal works. Until very recently, there were no roads that connected Sittilingi valley to the nearby towns. This meant little access to any basic resources - health and education indicators were extremely poor.

Less than two decades ago, in 1992, one out of five babies in the Sittilingi valley died before they completed their first year and many mothers died in childbirth. The nearest hospital was 48 kilometres away and to find one with surgical facilities meant a journey of over 100 kilometres. The area was remote and poorly served by public transport. Buses at that time would run four times a day but even getting to a bus could involve a walk across fields lasting several hours. Even today, despite there being a road to the Sittilingi village, the hamlets resting beyond the hills are still out of reach.

Education, drinking water, road and electricity are main concern of the villagers. Sittilingi has power grid connection but experiences severe power interruption and low voltage (from 150V to 180V). This is especially so during the rainy and windy seasons, during which power lines tend to get spanned, and could take weeks to restore due to the inaccessibility. Electricity is generally available for 5 to 6 hours a day in single phase, whereas most heavy electrical machinery require three phase current for operation, therefore rendering them dysfunctional for most of the time. These conditions affect all facets of life in Sittilingi, from household needs to education, healthcare and livelihoods..

Tribal Health Initiative:

It was in this context that Tribal Health Initiative was started in 1993 by Dr. Regi George and Dr. Lalitha Regi. What started out as an outpatient clinic in a small hut, evolved over time into a full fledged 30 bed primary care hospital with rudimentary operation theatre, labour room, neonatal care, emergency room and laboratory. This preliminary work led to dramatic improvements in the health indicators such as maternal and infant mortality rates, and the tribal hospital fostered a deep trust with the villagers of Sittilingi.

After ten years of the work in providing medical care, an impact evaluation of the work revealed to THI that in order to meet their vision of health, their work needed to go beyond medical care and also look holistically at basic household needs, education and livelihoods. In order to understand unmet needs, the team decided to have one to one discussions with the villagers of the 21 villages covered by THI. As a consequence of this process, their newer initiatives have emerged such as the Organic Farming Initiative and the Tribal Craft Initiative.

THI has now expanded into a team of over 55 highly trained people, many of whom are from the nearby villages itself, working to improve the lives of the tribal communities living in the Sittilingi valley and surrounding hills through a variety of programmes in health care, community health, farming and craft work. The objectives of setting up of THI is to provide better quality of life to the local people which include:

• The highest possible level of physical, mental and social health.

• Enhancement of socio-economic status while retaining their pride, selfrespect and self-reliance and ensuring their active participation in programmes meant for their welfare.

• Highly conducive atmosphere for the growth and development of local cultures and customs.

Since farmers were losing much of their income to middle men, THI started the Sittilingi Organic Farmers Association (SOFA) in 2009 to improve the bargaining power of the farmers by helping them get better rates in the market. SOFA also promotes organic farming and agro processing, to increase the value that is captured by the farmers downstream. About 500 farmers have been registered, of whom half have got organic certification from the State Government.

Apart from health care and farming, THI aims to create a livelihood option by reviving the traditional craft of Lambadi, who are one of the prominent communities in Sittilingi. Lambadi community migrated from Rajasthan and they have very rich culture of art and crafts. The initiative has been given the name Porgai which means pride in Lambadi dialect. Women groups from the area have been trying to revive this traditional craft, and engage in tailoring and craft as a livelihood option.

SITTILINGI ORGANIC FARMERS' ASSOCIATION

In addition to promoting organic farming and helping farmers aggregate outputs, SOFA also has a value added processing centre that produced and markets millet based biscuits, health mixes, etc. At the time the project started, SOFA had 300 member farmers with an annual turnover of INR 350000. While their farmer base and the production was slated to expand rapidly, reliable electricity was turning out to be a barrier for progress.

TRIBAL HOSPITAL

In addition to being the only reliable primary care hospital in a 40 km radius, the tribal hospital also provides the facility for both minor and major surgeries. A necessity and luxury that is otherwise inaccessible to the people here. THI provides priority treatment for the tribal population, and collects a nominal fee from each and every patient. People throng to this hospital despite being charged for medical services (unlike the free services at government facilities). Therefore the hospital has a regular inflow of patients - over 200 outpatients every day. The hospital conducts more than 350 deliveries every year.

PORGAI

Porgai currently has 60 women associated with the center, out of whom 1 is the master tailor, 5 tailors, and the other women work from their homes and focus on the embroidery aspects. So there are 5 industrial grade sewing machines at Porgai to facilitate the tailoring. The women stitch traditional kurtas, bags, lambadi attires, etc, and market them on online portals, at different fairs, as well as sell them to textile companies such as FabIndia. Because of erratic and inconvenient hours of power supply, the women working under Porgai was finding it difficult to complete the orders on time.

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Approach

As evident from the context above, in each case there was a need for reliable electricity to sustain the respective services. The solution involved three key key aspects - technical, financial and social. In each case, the exact utilisation patterns of each equipment, as well their priority was understood in order to design a primary solar system that fully responds to the critical needs. High energy loads were first analysed to find efficient alternatives, so that the energy requirement could first be minimised. In different stages, high energy loads like baby warmers, industrial sewing machine motors, and so on were replaced with efficient ones. In each case, the financial implication of the solution was calculated carefully, both in terms of avoided alternate energy expenses, as well as potential increase in production in the case of SOFA. Based on this, a suitable financial product was jointly created to enable THI to own the systems over time. The final element is the social aspect of the solution.

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Sittilingi Organic Farmer’s Association

A 4.5kWp solar system has been installed to power the processing machines that have motors ranging from 0.5-2 HP. The system is designed to provide 4.5-5 hours of back-up and can run a combination of machines of 4 HP at a time. The machines connected to the system include a flour mill, grader/de-stoner, weighing machine and packing machine. The total cost of the solution was INR 590000. Based on the projected increase in production due to reliable electricity, it was determined that SOFA would be able to pay around INR 4000 every month from their increased profits. A sum of INR 169205 was therefore made available as a soft loan amount to SOFA from SELCO Foundation, with a return period of 36 months at 5% per annum and a monthly EMI of Rs.4310. The rest of the amount was borne by SELCO Foundation as the Research and Development cost, as this was the first project of its kind and therefore the risks, if any, was not to be entirely passed on to SOFA. Ideally, if a longer term credit facility is made available to such processing centres, they will be able to own these systems without the need for much subsidisation.

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Tribal Hospital

The solution has been designed optimally taking into account the type of loads and number of hours of utilisation. Primary solar system with maximum load capacity of 2500 watts and maximum 18 units per day has been installed. During the operation time the solar system supports the loads like suction machine, patient monitor, shadow less light, cautery, ventilator, air-conditioning machine, anaesthesia machine and luminaries. On the day before the OT day, the same system powers an industrial grade autoclave to sterilise all the equipment required during emergencies. In this manner the system is fully optimised for the OT. In other times system takes any load as required. The total system cost was INR 840000. THI was able to pay INR 300000 up front, and requested that they pay the rest in instalments. Since THI was paying close to INR 15000 every month towards diesel expenses for the OT which would now be avoided, THI availed another interest free soft loan of INR 440000 from the Foundation, paying back a monthly EMI of Rs 14667 over a period of 30 months. Not only that, since the solar system is designed for primary operation (not as a back up for grid electricity), this would also result in savings on the electricity side. While it might not be possible for hospitals (unlike businesses) to own these systems by availing credit, what this demonstrates is that decentralised renewable also makes financial sense in the long term. The intangible benefits on the healthcare side, which might outweigh the tangible financial gains, are mentioned in the section below.

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Porgai

The sewing machines being used at this centres are industrial sewing machines, which provide the high speed of 2000-2500 stitches per minute that is needed for stitching with hard needles. These machines typically use clutch motor of 0.33 HP. Once the machines are switched on, these motors keep running all the time whether stitching is being done or not, which results in significant energy wastage. These clutch motors were replaced by induction motors controlled by Variable Frequency Drives (VFD) to reduce the cost of solar powering the setup. The induction motors are more energy efficient, and the VFD device helps control the speed of the motor, while also controlling the surge currents from the motor. With lower surge current, a lower size inverter can be installed, further bringing down the cost of the solar system. Initial observations show that there is about a 50% savings in daily energy consumption. All the systems are designed for 8 hour shift during daytime (typically 9am to 5pm). The total cost of five solar powered sewing machines were INR 402000 which was funded by TITAN under their Corporate Social Responsibility program. While replicating this solution, a suitable financial product can be designed based on the increase in production arising from the solution.

Model for Replication with other partners

The role of community partners cannot be discounted in any of the interventions in Sittilingi. The community organisations bridge the important gaps in training, human resource training, financial and socio-economic assessment, as well as market and social linkages (backward and forward).

Certain geographies have had a history of community based organisations where these parts of the ecosystem can be easily built up, whereas in others SELCO needs to train NGOs to be able to fill these gapsespecially true for states in the North East. As part of replication of such projects in other geographies, a scoping exercise to find the relevant partner is key.

SELCO Foundation has also started an NGO in Residence program that allows for mentorship and cross learning between different organisations- making sure that learnings and failures are transferred. For example in 2017, SELCO Foundation arranged an exposure cum training for MOSONiE, an NGO from Meghalaya in North East India. MOSONiE wants to work on sustainable agriculture practices and a cross learning visit was arranged at District Agriculture Training Centre (DATC), Chitradurga and Mysore Rehabilitation and Development Agency (MYRADA).

Pre Intervention scenario

In this context, SF connected with India Foundation for Humanistic Development (IFHD) in early 2016 to learn more about their work in incubating Farmer Producer Organisations (FPOs). IFHD helps FPOs gain the escape velocity from orbit of farmers collectives to that of a self sustaining business enterprise capable of accessing mainstream financial instruments. IFHD had been working closely with the Tribal Health Initiative to help them set up the Sittilingi Organic Farmers Association (SOFA), and it was in this context that SF was introduced to SOFA and THI. Be it the tribal hospital, agro processing centre under SOFA or tailoring initiative under Porgai, electricity is considered as the life line for their efficient functioning. Furthermore, thousands of households that live in the inaccessible Kalrayan hills still do not have any means of electricity, and rely on kerosene, firewood and other unsustainable sources for their daily energy needs. SOFA: The agri processing machines such as de-stoner, de-husker, flour mill etc work on three phase electricity supply, which was available for only 2-3 hours every day. Combined with low and erratic voltages which cannot sustain the equipment functioning, their production capacity was severely impacted. The farmers were forced to work odd hours in the night (mainly between 11:00 pm and 3 am) and making it difficult for them to reach their optimum production targets. With a fear of not being able to complete the production on time, they were hesitant to take on more orders, therefore reducing the potential income their farmers could have earned. At the Tribal Hospital, Erratic electricity and voltage fluctuations affected the functioning and durability of medical expensive and sensitive equipment, especially in the operation theatre. The hospital was dependent on Diesel Generator (DG) set for the entire day which costed THI on an average 15000 INR/month as diesel expenses and even more during the rainy season when the power supply gets more erratic. Moreover, a dedicated human resource was needed to manage fuel, operate the DG set and monitor it during the surgeries making sure it runs uninterruptedly. Apart from this, the DG set was a highly polluting source of electricity and its sound was not conducive for the peaceful hospital atmosphere. On some days, they could work for only 2-3 hrs, which not only meant that the centre could not complete the orders on time, but also that they did not have the confidence to take more orders from the interested buyers and vendors. Also, since the women get paid per hour, this was significantly affecting their monthly income as well.

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Impact

SOFA: There is a significant savings in electricity bill from Rs. 3000 to currently spending Rs. 100-200 per month with the solar system .The savings are helping association in paying monthly EMI. • Post intervention, the processing has gone from 250 to approximately 550 Kgs per day, thereby, increasing profits. The regular power supply has increased the earning of the members • Since installation of the solar unit, the members has increased from 300 to 600 members and their turnover from 35 lakhs per year to almost 75 lakhs this past financial year. • Additionally the FPO has created employment opportunities to local women, hiring 3 women initially and currently hiring 10 women (3 full time and 7 part time).

TRIBAL HOSPITAL: • The smooth functioning of OT with reliable solar energy has succeeded in increasing the confidence of the patients and hospital staff. • There is no need of any dedicated human resource to operate and monitor DG Set, who can be engaged for other purposes. The DG Set is used only during emergency. • Based on these impacts, THI has also upgraded their labour room with solar powered energy efficient equipments such as the radiant baby warmer and photography unit.

PORGAI: • Porgai has given employment to women who, otherwise, used to work as a contractual labourers. About 60 women are associated with Porgai and on an average they earn Rs.4000-Rs. 5000 per month. Now they can take on more orders and consequently increase their incomes. • With the installation of solar powered sewing machines, there is noticeable decline in the electricity bill and the administrative cost. The Porgai business has achieved breakeven point this financial year.

DEMAND FOR SOLAR HOME SYSTEMS As mentioned earlier, the nature of electricity also affects the basic needs of households in the region. The farmers associated with SOFA are also organised in terms of smaller entrepreneur groups, which meet regularly. At one of these meetings, SOFA introduced the concept of solar solutions for homes, and a couple of systems were installed in the village for demonstration. Eight farmers approached SELCO to purchase the solution. SOFA itself was willing to provide short term loans at 2% interest per month for the farmers to purchase these systems. SOFA wants the demand to grow organically as per the needs of the farmers, and upon seeing the quality and reliability of the systems, 10 more have already approached SELCO for the solar home systems. Once the demand becomes large enough, SOFA would explore bringing in appropriate financial partners to finance the systems.