Barriers, facilitators and strategies for implementing on-site hospital solar power in low- and middle-income countries: a systematic review, global prioritisation survey and development of an implementation tool

Introduction: Healthcare facility power-outages in low- and middle-income countries (LMICs) are common and affect patient outcomes. Decentralised solar energy has the potential to reduce power-outages in healthcare settings, yet adoption in LMIC remains modest. This study aimed to identify and prioritise the barriers, facilitators and strategies of on-site healthcare facility solar power implementation.

Methods: Methodology was conducted in three phases. In phase 1, a systematic review was completed to summarise barriers and facilitators to implementation of on-site solar power in LMIC healthcare facilities. Any qualitative or mixed-methods study relating to solar power installation from 2009 to 2024 in LMICs was eligible to be included. Barriers and facilitators were extracted from the identified studies and mapped to the Consolidated Framework for Implementation Research. In phase 2, the importance of these barrier and facilitator factors was contextually prioritised through an international survey of healthcare workers on a 5-point Likert scale. In phase 3, strategies were developed from these barrier and facilitator factors to create a solar implementation tool (SOLAR-IT).

Results: In phase 1, out of a total of 3678 individual records, 28 studies were included in the systematic review, from which 19 barriers and 29 facilitators were identified. In phase 2, the global survey was completed by 260 participants from 47 LMICs. The barrier with the highest ranked importance was the upfront capital expenditure of solar panel installation, while the most important facilitator was to reduce the cost of solar panels through government intervention. In phase 3, 23 strategies were synthesised within four domains to create the SOLAR-IT.

Conclusion: This study describes globally prioritised implementation factors and a strategy tool, which can enable teams to speed up implementation of on-site solar power in a time of extreme global need.