Last week’s U.N.-sponsored report on tracking Sustainable Development Goal 7 brought some good news. The number of people without access to electricity has fallen from 1.2 billion in 2010 to 789 million in 2018. But the report also noted that many public facilities still lack access. The most recent cross-country data on electricity access in health facilities suggests that 25 percent of health clinics in six surveyed countries (Cambodia, Myanmar, Nepal, Kenya, Ethiopia, and Niger) lack any electricity access at all—virtually the same ratio reported in a similarly comprehensive cross-country survey nearly 10 years ago. Furthermore, only 28 percent of clinics and hospitals report having reliable electricity.
上週，關於聯合國贊助追踪的可永續發展的「目標7」報告帶來了一些好消息。無法獲得電力的人數從2010年的12億下降到2018年的7.89億。但是該報告還指出，許多公共設施仍然缺乏電力。有關醫療機構電力供應的最新跨國數據顯示，在六個被調查國家（柬埔寨，緬甸，尼泊爾，肯尼亞，埃塞俄比亞和尼日爾），有25％的衛生所根本沒有電力供應–這與在將近10年前進行的一項類似的綜合跨國調查中報告的比率基本相同。此外，只有28％的診所和醫院回報有可靠的電力。
Reliable power is critical for effective responses to COVID-19 and other diseases. Virtually all diagnostic tests for active COVID-19 infection currently require electricity. Patients who need further diagnosis (e.g., pulse oximetry) or treatment with ventilators or oxygen masks have to be placed in clinics with reliable power; outages for even a few minutes can be life-threatening. Besides, electricity powers sanitization and cleaning equipment like autoclaves and air filtration and, in some places, pumped clean water. These are necessary for preventing the spread of infection among patients and medical workers.
可靠的電源對於有效應對COVID-19和其他疾病非常重要。幾乎所有針對源自COVID-19感染的診斷測試目前都需要通電。某些需要進一步診斷（例如脈搏血氧飽和度）、使用呼吸機或氧氣面罩進行治療的患者必須被安置在可靠的診所; 即使中斷幾分鐘，也可能危及生命。此外，電力還被用於消毒和清潔設備，例如高壓滅菌器和空氣過濾，以及在某些地方需要輸送清潔的水。這些對於防止感染在患者和醫務人員中傳播是不可少的。
Some African countries have demonstrated remarkably successful responses to COVID-19, leveraging institutions and assets built during previous polio and Ebola outbreaks. Still, improving power reliability to health facilities should be a big part of the short-term policy response to COVID-19 in sub-Saharan Africa. Over the longer term, better access to reliable and sustainable electricity at health facilities is central to programs for increasing health system resiliency and quickening economic recovery.
一些非洲國家利用了先前小兒麻痺症和伊波拉疫情爆發期間建立的機構和資產，已經展示出對COVID-19的大成功。儘管如此，在撒哈拉以南的非洲，對COVID-19的短期政策應對措施中，提高醫療機構的電力應該是非常的可靠。從長遠來看，在醫療機構中更好地獲得可靠和持續的電力，對於提高醫療系統的適應能力和加快經濟復甦的計劃至關重要。
THE POWER TO DETECT, TREAT, AND VACCINATE
檢測，處理和接種疫苗的能力
Electricity is just one of the many resources that enable health systems to detect, prevent, and treat infectious diseases; clean water, decent equipment, qualified staff, and medical supplies are also essential. But electricity generally has a lot to do with how effectively these resources work.
Problems with diagnosis and tracking in individual clinics can quickly lead to regional and national emergencies. Disease surveillance—the “eyes and brain” of infectious disease response—relies on electricity-dependent equipment for timely testing and sharing of information. Health facilities with limited access to power and communications systems inevitably struggle with diagnosis and transmission of case reports to central authorities, rendering them blind and mute. The results are delays in detecting and responding to outbreaks early, before they spin out of control.
電力只是使衛生系統能夠被檢測，被預防和治療傳染病的眾多資源之一；乾淨的水，堪用的設備，合格的人員和醫療用品也很重要。但是，電力通常與這些資源的有效運作有很大關係。
個別診所的診斷和追踪問題很容易導致地區和國家的緊急情況。疾病監測（即傳染病追蹤的“眼睛和大腦”）依賴於電力相關設備來及時測試和分享信息。不可避免地，難以獲得電力和通信系統的醫療機構難以診斷和將病例報告傳送給中央，使他們如同喑啞般的無法在狀況內，導致無法在爆發失控之前及早發現和應對。
A study of tuberculosis clinics in southwest Ethiopia found, for example, that in places with frequent power interruptions, TB diagnostic tests that normally provide results in two days took more than a week to process. This led clinic staff to refer patients to more distant health facilities, requiring patients to ride on crowded public buses and risking more transmission. Others, unable to afford the travel or time away, simply returned to their communities, risking their own health and that of others.
例如，對伊索比亞西南部結核病診所的一項研究發現，在停電頻繁的地方，通常在兩天內提供的結核病診斷測試結果需要花費一個多星期的時間才能完成。這導致診所工作人員將患者轉診到更遠的醫療機構，以及要求患者乘坐擁擠的公共巴士，並有更多傳播的風險。其他人無力負擔旅行或時間，只能冒著自己和他人健康的風險，返回社區。
Another example: A study of 33 hospitals in 10 countries found that unreliable power was the single most common cause of medical equipment failure. Facilities with on-demand power are significantly less likely to have medical equipment with high levels of contamination. But electricity access affects human capital, too. Health care workers prefer living in villages with access to electricity, and this in turn reduces absenteeism. Research on job satisfaction among health care workers finds that electricity deficits turn simple tasks like putting in an IV line into frustrating challenges. In the study, nurses and doctors expressed fear for their own lives as they handled blood samples and other potentially contaminated fluids when working in the dark.
另一個例子：對10個國家中的33家醫院研究發現，不可靠的電力是醫療設備故障的最常見原因。具有正常供電的醫療設施使用高污染程度的醫療設備的可能性降低許多。但是，電力供應也會影響人力成本。醫護人員更喜歡住在有電的村莊，這反過來減少了缺勤率。衛生保健工作者對工作滿意度的研究發現，電力短缺使簡單的任務，例如使靜脈輸液管變得很困難。在這項研究中，護士和醫生在暗處工作時對於在處理血液樣本和其他可能被污染的液體時，表達了對自己生命健康的恐懼。
Vaccines commonly spoil if not kept between 2 and 8 degrees Celsius, so powering a cold chain will be critical to delivering a COVID-19 vaccine when it becomes available, as well as safely moving medications, biological samples, and blood for transfusions. In many parts of sub-Saharan Africa, health workers pack vaccines for diseases such as polio and measles into portable coolers and travel across unpaved roads—a major challenge that emerged in delivery of the Ebola vaccine in West Africa—to villages where they go door to door to vaccinate children. They can go only as far as the ice will last.
如果不保持在2到8攝氏度之間，疫苗通常會變質。因此，為運輸的冷藏鏈供電對提供COVID-19疫苗以及安全運輸藥物，生物樣品和血液以進行輸血至關重要。
在撒哈拉以南的非洲許多地區，衛生工作者將小兒麻痺症和麻疹等疾病的疫苗包裝到便攜式冷卻器中並穿越未鋪砌的道路，到達了他們所要進入的村莊給孩子接種疫苗。他們只能走到冰層仍存在的地方，這是在向西非運送伊波拉疫苗時出現的主要挑戰。
Vaccinations against diseases like the coronavirus that can readily mutate must be adapted regularly or given multiple times, underscoring the importance of last-mile electrification. And even before vaccines leave a refrigerator, unreliable power can render them unusable. The WHO estimates that nearly 50 percent of freeze-dried and 25 percent of liquid vaccines are wasted each year, in large part due to cold chain electricity disruptions.
對易於變異的冠狀病毒等疾病的疫苗必須定期或多次接種針，這點強調了最後一里供電的重要性。即使疫苗尚未離開冰箱，不可靠的電源也會使其無法使用。世界衛生組織估計，每年浪費近50％的凍乾疫苗和25％的液體疫苗，主要是由於運輸的冷藏鏈中斷。
Even after the current crisis abates, lack of access to reliable power will pose challenges. Low water levels at Zimbabwe’s largest hydroelectric plant last year led to routine power cuts at virtually every clinic outside the largest referral hospitals, so pregnant women across the country were asked to bring candles to provide light for giving birth. In many countries, reports of surgery by light from candles, kerosene lamps, and mobile phones when the power goes out are all too common.
即使在當前的危機減輕後，仍然無法獲得可靠的電力仍然是個挑戰。去年，辛巴威最大的水力發電廠的低水位，幾乎導致除了最大的轉診醫院以外的每個診所都被例行停電。因此，全國各地的孕婦都被要求帶上蠟燭以提供分娩所需的光。在許多國家，停電時使用蠟燭，煤油燈和手機進行手術的報導十分常見。
OFF-GRID SYSTEMS SHOULD BE IN EVERY PANDEMIC FIGHTER’S PLAYBOOK
斷電時的系統應該出現在每個對流行病的戰鬥者的手冊中
Extending electrical grids to thousands of clinics in rural communities will take years if not decades. Fortunately, the options for rapidly deployable energy solutions have increased a lot in recent years. Massive declines in solar and battery costs combined with the advent of remote management systems have created a vibrant off-grid energy sector that already provides services to over 250 million Africans. While most customers use small solar lighting devices, larger solar and solar-diesel systems can provide a reliable, grid-like energy experience for a range of applications that includes health care facilities.
將供電網擴展到農村社區的數千家診所將需要數年，甚至數十年的時間。幸運的是，近年來，可快速部署的能源解決方案選擇已大大增加。太陽能和電池成本的大幅下降，加上遠端管理系統的出現，造就了一個活躍的電力自行供給能源部門，該部門已經為超過2.5億非洲人提供服務。儘管大多數客戶使用小型太陽能照明設備，但大型太陽能和太陽能柴油系統可以為包括醫療保健設施在內的一系列應用提供可靠的網狀電能體驗。
Off-grid systems are forecast to be the low-cost electricity solution for more than 70 percent of rural people currently lacking access. And they can be quick to install. In Nigeria, for example, the Rural Electrification Agency and private firms recently constructed four solar minigrids at hospitals treating COVID-19 patients in just two weeks. These systems, which can reliably accommodate the needs of hundreds of patients, will outlast the pandemic, with operational lifespans pushing 20 years if they are properly maintained and batteries are replaced every five to seven years.
「非靠電網供電系統」預計將是目前70％缺少電力的農村人口的低成本電力解決方案，而且它們可以快速安裝。例如，在奈及利亞，農村電氣化局和私營公司最近在短短兩週內就在為COVID-19患者治療的醫院中建造了四個太陽能微型電網系統。這些系可靠地滿足數百名患者的需求，它將比疫情更持久，如果維護得當，並且每五到七年更換一次電池，其使用壽命將延長20年。
Now may be the ideal time to commit resources to power off-grid health facilities for another reason: The off-grid sector is facing unprecedented financial pressure. The economic crisis is making it difficult for African energy customers to pay their bills. New orders are drying up, investment is slowing, and many of these companies are running out of cash. Nearly 370,000 jobs are at risk sector-wide.
另一個原因，現在也是投入資源於「非靠電網醫療設施系統」的理想時機：不靠電網的行業正面臨前所未有的財務壓力。經濟危機使非洲能源客戶難以支付賬單。新訂單枯竭，投資放緩，許多公司的現金都快用光了。全行業將近370,000個工作處於危險之中。
Governments and donors are recognizing the opportunity to put this slack capacity to work to build resilient health care systems. Notably, USAID is supporting off-grid developers to provide reliable energy to clinics across sub-Saharan Africa. The World Bank and its partners are looking at how to redirect energy programming to incorporate health facility needs.
各國政府和捐助者正意識到有機會來建立有韌性的衛生保健系統。值得注意的是，美國國際開發署正在支持非靠電網開發人員，為撒哈拉以南非洲各地的診所提供可靠的能源。世界銀行及其合作夥伴正在研究如何重定能源計劃，以納入醫療機構的需求。
ELECTRIFYING HEALTH CARE
電器保養
Meeting short- and long-run health sector needs requires systemic planning across sectors and better data. As frightening as it is that 10 countries in Africa have no ventilators whatsoever, this is just one symptom of the institutional and infrastructure gaps that existed well before the present crisis.
要滿足衛生部門的短期和長期需求，就需要跨部門的系統規劃和更好的數據。令人恐懼的是非洲有10個國家根本沒有通風機，這只是在目前危機之前就已經存在的體制和基礎設施差距的症狀之一。
In many cases, the authorities simply lack information about which clinics suffer from electricity deficits. The WHO, World Bank, USAID, Gavi and national governments all collect data on health centers’ energy access, but data are absent in some countries and nearly a decade old in others. Better-integrated governments can be a big help; one in-progress survey we know, in Uganda, is supported by both the ministry of energy and ministry of health. The WHO, IRENA, World Bank, and Sustainable Energy for All plan to commission a global assessment of data on electricity access, reliability, and demand in health care facilities. This will inform decisionmaking by serving as a benchmark against which progress in electrifying health care facilities can be measured.
在許多情況下，當局只是缺乏哪些診所遭受電力短缺的信息。世衛組織，世界銀行，美國國際開發署，全球疫苗免疫聯盟和各國政府都在收集有關衛生中心能源獲取的數據，但在某些國家/地區缺少數據，而在另一些國家則已有近十年的歷史。整合程度更高的政府會大有幫助；我們知道，在烏干達，一項正在進行的調查得到了能源部和衛生部的支持。世衛組織，國際再生能源組織，世界銀行和(全民可持續能源計劃組織)委託對有關醫療設施的電力供給、可靠性和需求的數據進行全球評估。這將透過作為衡量醫療設施電氣化進度的基準，來為決策提供依據。
We need more research on effective ways to electrify health facilities. A review of nearly 80,000 papers on energy access and transitions identified fewer than twenty that discuss how energy services enhance health care. With competing demands in low-income countries, a strong evidence base is needed to galvanize high-level policy and financial support and break down silos across the energy and health sectors.
我們需要對使醫療機構電氣化的有效方法進行更多研究。對近80,000篇有關能源獲取和轉換的論文進行的審查發現，只有不到20篇討論能源服務如何改善醫療保健的論文。在低收入國家，由於競爭激烈的需求，需要強有力的證據基礎來激發高層政策和財政支持，並打破能源和衛生部門的孤軍奮戰。
COVID-19 has exposed the interrelated nature of crisis response and recovery. In Africa, where so many challenges lead back to energy access, gaps in basic infrastructure like electricity create serious vulnerabilities. Remedying electricity access in health facilities in response to COVID-19 brings us a step closer to ending the vicious cycle of panic and neglect in preventing deadly diseases.
COVID-19展示了危機應對能力和恢復力的相互關聯的性質。在非洲，如此多的挑戰又導致了能源需要更多的獲取，在電力等基礎設施方面的不足造成了嚴重的設施脆弱性。呼應這次COVID-19，對醫療機構的用電進行補救，將使我們更快結束在預防致命疾病上的恐慌和疏忽的惡性循環。
The authors gratefully acknowledge assistance and comments from Luc Severi (SEforALL); Gavin Yamey, Jonathan Phillips, and Marc Jeuland (Duke); and Michael Emch and Jonathan Parr (UNC).
作者非常感謝Luc Severi（SEforALL）的協助和評論；Gavin Yamey，Jonathan Phillips和Marc Jeuland（杜克大學）；以及Michael Emch和Jonathan Parr（UNC）。