A Prescription for Climate Change - The MSF Solar Air Conditioning Case
There is an elephant in the room in the humanitarian health sector. While we have mastered many skills in responding to acute humanitarian health needs, how environmentally sustainable are our efforts in the long term? MSF has been taking a long hard look at itself recently (alongside many other humanitarian and healthcare actors), and a disjoint is clear between the ‘do no harm’ ethos and the long term effect of many of our activities by-products. Not to diminish the value of the lifesaving care MSF provides, but just think of the fuel our vehicles guzzle to reach remote regions, the generators that power our clinics and the waste disposal requirements for our interventions.
Positively there is an ever growing cohort within MSF and within the humanitarian sector who are mobilising for climate justice, advocating for change, and asking the hard questions. This week we share an insight into one such effort being pushed by the SIU and led by Per-Erik Eriksson - the Solar Air Conditioning Case Manager.
Global Health and Climate - A Brief Background
Some of our most significant public health and global health challenges have been shown to be exacerbated by climate change — with warmer ambient temperatures impacting the transmission of infectious diseases such as dengue fever, malaria and other vector-borne conditions, not to mention the increasing prevalence of climate-related malnutrition. The regions that humanitarian organisations predominantly work in also happen to be those that have typically contributed the least to the dangerous flux of climate, yet bare the brunt of the climate change burden from increased disease prevalence to climate-related conflicts.
The cycle is vicious and highly unjust by any standards as outlined in the Lancet Countdown publication which projects that without urgent and consolidated climate justice efforts that we could run the risk of undoing the last 50 years of public health gains globally.
As flagged in a recent MSF Webinar discussing the Lancet climate and health publication, this issue is so much bigger than MSF alone - it is a multilateral imperative calling for immediate action by private and public sectors alike. However, it is a responsibility of MSF to honestly assess their own impact and mitigate against any further negative contribution
As MSF, what we ultimately want to reach is a point where we can confidently provide sustainable healthcare support in tandem with mitigating against adverse effects caused by climate change. While the challenge of climate change, particularly in the humanitarian context, seems like a sometimes insurmountable task, opportunities for change are presenting themselves to us more frequently than before, and with wider spread buy-in from the global community. One such opportunity can be found in solar-energy innovations.
The SIU has engaged with numerous internal and external bodies in an effort to address climate change. This includes the MSF Operational Centre Brussels (OCB) Energy Vision recently referred to in a Chatham House report entitled 'The Costs of Fuelling Humanitarian Aid'as the most comprehensive analysis of systematic energy use undertaken in the humanitarian sector thus far. The Energy Vision project was launched to consider the potential of all energy alternatives (generators, photovoltaic solar panels, solar thermal panels, etc.) and which served as a springboard for the deep dive into the Solar Air Conditioning case discussed in depth in the next section.
The Solar Aircon (AC) Case - A Case Manager Insight with Per-Erik Eriksson
One of the largest drivers of fuel consumption within MSF field operations is air conditioning (AC). AC is essential where medical needs call for controlled temperatures in pharmacies, operating theatres and laboratories. In addition, AC in offices and residences provides better staff working conditions.
AC fuel consumption is estimated at 35%-50% of MSF’s total fuel use. Usage of AC is predicted to increase considerably the coming years as we aim to improve our facilities for both patients and staff alike, in combination with anticipated increasing ambient temperatures. With this is the realisation that the current model is highly unsustainable.
This Case was set in motion in order to test a viable renewable energy alternative for AC was clearly in line with our organisational ambition to become more sustainable and reduce our carbon emissions and ecological footprint - but also to reduce costs and make operations more autonomous. The SIU, therefore, approached the cross-sectional Energy Working Group with a proposal for the Transformational Investment Capacity (TIC), and through this, OCP decided to sponsor the successful application.
Per-Erik Eriksson is an innovation consultant and case manager for the Solar Air Conditioning Case. Per-Erik has a wide range of experience covering development, innovation and research in the building sustainability sector. While working as a technical logistician with MSF in DR Congo, he initiated and carried out the conversion of a field hospital energy system to a solar energy system before the hospital was handed over to the local authorities. He received his PhD in engineering from the Chalmers University of Technology, Sweden.
How did it all begin?
“It all started quite a few years ago among the energy referents in all our operational centers. So we were in contact increasingly through the SIU in 2017 while I was working on another case with Solar Oxygen and we started to look into what more could be done in terms of solar energy. This was what the energy referents were most interested in because a very high proportion of the consumption of diesel through the generators were going towards air conditioning for the hospitals. So then the SIU proposed to take on this case and we wrote an application to the TIC Fund and gradually it evolved and became a full project in the winter of 2017/2018 and I was confirmed as case manager in May in 2018.”
What problem is this case addressing?
“Air conditioning for the hospitals is a challenge in terms of our acute need for cooling medicines and maintaining the efficiency and comfort of the personnel and patients in the hospitals - these demands naturally result in very high consumption of energy. We often find ourselves having to upgrade or upsize generators and electricity networks in our facilities.
Another challenge is actually getting diesel to many of the contexts and projects we are working in especially in very remote locations. For example, in the 2016 mission in Congo I mentioned it would take three days on a truck to transfer the diesel to a project. This sort of logistical challenge is of course closely connected to our environmental footprint. If we really do want to work with climate change mitigation and not only the consequences of climate change, but to really go beyond this and lessen our footprint, the diesel aspect is one of the big steps we can and must take.
Also worth mentioning — on air conditioning for the hospitals in particular — in the contexts we work in that require cooling for medications, operations or workforce efficiency - the highest needs are typically coupled with the presence of direct sunshine! The power need and the available solar power are almost identical curves! So air conditioning for solar power has been of great interest for many years in the industry but it’s not really until now that there is a possibility of actually implementing and using. To some extent it is a timing issue.
The vast majority of hospitals MSF is working with, or running, at the moment are running on diesel generators. The reason for this is that the power grids in most of the contexts we are working in are not powerful enough to support the needs of the hospitals and in many of our projects there is no power grid at all. If we were to be successful in scaling-up our solar air conditioning solution it would be a significant impact on improving our footprint.”
What stage is the case at now?
“In December 2018 we finished 2 months of field testing in Haiti. Since May last year we spent a lot of effort in scanning the entire worldwide market in terms of what equipment is actually available. We ordered two kinds of air conditioners that seemed to be the most straightforward to implement and had them delivered to Haiti. These we installed and are currently up and running so things are looking very promising!
The supply centre in France MSF Logistique have already made the first follow-up order from the manufacturer. There are some remaining technical evaluations that will need to take place over the coming months to make a wider implementation possible.
So in that sense it is very good - things are progressing at a healthy pace. On the other hand evaluation of broader use cases and documenting wide ranging recommendations and insights was a bigger challenge that did not quite succeed in this initial iteration of the case investigation but will be followed up on in the coming months. We do have some data on this but as it turned out the actual air conditioners were not the big problem with regards to this, it was actually the monitoring equipment. It was essentially not robust enough for remote communication in the type of context we were in.
Additionally in the market survey, we also identified some other technologies (aside from the 2 types we ordered) that would be potentially interesting to look further into. So, what we have so far are hybrid air conditioners, these are what we currently find most interesting and viable.
These can work directly on solar PV power from panels. You basically take 2 cables from each end of the panel array and plug into the air conditioner system and you are up and running once the sun is shining. At the same time as this you can also plug in a normal “plug in the wall” current, from the generator into the same AC so that during daytime it can run on solar power only but if we need cooling at night it can take power from the generators. This is a pretty good combination as generators are typically not very much loaded at night time. So if they are still running at night it can be used for cooling in a relatively efficient manner. If we need to implement more in the project, we can implement these hybrids with solar panels and probably use spare generator capacity for the night – thereby avoiding to install more generator capacity.
For pure daytime needs like consultation rooms in the hospitals and clinics, contexts where we installed two of the units in Haiti, it’s more or less perfect because all the cooling you need is during the daytime so they can run on solar only.
The big problem in general is the pure night time needs like we have for housing in some projects then it is more difficult. For this we experimented with a battery backup system. We charged batteries with solar panels and used the batteries for the night time cooling. This however is a very expensive technology. Durability is also a big problem and of course the environmental questions around batteries. For this, there are other solutions emerging where you can produce the cold during daytime and store as ice or similar mediums and then distribute that cooling during the night instead. This is some equipment that would absolutely be interesting to look further at in a follow up project.”
Is there MSF wide buy-in that this does need to happen in the near term?
“Yes, among the energy referents of the 5 operational centers. And they have intersectional cooperation and a Working Group. All the energy referents are clearly interested in seeing this happening and they have a reasonably big say in the matter. Having said this, all direct decisions are taken by the projects or the missions. So the HQ can ultimately not say how we are going to implement this all across the field as the final decision must be made at that level.”
Challenges and Learning for Humanitarian Health Innovators
“Firstly to try and do all of this in 6 months is crazy, but unfortunately is necessary. To do this really well we would have ideally needed 6 months dedicated to market landscaping, doing initial testing in a regulated or know context and then another few months if all this went well for the actual field testing. But it is a challenge to champion that approach in MSF and other similar organisations. At the same time I’m happy we pushed it to a field test otherwise it may have been pushed out dependent on budget for the following year, so it works both ways - the balance of timing is tricky.
Also, it is difficult to simply get things to the field contexts we are working in; to get it ordered, to get it there at the right time, to get it up and working. This was particularly noticeable with the monitoring equipment - when it doesn’t work what can you do? You can’t go out and buy a replacement - even in the capital Port-au-Prince in Haiti where there are 3 million inhabitants. These are the kinds of variables we have to consider working in these contexts. To try and test better before going out to the field I would say is key to even better success of these types of cases. So they are definitely some learnings.”
How do you identify a field test location and the right solution ready for a Case?
“Normally finding an appropriate field test setting is a challenge in itself, however we were lucky to find the setting for the Solar Aircon Case with relative ease. The hospital in Haiti was really perfect. Most of the technical expertise that I needed the support of was already a part of the project there. Additionally it was perfect as it was a relatively stable context, a hospital that OCP has decided to develop over a number of years even though it is no longer an emergency setting - all these things added up.
For a first test of anything I would encourage the identification of similar types of settings. Going straight to an emergency context would just be too difficult for the first stage testing. And then it is also a personal question - the head of the mission and project responsible has to be willing to accept.
The initial scoping for an AC solution was largely internet searches and interviews and conversations with research groups. One of the issues with research groups and many existing organisations working in this space is that a lot of the work has typically been done around high income contexts with readily available power backup if solar power cannot provide enough at all instants. In our context there is no backup, we wanted to run on solar only and we cannot rely on a power grid.
Even though MSF is big we are not necessarily seen as profitable enough for someone to develop something specific for our use in the field. Maybe in the future, for the likes of the ICRC, the UN and MSF to join forces on this and collaborate for these types of solutions in order to make the volumes of products substantial enough be economically viable for a producer - something more like the Target Product Profile model. We didn’t really find anyone else in the global health or humanitarian space who had experience with this kind of project.”
“This stage of the project finished in January so for the time being that is it. It was only scheduled as a 6 month project from the beginning and we quickly realised when we kicked it off that it was impossible to do the field testing and everything else in that time so we extended for another 2 months. There will be follow up - we are hoping to continue with some engagement with the other OC’s to investigate the other technologies and build out the findings to encourage future scale.
In terms if dissemination we will present the research at the MSF Scientific Days in London this May and circulate a report internally with MSF to help others in the organisation understand this opportunity and the evidence and insights we have gathered from this Case.
But what I'm really excited about is that the follow up order for the solar air conditioning systems that has been placed and will start to be implemented by other strands of MSF in 2019. Some units have been ordered for implementation in South Sudan by OCB, for Malawi in OCP and for OCA in various projects. We have set a great baseline for its continued iteration.”
A Concluding Thought
There remains some way to go in terms of organisation wide mobilisation, to share insights and build actionable data guidelines, if the Solar Aircon success over such a short period of time is anything to go by, the potential is huge for humanitarian and global health sector impact and leadership in climate change action.
Climate change is an existential threat, there are no two ways about it but there is undoubtedly an opportunity to be found in every individuals impact, every process and each and every policy. Ignite change, share learnings and persevere.
There is a responsibility to collaborate with all sectors to contribute field-based data and analysis on impact and vulnerability mapping, and the efficacy of adaptation interventions. We need to replicate the robust reporting of the private sector, set audacious goals to accurately represent both the depth of the crisis and the progress being made. MSF is well-placed to link on-the-ground realities with scientifically-informed policies.