Introduction
Health infrastructure stands at the intersection of two global imperatives, achieving universal health coverage and ensuring clean, reliable energy for all. Today, more than one billion people worldwide depend on health facilities that operate without reliable electricity, clean water, or climate control. According to the World Bank (2025), 25% of health facilities in low- and middle-income countries (LMICs) lack access to electricity entirely, while one in three experience regular disruptions. The consequences are profound: power outages interrupt critical procedures, vaccines lose potency, and essential diagnostics become unreliable. As UNOPS (2024) emphasizes, “access without reliability is an illusion of progress.”
Globally, the conversation has shifted from electrification as a technical objective to energy inclusion as a health systems strategy. The World Bank’s Improving Healthcare Access Through Renewable Energy underscores that resilient healthcare now depends as much on decentralized energy as on human resources or financing. In India and the Philippines, hybrid solar systems have cut diesel reliance by 60–70%, saving over US$25,000 annually per facility and extending service hours by up to six hours daily. Similarly, in Haiti, solar microgrids installed through public–private partnerships reduced monthly fuel costs by US$22,000, enabling funds to be redirected toward patient care and equipment maintenance. These results are not isolated; they illustrate a structural evolution in health delivery, where inclusive, co-created energy systems define operational continuity.
At the global level, the convergence of Sustainable Development Goal 3 (Good Health and Well-being) and Goal 7 (Affordable and Clean Energy) signals a shared agenda for climate-resilient, community-anchored infrastructure. Achieving SDG 3 targets will require US$371 billion annually and the construction of over 415,000 new health facilities in LMICs, according to UNOPS (2024). Yet even this scale of investment will falter without frameworks that prioritize participation and gender equity. Evidence from SEforALL (2025) demonstrates that health centers with community co-management and gender-inclusive energy design maintain 40% higher operational reliability during climate shocks than those managed externally. The findings affirm that technology alone cannot deliver resilience; it must be embedded within inclusive governance.
Nowhere is this interplay between energy, inclusion, and health outcomes more evident than in Africa. Across the continent, roughly 60% of rural healthcare facilities lack reliable power, and over 100,000 clinics function entirely off-grid. The SEforALL report shows that in sub-Saharan Africa, one in four health facilities has no access to electricity, and another 30% experience frequent power failures. The implications extend beyond lighting and refrigeration; unreliable power limits digital health records, disrupts laboratory operations, and endangers maternal care. According to the African Development Bank (2025), energy poverty in health facilities contributes indirectly to tens of thousands of preventable deaths each year, particularly among mothers and newborns.
In response, a wave of inclusive, decentralized energy initiatives is emerging across the region. The AfDB’s US$46 million project in Sokoto State, Nigeria, exemplifies this transformation, funding solar hybrid systems and cold-chain units for rural clinics. Early assessments show a 30–40% reduction in vaccine spoilage and continuous service delivery even during grid blackouts. In Mozambique, an IRENA-supported program (2025) has electrified over 80 rural health centers through solar mini-grids, ensuring 24-hour service availability and climate-resilient vaccine storage. Kenya’s community energy cooperatives, especially in Turkana and Garissa, are enabling women-led microgrids to power dispensaries and maternity wards, reducing maternal mortality rates while generating local employment.
What links these successes is not merely the deployment of renewables but the model of inclusion driving them. UNOPS (2024) and SEforALL (2025) emphasize that infrastructure designed with communities rather than for them produces outcomes that are more sustainable, accountable, and gender-equitable. In Ethiopia and Malawi, women now serve as solar maintenance operators and energy managers for health facilities, increasing system uptime by 25% and enhancing local accountability. This gender dimension is not peripheral; it is central. Across Africa, women constitute 70% of the health workforce but hold less than 25% of leadership positions in health and infrastructure planning. Bridging that gap is essential to building resilience that lasts.
Still, challenges persist. Many projects remain pilot-scale, constrained by fragmented financing and policy silos between energy and health ministries. The Development Research EU (2024) study on sustainability in health systems highlights that fewer than 10% of African energy projects integrate explicit health or gender objectives. The lack of intersectoral coordination means that even successful pilots often fail to scale or sustain. Moreover, maintenance remains a chronic weakness systems installed without community ownership frequently fall into disrepair after donor exit.
Addressing these structural gaps requires a paradigm shift in how development programs are conceived and implemented. The University of Bristol’s “Sustainable, Holistic and Inclusive Energy Systems for Well-being” project underscores the importance of participatory frameworks linking local knowledge, gender equity, and technological design. Similarly, SWP Berlin (2019) warns that energy transitions that exclude social participation risk reproducing inequities in access and decision-making. Resilient health infrastructure, therefore, must rest on three interdependent pillars: technical reliability, institutional inclusion, and social co-creation.
The evidence from across Africa and the broader Global South points to a clear conclusion: the future of healthcare depends on the democratization of energy. Decentralized systems, co-managed by communities and informed by inclusive design, do more than power hospitals; they build trust, equity, and climate resilience. For policymakers and global financiers, the lesson is equally direct. Resilience cannot be imported; it must be co-created. The next decade must therefore focus not only on scaling renewables but on embedding participation, gender equity, and local stewardship at every level of health-energy planning. Only then can energy truly become the lifeblood of universal health coverage, lighting the path toward systems that are both sustainable and just.
Characteristics of the New Framework for Inclusive Health Infrastructure
The emerging framework for resilient and inclusive health infrastructure redefines how energy systems are conceptualized, deployed, and governed. Unlike earlier models that viewed electrification as a technical add-on, today’s paradigm positions energy as a core determinant of health system functionality and equity. It emphasizes decentralization, participation, inclusivity, digital transparency, and climate adaptability, interlocking pillars that together sustain service continuity and social ownership.
Decentralized Energy Architecture: At the center of this new framework is a shift from centralized, grid-dependent systems toward decentralized, renewable-based architectures. Solar hybrid microgrids and modular battery systems now underpin primary health care resilience in off-grid or weak-grid areas. According to SEforALL’s 2025 study on climate-resilient primary health care, 60% of rural health facilities in Sub-Saharan Africa still lack reliable power, while decentralized solar solutions have demonstrated uptime reliability exceeding 98% in pilot sites across Kenya and Sierra Leone. Similarly, the International Renewable Energy Agency (IRENA) reports that inMozambique, solar hybrid systems have improved vaccine storage reliability by40% and reduced diesel dependency by 65% in rural districts. These systems are not only environmentally sustainable but financially efficient, reducing lifetime energy costs by up to 30% compared to diesel-based alternatives. The AfDB’s US$46 million Sokoto State Health Project in Nigeria exemplifies this transition, integrating solar hybrid energy and cold-chain capacity across 120 health facilities. This decentralized model is more than an engineering solution; it is a structural reorientation of public health resilience, one that decentralizes power in both a technical and governance sense.
Participatory Co-Design: A defining characteristic of the new framework is participatory co-design, designing with communities, not for them. Development research now consistently shows that projects co-created with end users exhibit stronger maintenance, cost recovery, and institutional trust. The World Bank’s 2025 feature on improving healthcare access through renewable energy highlights successful models in Haiti and thePhilippines, where health facility electrification was co-designed with local health committees. These communities actively participated in system design, site selection, and management training, leading to 20–25% longer system lifespans than in externally managed projects.
UNOPS underscores this approach in its framework for developing inclusive energy infrastructure, where local engagement and context-specific design are non-negotiable components of project planning. In Malawi, for instance, health centers that formed joint energy-health management committees achieved faster response times for technical faults and better cost-sharing mechanisms. Participatory co-design thus transforms beneficiaries into co-stakeholders, embedding accountability within the system’s DNA.
Gender-Inclusive Governance: No inclusive framework can be complete without gender equity at its core. Women’s participation in local energy governance and operation not only advances social justice but also enhances system efficiency. Studies from SEforALL and UNOPS reveal that women-led maintenance teams in community energy projects report 15–20% higher operational uptime and greater community trust in health facility reliability. Gender-inclusive governance also carries multiplier effects. In Rwanda and Tanzania, programs training women technicians to manage solar-powered cold-chain units improved vaccine reliability and maternal service delivery. Furthermore, gender mainstreaming frameworks from Development Research Europe demonstrate that when women serve on local infrastructure boards, decision-making is more attuned to service continuity and affordability, both critical to sustained health outcomes. This governance shift aligns with SDG 5 (Gender Equality) and SDG 7 (Affordable and CleanEnergy), positioning inclusivity not as a parallel agenda but as a performance variable within infrastructure success metrics.
Digital Integration: The modern health-energy nexus is increasingly digital. Real-time monitoring, predictive analytics, and remote diagnostics now form the backbone of resilient infrastructure management. According to IRENA, digital control systems in off-grid clinics have reduced unplanned downtime by up to 40%, while enabling remote management of solar generation, battery health, and equipment loads. The integration of digital tools extends beyond energy optimization. In the World Bank’s renewable health projects in Asia and Africa, smart dashboards link energy metrics to health data, tracking vaccine temperature logs, clinic operation hours, and patient throughput. This integrated data ecosystem supports evidence-based decision-making, ensuring that energy reliability directly translates into improved health outcomes. Moreover, digital transparency fosters accountability. Communities can access performance dashboards, while health administrators receive automated alerts for maintenance, creating a virtuous loop of responsiveness and trust.
Climate Adaptability: Finally, the new framework embeds climate resilience as a design principle, not an afterthought. Health facilities powered by renewables must withstand not only demand variability but the physical shocks of a warming planet. The SWPBerlin report emphasizes that climate-smart design elevated solar arrays, flood-proof battery storage, heat-resistant insulation, and extended system lifespans by over a decade in vulnerable regions. In Mozambique,IRENA found that hybrid solar systems designed with climate-adapted specifications maintained 95% operational integrity during extreme weather events that disrupted grid supply. Similarly, UNOPS advocates for “resilience-by-design” principles, integrating renewable systems with natural ventilation, passive cooling, and sustainable materials. As climate disruptions intensify, adaptability ensures that health infrastructure remains not just powered, but prepared.
Strategies for Building Resilient, Inclusive Health Infrastructure in Africa
Financing Inclusion: Sustainable health infrastructure begins with financing models that align investment incentives with performance and social outcomes. Conventional donor grants and capital subsidies are giving way to results-based financing (RBF), blended finance, and climate-health funds that reward verified service uptime and inclusion metrics.AfDB’s integrated loan structures demonstrate how linking disbursement to energy performance can ensure accountability while mobilizing private capital.Similarly, UNOPS’ value-for-money design approach, balancing lifecycle efficiency with local economic participation, illustrates the shift from project delivery to systemic sustainability.
Emerging tools such as Green Health Bonds andResilience Funds provide scalable mechanisms for governments to attract investment while embedding inclusion criteria. The goal is clear: financing should not only electrify clinics but also institutionalize frameworks that sustain them beyond project cycles.
Policy Integration: Fragmented governance remains a primary obstacle to resilient infrastructure. Integrating energy, health, and climate policies under unified planning frameworks is essential to avoid duplication and ensure continuity. National strategies increasingly embed renewable energy targets within health sector plans, transforming energy access from a peripheral goal into a health system requirement.
At the continental level, AU-led coordination through regional energy centers is harmonizing standards for health facility electrification and renewable system certification. Such integration ensures that resilience planning is not isolated to ministries or projects but embedded within national development frameworks and regional regulatory ecosystems.
Capacity Building and Local Ownership: Infrastructure resilience ultimately depends on local capacity and governance. Training technicians, health workers, and community operators to manage decentralized systems ensures technical continuity and accountability. Beyond technical training, capacity-building initiatives increasingly emphasize gender equity, enabling women to serve as engineers, supervisors, and energy managers. Institutionalizing community energy governance boards (CEGBs) anchors local ownership in formal structures. These boards oversee fee collection, fault reporting, and performance tracking, transforming users into co-managers of critical assets.Such social infrastructure complements physical infrastructure, ensuring that systems remain operational, trusted, and financially sustainable.
Data and Digital Systems: The digitalization of health-energy systems marks a turning point in how resilience is managed.Real-time monitoring, IoT-enabled diagnostics, and predictive analytics are replacing reactive maintenance with proactive, evidence-based management. National dashboards linking energy data to health outcomes now allow ministries to visualize the operational status of clinics, anticipate failures, and allocate resources efficiently. Integrating energy indicators into Health Management InformationSystems (HMIS) connects infrastructure reliability with service delivery metrics—vaccine cold-chain performance, clinic uptime, and maternal care continuity. Digital integration not only enhances efficiency but also reinforces transparency. Automated reporting and open-access dashboards strengthen public trust, donor confidence, and cross-sector coordination.
Regional Collaboration: Africa’s pathway to resilient, inclusive health infrastructure will be accelerated through regional cooperation. Shared learning platforms, joint procurement systems, and harmonized technical standards reduce costs and facilitate replication across borders. Regional power pools and development networks coordinated through AU and ECOWAS enable bulk procurement of solar components, reducing equipment costs while ensuring quality control. Collaborative research under continental initiatives like SEHA (Sustainable Energy for Health Africa) helps consolidate evidence, streamline investment pipelines, and attract global finance. Regional collaboration also expands the knowledge economy, linking universities, research centers, and innovation hubs with practitioners in the field. This ecosystem approach ensures that best practices are continuously refined and that policy and technical innovation move together.
Comparative Overview: Electrification of Health Infrastructure
Development Paradigm for Countries
The future of health infrastructure lies not only in how systems are powered, but in who powers them and why. The new development paradigm redefines success beyond access metrics, toward an architecture of agency, inclusion, and accountability. Electrifying clinics is no longer sufficient; the challenge now is to ensure that energy becomes a platform for empowerment, where resilience is co-created, not delivered.
At its core, health equity is an outcome of design, not charity. When energy systems are inclusive, participatory, and gender-balanced, they do more than keep the lights on; they recalibrate who holds power within development processes. Every solar array on a rural clinic roof and every digital monitoring dashboard in a district health office represents a shift toward distributed authority, toward communities that are no longer passive recipients, but active custodians of their own resilience.
Local agency is the connective tissue of this transformation. In communities where women manage microgrids, where technicians are trained from within, and where data transparency allows citizens to monitor system performance, the boundaries between “provider” and “beneficiary” blur. Development becomes an iterative, self-correcting process, grounded in shared responsibility and collective intelligence. The same frameworks that sustain electricity also sustain trust.
This evolution carries profound governance implications. Inclusive energy systems don’t just electrify clinics; they reconfigure how institutions learn, adapt, and respond. They make governance more relational, defined by participation, not hierarchy. When rural health facilities can maintain 24-hour operations through community-managed solar networks, resilience becomes less about external aid and more about internal capability.
This is the essence of the new paradigm: development as co-creation. It’s not a transition from darkness to light, but from dependence to dignity, a movement that measures progress not by infrastructure built, but by capacity sustained. The ultimate indicator of success will not be the megawatts installed or facilities connected, but the communities empowered to maintain and expand them.
