PowerTrace

It takes a coordinated effort to treat patients and save lives: nurses, surgeons, administrators, and maintenance staff. But when hospitals in low- and middle-income countries (LMICs) lose both grid and backup power, nobody can do their job, and patients' lives are at risk. Grid electricity can fail at any time, so hospitals rely on diesel-fueled generators to keep things running. But backup generators fail too—and when a full blackout occurs, lives are at stake.

Unreliable power is a barrier to health equity. Close to 1 billion people are served by health facilities with unreliable or no power at all. More than 40% of surgical facilities in sub-Saharan Africa have unstable power. Hospital blackouts are a common impediment to healthcare delivery in LMICs, and a major source of stress and anxiety for hospital staff in every role.   Frequent grid outages tax the backup generators in these points of care, and resource-strapped personnel struggle to manage the generators with limited information about when or how often they’re running. This means hospitals with ICUs, surgery theaters, and other continuous power requirements experience full blackouts, which jeopardize patient lives.

The issue goes beyond mere inconvenience. It intersects with various socio-economic and health-related factors, exacerbating existing healthcare disparities and hindering efforts to improve health outcomes. Modern healthcare heavily relies on electricity to power medical equipment such as ventilators, incubators, and surgical tools. Without reliable power, these crucial services become unreliable or unavailable, putting patients' lives at risk and hindering efforts to address both communicable and non-communicable diseases. In regions with limited or inconsistent electricity access, childbirth often occurs in poorly lit environments without necessary medical equipment, increasing the risk of complications and adverse outcomes for mothers and babies.

Staff stress the criticality of detecting grid failures promptly to avert potential fatalities during surgeries or critical care. The unpredictability of outages amplifies budgetary challenges, with diesel fuel costs soaring, straining hospital finances. The absence of outage information exacerbates administrative burdens, fueling tension among staff and complicating procurement processes. The cumulative effect is a healthcare system operating on the brink, where each blackout threatens patient safety and strains already limited resources. Addressing this challenge requires proactive solutions that provide real-time outage alerts, empowering healthcare professionals to maintain uninterrupted services and enabling administrators to mitigate financial strain.

Biomedical Engineers (BioMeds) and Medical Superintendents (MedSups) grapple with the consequences daily. BioMeds, responsible for maintaining crucial medical equipment and power supply, face the daunting task of managing backup generators amidst grid failures. As one BioMed told our team: “You know it can cause death…. It has actually caused death. Let's say it's an operation in theatre. And you don’t know that you had little fuel left, and your generator sucks in air. Even if you rush to the petrol station and collect fuel, you will have to remove that airlock which takes time and the patient is on the table… which could lead to the patient dying for no reason.” 

Nexleaf’s PowerTrace power monitoring device is a remote sensor that continuously monitors grid power supply and integrates with a notification system to send SMS alerts to users’ phones within one minute of a detected outage. The monitor automatically checks the status of available backup power sources (e.g., diesel-powered generators) and triggers a second alert if the backup fails to activate within five minutes of the grid outage. SMS alerts can be customized for different recipients, including biomedical engineers, facility administrators, and district managers. These real-time alerts are a game-changer for health care workers. BioMeds can immediately check on back-up generators in the event of a grid outage to ensure they have enough fuel to keep working without interruption. Restarting a generator that has run out of fuel is an arduous, time-consuming task, so the grid outage alerts alone are a major boon for BioMeds, who are generally nowhere near the back-up generator powerhouse and do not otherwise know when they are burning fuel. Real-time alerts to hospital administrators give them the information they need to immediately contact the power utility as soon as an outage starts, and provide up-to-the-minute information that enables the utility workers to address the outage swiftly. Our devices record detailed power outage data on the timing and duration of both grid and generator outages, allowing for trend analysis using our customizable PowerTrace dashboard application. This ensures timely action in the event of power disruptions and helps decision-makers pursue off-grid electrification projects that address specific facilities’ power challenges.

Nexleaf’s PowerTrace health facility power monitors offer a proven solution that will infuse all levels of a country’s health infrastructure with the data to drive context-specific clean energy investments and evaluate the impact of clean energy resources once they are deployed. Our tech is the culmination of 10+ years of collaborative research and innovation in low-resource settings, where end users inform the design and deployment of our products. We have tested our hardware and software in health facilities in Kenya, where power outages are a daily challenge for staff and patients. 

Health workers report that PowerTrace enables them to keep medical equipment online longer by ensuring backup generators run reliably and efficiently. Hospital administrators have used the data generated by our devices to make the case for strategic resource investments, bolstering the ability of their facilities to deal with chronic energy shortages. Expanding our system to more health facilities will replicate this effect, facilitating immediate action to safeguard vaccines and making the business case for pursuing affordable grid alternatives like facility solarization. The resulting climate and sustainability benefits are manifold: First, improved generator usage forecasting will help facilities budget for fuel consumption and resolve grid outages more quickly, leading to decreased diesel emissions. Second, data on outage patterns will unearth opportunities for smoother operations and maintenance practices, including procurement of outage-proof fridges and transition to clean energy sources like solar. Third, data visibility enables efficient, resilient health systems that deliver a better standard of care to patients. 

While health workers are the users of our innovation, all patients in the health system are the ultimate beneficiaries. Data-driven infrastructure management helps to build a more effective, resilient nationwide health system that delivers consistent care and ensures economic and environmental sustainability. Specific users include:

Biomedical Engineers: Biomedical Engineers (BioMeds) manage, maintain, and fix equipment in hospitals, and they are also generally responsible for backup power management (generators). They are the primary users of PowerTrace, and direct feedback from these users informed how this intervention was designed. Nexleaf and its partners in this project originally set out to measure the impact of real-time data on total power outages, or blackouts. The BioMeds suggested we also place a sensor that could detect when the grid went out and power shifted to the generator, triggering an SMS alert. This innovation, suggested by BioMeds, has proven to be the primary benefit of the application. The BioMeds our team has interacted with over the years are dedicated professionals with difficult jobs and very little leverage to advocate for resources. Tools like PowerTrace have proven especially helpful for BioMeds who might otherwise be unaware of problems they’re responsible for solving, and with little recourse to their supervisors to appeal for the necessary resources. 

Medical Superintendents / Hospital Administrators: The burden of patient outcomes falls on these roles. They are responsible for stretching budgets, coping with shortfalls that can result in health workers not getting paid for months, and trying to keep the lights on and equipment working to provide basic care. Equipment and power data help them make informed procurement decisions, advocate for improved resources, follow up with care providers on equipment usage patterns, and liaise with grid power providers to get the power back on in the event of a grid outage (which happens frequently).

RIVOs and DIVOs: Regional Immunization and Vaccine Officers (RIVOs) and District Immunization and Vaccine Officers (DIVOs) are responsible for tens of thousands of dollars of vaccines at the regional and district levels. They need better information and tools to help them manage a complex distribution system complicated by last-minute planning, fuel budget shortages, and ad-hoc elements (like vehicle availability). With vaccine distribution planning dependent on an increasingly unpredictable weather season schedule, RIVOs and DIVOs need planning resources that take a variety of data types, including weather data, into account. 

MoH Personnel / National Directors (e.g. EPI Director): National personnel need specific, real-time equipment and power data to advocate for and allocate the resources needed to improve on the status quo of their health systems. Higher-level personnel in the MoH have used PowerTrace power data to make the case for the solarization of an entire hospital that was also used to store vaccines, to demonstrate the cumulative savings over generator diesel fuel and potential cost of both vaccines lost and disruptions in care due to frequent grid outages.

PowerTrace was first suggested by BioMeds who told us they wanted to get alerts not when the power went out, but rather when the grid power went out and the backup generators came on. This type of feedback loop is central to how Nexleaf operates as a non-profit technology company,  with 39% of our team (18 out of 46) based in East Africa and nearly 20% (9 out of 46) based in South Asia, we are able to develop close partnerships with Ministry of Health workers at every level of a health system - from facility-level technicians up to senior administrators. Nexleaf brings together technologists with experience in public health and development implementers, achieving adoption of our digital solutions through tireless engagement with users and refinement of our tech. 

Nexleaf’s approach is unique to the sector, as we work directly with Ministries of Health to develop our hardware, dashboards, and data visualizations, ensuring that they are positioned to support data-driven resource investments for safer and greener vaccine storage. We build software and data solutions that integrate with existing national health information systems, avoiding data silos. We share lessons from our work with any country that can put them to use, regardless of the devices or technologies they use. Our focus on sharing data insights and amplifying the voices of people on the ground enables us to build trusted cross-sector partnerships, and our commitment to affordability allows countries to sustain a long-term budget for our services, ensuring a lasting impact.

Our PowerTrace team draws on various areas of experience, comprising engineers, public health experts, and program implementation specialists based in Kenya, Tanzania, and the United States. The Team Lead for PowerTrace, Ednah Kiome, is Kenyan and is based in Nairobi where she works regularly with workers at every level of the Ministry of Health to ensure that our solutions are meeting the needs of their facilities. Our Product Manager, Amos, has extensive experience in public health interventions and health system strengthening in LMICs. His deep understanding of issues affecting health facilities and his collaborative relationships with various users, from national stakeholders to biomedical engineers, provide valuable insights in designing and delivering the solution.

PowerTrace has been user-tested and is ready to scale to health facilities locations in Kenya within 6-12 months. The technology is currently used at 22 hospitals in 10 regions, with 46 health workers subscribed to receive SMS power alerts and 24 data dashboard users. Because we are currently exploring the appropriate business model, we have selected Pilot for the current stage of our solution. 

Nexleaf conducted a nine-month pilot study in Kenya, deploying PowerTrace IoT devices at eight county hospitals. Each hospital was equipped with two devices: one to monitor grid power and the other to monitor backup generator power. When Nexleaf’s system detected an outage, our partner organization, PagerDuty, provided real-time text message alerts to biomedical engineers and medical superintendents, informing them of grid lapses, generator uptake, and outage resolution. After evaluating the results of this pilot, we began expanding PowerTrace to an additional 14 facilities. 

Data from our pilot study found that the average hospital went without power for about 20 hours per month. Biomeds and hospital administrators who received SMS outage alerts and data dashboard access reported wide-ranging benefits, including fewer generator problems, reduced fuel consumption, the ability to seek faster resolution with the grid operator, and increased morale and cooperation among workers. Our Power of Outage Alerts report offers an overview of the study, including direct feedback from the people it benefitted.

Pilot results from Kenya indicate that facilities can cover the cost of PowerTrace with the diesel fuel cost savings the solution affords. To further develop the solution, we need support in devising a pricing structure and a pitch strategy. We are also seeking to expand and diversify our board with more members from the geographies we serve. 

As technologists, we iterate, fine-tune, and interact with users constantly to ensure our solutions work for the people who use them. We understand that when data-driven solutions prove effective for users and integrate into workflows, then systemic improvement and improved patient care will follow.

By gathering feedback from every level of the system we strive for continuous iteration to make our products and data as useful as possible. Including through:

• Real-time Monitoring and Alerts: PowerTrace offers real-time monitoring of grid power supply. It integrates with a notification system to send SMS alerts to users' phones within one minute of detecting an outage. This rapid response capability enables healthcare workers to take immediate action to mitigate the impact of power disruptions on patient care.

• Integration with Backup Power Sources: PowerTrace goes beyond simply monitoring grid power supply by automatically checking the status of available backup power sources, such as diesel-powered generators. If a backup fails to activate within five minutes of a grid outage, a second alert is triggered. This integration ensures continuity of power supply during critical moments, enhancing the reliability and resilience of healthcare facilities.

• Customizable Alert System: SMS alerts can be customized for different recipients, including biomedical engineers, facility administrators, and district managers. This tailored approach ensures that relevant stakeholders receive timely notifications, facilitating coordinated responses to power outages and enabling more efficient resource allocation.

• Detailed Data Collection and Analysis: PowerTrace records detailed power outage data, including the timing and duration of both grid and generator outages. This data allows for trend analysis using a customizable dashboard application, enabling healthcare facilities to identify patterns and make informed decisions to improve energy management and infrastructure planning.

• Potential for Broader Positive Impacts: PowerTrace empowers decision-makers to pursue off-grid electrification projects tailored to specific facilities' needs. The data generated by PowerTrace can inform energy planning initiatives and catalyze investments in clean energy solutions, ultimately improving energy access and resilience in underserved communities beyond the healthcare sector.

• Market Shaping: As more healthcare facilities adopt PowerTrace and similar innovative solutions, the market for power monitoring devices and related services is likely to expand, driving competition and innovation in the sector. PowerTrace's emphasis on data-driven decision-making and sustainability could influence broader trends in energy management practices, contributing to a more resilient and environmentally sustainable healthcare infrastructure globally.

Nexleaf’s approach is unique to the sector, as we work directly with Ministries of Health to develop our hardware, dashboards, and data visualizations, ensuring that they are positioned to support data-driven resource investments for safer and greener vaccine storage. We build software and data solutions that integrate with existing national health information systems, avoiding data silos. Our focus on sharing data insights and amplifying the voices of people on the ground enables us to build trusted cross-sector partnerships, and our commitment to affordability allows countries to sustain a long-term budget for our services, ensuring a lasting impact.

By continuously monitoring the power supply in healthcare facilities and sending alerts during outages, healthcare workers will be able to respond quickly to keep essential medical equipment running, improving patient care and safety. 

By providing real-time data on the amount and duration of power outages, facility administrators will be better able to budget for fuel and other costs associated with maintaining generators, ensuring that scarce resources can be allocated efficiently.

By collecting detailed data on power outages, PowerTrace enables decision-makers to invest in better energy solutions tailored to each facility's needs. As a result, healthcare facilities become more resilient to power disruptions, leading to better health outcomes for communities.

Power supply problems are clearly a primary impediment to healthcare delivery in LMICs. Nexleaf is committed to helping countries address grid inadequacies, strengthen backup power resources, build the case for alternative energy options, and deploy modern information systems for managing an uncertain power landscape. This work is critical to patients' lives and an essential component of quality care access for all.

We envision health systems that deliver safe, reliable health care to all patients with minimal environmental cost. To make healthcare delivery safer and greener, countries need accurate, timely electricity data to support operations and equipment maintenance and make permanent investments in reliable health facility infrastructure. We believe that PowerTrace data from vaccine storage locations will support facility solarization as a cost-effective and dependable primary or back-up electricity source, leading to safer vaccine conditions and a reduced carbon footprint for the healthcare sector. Key indicators include:

• # of HCWers receiving alerts/ benefitting from the tech

• # of health facilities served

• reduction of blackout power outages to 0

• reduction of diesel fuel costs in $$$

• reduction of diesel generator emissions

Nexleaf’s PowerTrace power monitoring device is a remote sensor that continuously monitors grid power supply and integrates with a PagerDuty-enabled notification system to send SMS alerts to users’ phones within one minute of a detected outage. The monitor automatically checks the status of available backup power sources (e.g., diesel-powered generators) and triggers a second alert if the backup fails to activate within five minutes of the grid outage. SMS alerts can be customized for different recipients, including biomedical engineers, facility administrators, and EPI managers.

In addition to providing real-time alerts to health workers, our devices record detailed power outage data on the timing and duration of both grid and generator outages, allowing for trend analysis using our customizable PowerTrace dashboard application.

The PowerTrace base station is physically durable and relies on the 2G cellular network, which is relatively inexpensive and widely accessible even in regions with limited network infrastructure. The base station includes NB-IoT technology, known for low power consumption, and simplifies integration with existing cellular infrastructures such as 2G, 3G, or LTE networks. This feature ensures a smoother and more cost-effective rollout, making our innovation future-proof. The base station battery can last up to 7 days between charges, ensuring that data is consistently transmitted during power outages that last up to a week.

PowerTrace tech comes with robust installation and support materials in the relevant local language. Nexleaf devices have been deployed in more than 30 countries across Africa and Asia, and our team has extensive experience adapting marketing, training, and customer support materials for local settings.

Our PowerTrace team of 6 draws on various areas of experience, comprising engineers, public health experts, and program implementation specialists based in Kenya, Tanzania, and the United States. All staff work part-time on the solution.

2 years

Nexleaf has an interdisciplinary team of 46 full-time employees, with 39% of our team (18 out of 46) based in East Africa and nearly 20% (9 out of 46) based in South Asia. The East Africa-based Nexleaf customer and product teams that enable this mission are female-led, as are the majority of management-level roles across our global organization. The PowerTrace Team and Technical Leads are both Kenyan women. The PowerTrace Team Lead, Ednah Kiome, sits on Nexleaf’s Leadership Team, along with our CEO, Head of Customer, and Director of Manufacturing and Logistics, all women of color.

Nexleaf has partnerships with Ministries of Health in dozens of countries and a long track record of working with multilateral organizations to develop and scale our innovations. For our power monitoring work, a newer area of Nexleaf development, we have partnered with stakeholders in the Kenyan health system and received a $100,000 grant and in-kind support from PagerDuty, whose digital operations platform enables our SMS alert system.

Additionally, we raise funds from foundations and institutional donors to support our work. Our ColdTrace solution, remote temperature monitoring devices, generate revenue via sales Ministries of Health through Unicef and other multi-lateral organizations 

• Improve scalability PowerTrace 

• Obtain PQS certification through Unicef to expand access by Ministries of Health

• Raise funds from multi-year, catalytic grants from iNGOs / family foundations in the Data Science for Good and Digital Health spaces

• Develop a pipeline for revenue from contract-based work with development partners