Building an Environmentally Sustainable Clinical Research Center in Remote Rural Liberia A case stud

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Building an Environmentally Sustainable Clinical
Research Center in Remote Rural LiberiaA case
study Fatorma Bolay, PhDWHO/Country Office
LiberiaLiberia Institute for Biomedical
Research Annette C. Kuesel, PhD, E. R.
FletcherUNICEF / UNDP / World Bank / World
Health OrganisationSpecial Programme for
Research and Training in Tropical Diseases
(TDR)Matthias Bergmann, Dipl.Ing
(FH)Hochschule for Technik und Wirtschaft
Berlin, GTZ
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Overview

• Liberia today infrastructure and health care
  challenges
• Clinical Research Centre in a remote rural area
  to test a new drug for river blindness
• The challenges no infrastructure, no
  electricity, no reliable fuel supply
• Vision a solar powered research facility
• Ideas for a global fund for low carbon print
  health facilities and a tool kit for health
  facilities in developing countries

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Liberia today

• One and a half decades of civil conflict led
• To massive displacement of population with
• high insecurity
• severe disruption of social services, including
  health care
• Negative impact on the health status of the
  population, especially women and children

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Liberia's Health Statistics 2007

• Infant mortality 71 / 1,000 live
  births
• lt5 years child mortality 110 / 1,000 live
  births
• Maternal mortality ratios 994 / 100,000 live
  births
• HIV prevalence in general population 1.5
• Access to safe drinking water 54
• Access to proper sanitation 10
• Moderate malnutrition 13
• Severe malnutrition 6

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Liberia's Infrastructure

• Over 90 of the countrys basic infrastructure
  was damaged
• Country is grappling with maintenance and
  rebuilding of destroyed infrastructure
• Roads to reach rural population are in deplorable
  condition
• Towns and villages are without electricity
• Health workers depend on flash lights during
  emergencies at night.

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Health System InfrastructureCurrent status and
plans

• ONLY 30-40 of Liberians have access to health
  care
• 274 / 400 functioning health facilities now have
  solar fridges for immunization services
• The Ministry of Health of Liberia cannot provide
  generators and sustain fuel supply to the 400
  health facilities
• Lack of power impacts health, e.g. emergency
  obstetrics case management to reduce new born and
  maternal mortality
• Ministry is reviving pre-war plans to provide
  solar-based electricity to all peripheral health
  facilities
• Needs assistance from government and
  international partners 

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Objective

• Build Clinical Research Center in Rural Liberia
  to conduct clinical trials for new tools for
  neglected tropical diseases according to
  international guidelines including
• Laboratories
• Clinical / Ophthalmological examinations
• Subject/Patient accommodation
• Communication/Internet access
• Doctors' offices / Documentation

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Challenge

• No electricity
• 8 and 20 hrs drive from Monrovia
• Day time highs 28?C to 36?C
• No communication, not even cell phones work

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Sustainable features of centre's construction

• Located near health center and school
• Modern, sun-dried mud brick construction
• insulating and maintain temperature in 23-25? C
  range
• Trees to be planted for shading
• Use of locally available materials and (wo)man
  power
• Basement for cool storage/insulation
• Ventilation features e.g. overhanging roofs and
  special orientation of labs with temperature
  sensitive equipment
• Roof capable of supporting photovoltaic solar
  panels

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Vision of a low carbon print research facility

• First steps
• Obtained advice from GTZ and Hochschule fuer
  Technik und Wirtschaft Berlin (HTW)
• Discussion of our options
• Solar-powered health waste facility -
  preliminary investigation
• Sustainable electricity generation for research
  center water, wind, biofuel from waste (nearby
  rice fields and banana plantations), solar,
  preliminary investigation of all options
• Option chosen Solar in combination with long
  term biomass/biodiesel development

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The solar-power option

• Photovoltaics-based electricity
• Detailed specifications and cost estimates
  developed by GTZ and HTW for three levels of
  energy generation
• Clinical Research Centre built for current study
• Future expansion of Centre and/or neighbouring
  health centre
• Expansion of Centre neighbouring health centre
  Bolahun high school

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Key issues considered

• Precise calculation of research centre's energy
  requirements by type of laboratory equipment,
  energy usage/usage time
• Difference in costs for system meeting current
  demands at 'minimal' cost vs. system that can be
  expanded to provide more energy with minimal
  additional investment
• System suitable as template for other Liberian
  health facilities

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Renewable energy source the technical plan

• Photovoltaic system with back up generator
• TECHNICAL SPECIFICATIONS for PV panels,
  inverters, batteries
• Long term plan to integrate biodiesel option,
  using agricultural waste (rice, bananas)
• Cost estimates for PV system at three power
  options
• 10 kW ca. 200 000 USD (140 000 USD excluding
  solar panels)
• 12 kW ca. 220 000 USD (140 000 USD excluding
  solar panels)
• 15 kW ca. 250 000 USD (150 000 USD excluding
  solar panels)
• Including PV generators, island inverters,
  battery, 'accessories' and installation.
• Discussion with NGOs for
• Donations of trained and volunteer installation
  labour to lower costs
• Training Liberians in installation and
  maintenance of solar power installations

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Now we have a plan, BUT

• Clinical Research Project does not have the funds
• Over the 3 year life time of the research
  project, oil-based electricity generation is
  cheaper
• First donor we approached rejected request for
  donation of solar panels
• Then donated 300 kW whole PV system to
  Europe-based international NGO
• So for now
• Oil based generator and back-up generator
• Search for a Donor (or 'consortium' of donors)
  continues

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Tools and resources that would be helpful for
future endeavours __________'Global Fund for
low carbon print Neglected Health Facilities'
for financing'How to' Toolkit for countries
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A 'Global Fund for low carbon print Neglected
Health Facilities' Why?

• Sustainable design typically is not financially
  justified within the short-term time frames of
  most project planning
• The 'Global Fund to Fight AIDS, Tuberculosis and
  Malaria'
• 'invests the worlds money to save lives' by
  making available drugs accessible to those in
  need
• A 'Global Fund for low carbon print Neglected
  Health Facilities' could
• invest the worlds money to mitigate climate
  change AND save lives by making renewable energy
  sources accessible to developing countries

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Toolkit for low-carbon health facilities

• Checklist of issues to consider in planning
• 'How to' guide for energy efficient building
  design
• Regionally-adapted best practices for new
  building siting and design
• Revive/upgrade sustainable traditional
  construction that harnesses local know-how and
  stimulates local economies, e.g. the mud brick
  construction in Liberia
• Transport options Considering bicycles (instead
  of jeeps/motorcycles), when appropriate
• Medical equipment selection guide
• 'Medical' and energy consumption specifications
  of clinical/diagnostic equipment
• Generators that can work with biodiesel
• Solar powered alternatives to standard equipment
• Suppliers and price ranges
• Contact info for all technical, financial, other
  advice
• Distribution in all WHO country offices and
  Ministries of Health/Environment

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Acknowledgements and contact info

• We would like to particularly thank
• Dr. Uh, GTZ for his advice and facilitation of M.
  Bergmann's work on this project.
• Wyeth Pharmaceuticals for the grant to WHO to
  complement WHO/TDR and APOC funds for building
  the capacity for and conducting the research
  project for which the Clinical Research Center is
  being built
• Dr. Ndayimirije, WR Liberia, for his support of
  the project
• The Bolahun Community for the enthusiastic
  collaboration and support for building the
  Research Center
• For more information contact
• Dr. F. Bolay bolayf_at_lr.afro.who.int,
  bolayf_at_yahoo.com
• Dr. A. Kuesel kuesela_at_who.int
• E. R. Fletcher fletchere_at_who.int
• M. Bergmann bergmann_at_seewerk.de