MEDIUM-SIZED PROJECT BRIEF
PROJECT IDENTIFIERS
1. Project name: Passive Solar Heating
for Rural Health Clinics
3. Country or countries in which the
project is being implemented: China
2. GEF Implementing Agency:
World Bank
4. Country eligibility:
Ratified FCCC on 5 January 1993.
5. GEF focal area(s):
Climate Change
6. Operational program: OP 5 –
Removal of barriers to energy efficiency
and energy conservation
7. Project linkage to national priorities, action plans, and programs:
The proposed project supports the Government of China’s (GOC’s) priorities in the
health sector and is consistent with its priority greenhouse gas (GHG) control options.
With respect to GHG control, the project would reduce coal consumption at rural health
clinics by improving the energy efficiency of clinic buildings. Displacement of coal is the
primary mechanism for controlling GHG emissions in China, and improved building
energy efficiency has been identified as a priority in several GOC-supported studies1.
China’s plans to build 15,000-20,000 rural health clinics and thousands of schools and
community centers in the next five years is an opportunity to leverage substantial GHG
reduction through this proposed energy efficient health clinic demonstration project.
With respect to the health sector, the GOC has made a major commitment to improving
rural health clinics, as well as the planning, allocation, and utilization of health care
resources. During the 8th Five Year Plan (1991 – 1995), the (former) State Planning
Commission, Ministry of Finance and Ministry of Health (MOH) jointly organized the
Three Items Construction Program, aimed at rehabilitating township health centers as a
means of improving physical infrastructure and increasing patient use of the clinics.
Efforts were also made to rationalize allocation of health care resources and to increase the
efficiency of resource utilization. The Program was continued during the 9th Five Year
Plan, with increased attention and resources dedicated to rehabilitation of rural health
centers. In 1998, the GOC took a US$85 million credit from the World Bank for the Basic
Health Services (Health VIII) Project, including US$16 million for financing the
reconstruction and rehabilitation of over 1100 rural health clinics in 10 provinces, and
US$1 million for increasing the capacity to design and implement County Health
Resource Plans. This proposed project would complement Health VIII.
The implementing agencies for the Health VIII Project have worked with the World
Bank’s Asia Alternative Energy Program (ASTAE) to develop three passive solar heating
buildings/health clinics for pilot purposes. The pilots are complete and currently being
monitored. Results of the pilot will feed it to this proposed demonstration project.
8. GEF national operational focal point and date of country endorsement:
Mr. Yang Jinlin, Ministry of Finance
Submitted: Nov. 22, 1999 Acknowledged: Nov. 26, 1999 Endorsed: January 5, 2000
See Issues and Options in Greenhouse Gas Emissions Control, 1994, a joint study of China’s (former)
State Planning Commission and National Environmental Protection Agency, as well as the UNDP and the
World Bank.
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PROJECT OBJECTIVES AND ACTIVITIES
9. Project rationale and objectives:
Indicators:
1. Number of passive solar buildings
1. Stimulate health sector and other
community facility planners to
constructed by Ministry of Health
adopt passive solar building designs
and other government agencies.
2. Strengthen capacity of architectural
2. Number of energy-efficient passive
and engineering design institutes to
solar buildings designed by
design and build energy-efficient
architects and engineers.
passive solar buildings
3. Data on life-cycle cost advantages
3. Demonstrate the life cycle cost
of passive solar designs collected
advantages of energy efficient
and disseminated widely through
public awareness campaign
passive solar buildings in China
4. Coal use and CO2 emissions fall.
4. Reduce CO2 emissions
10. Project outcomes:
Indicators:
1. At least 30 new township health
1. Number of passive solar health
centers incorporate energy efficient
centers constructed under Health
passive solar design features.
VIII project.
2. Health and community facility
2. Passive solar building designs are
planners and architects become
published and widely disseminated
familiar with efficient passive solar
to health and community planners
building designs.
and to architects and engineers.
3. Energy efficient passive solar
3. Number of schools, institutional
designs replicated in other sectors.
and community buildings that
apply passive solar designs.
4. New township health centers use
significantly less coal, are more
4. Volume of coal use, internal air
popular, comfortable, and have a
quality, facility user numbers and
healthier indoor environment
comfort assessments.
11. Project activities to achieve
Indicators:
1. Energy-efficient passive solar clinic
outcomes (including incremental cost in
designs prepared and published.
US$ or local currency of each activity):
2. Energy efficient passive solar health
1. Develop appropriate designs for
clinic buildings demonstrated in
passive solar health clinics.
different regions.
(Incremental Cost $150,000)
3. Clinic building performance data
2. Construct about 30 prototype
collected and used to promote
passive solar clinics to demonstrate
passive solar design performance
the technology. (IC $200,000)
advantages and influence future
3. Performance monitoring and
building designs in China.
evaluation. (IC $175,000)
4. Awareness of benefits of passive
4. Outreach and promotion of the
solar design permeates through the
designs and their performance
health sector and spreads to other
advantages. (IC $125,000)
sectors.
5. Capacity building to give the design
5.
Core
of passive solar building design
institutes the design tools needed to
expertise created in China.
further develop the technology in
China. (IC $100,000)
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12. Estimated budget (in US$ or local currency):
PDF: $25,000
GEF: $750,000
Co-financing: $809,000
TOTAL: $1,584,000
INFORMATION ON INSTITUTION SUBMITTING PROJECT BRIEF
13. Information on project proposer:
The Project is proposed by the MOH’s Foreign Loan Office (FLO).
14. Information on proposed executing agency (if different from above):
FLO operates the national level project management office (PMO) for the Health VIII
Project and has been ASTAE’s primary counterpart for executing the pilot passive solar
heating buildings/clinics. Their experience with these previous efforts can be readily
leveraged for the proposed Project. In addition, they are in the unique position of being
able to coordinate efforts, which extend beyond provincial borders.
15. Date of initial submission of project concept: November 1999.
INFORMATION TO BE COMPLETED BY IMPLEMENTING AGENCY:
16. Project identification number: GM-P070161
17. Implementing Agency contact person: Robin Broadfield, GEF Coordinator, East
Asia and Pacific Region, World Bank. Tel. 202-473-4355.
E-mail:Rbroadfield@worldbank.org
18. Project linkage to Implementing Agency program(s):
GEF assistance to China for renewable energy development has focused primarily on
photovoltaic power and on utility level programs involving commercialization, market
expansion and improving equipment quality. GEF energy efficiency promotion assistance
has focused on developing energy service companies (ESCO) and improving end-use
efficiency in small-scale enterprises. This project combines aspects of both energy
efficiency and renewable energy promotion and focuses on public buildings in rural
areas. It thus complements and fills an important gap in the GEF’s ongoing energy
efficiency and renewable energy promotion activities in China.
As outlined in section 7, the proposed project is directly associated with the World Bank
Health VIII project and builds on that project’s pilot passive solar health clinic design
component. It also complements the World Bank’s on-going efforts to help China improve
energy efficiency and to prepare a large-scale commercial building energy efficiency
program for which China plans to seek GEF support in the near future.
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PROJECT DESCRIPTION:
Project rationale and objectives
The GOC is currently undertaking a major program of reconstruction and rehabilitation
of rural health clinics under the Three-Items Construction Program and the Health VIII
Project. While their building design manuals and guidelines include passive solar heating
features, these design features have rarely been incorporated in practice, despite previous
and ongoing ad-hoc efforts to promote them and their clear life cycle cost advantages.
Barriers to broad-scale use of the technology are: (i) limited awareness of the benefits of
passive solar heating among health sector planners and decision makers, (ii) shortage of
appropriate technical expertise within architectural and engineering design institutes, and
(iii) a lack of demonstrated and disseminated life-cycle cost savings and other benefits.
The proposed project will take advantage of the GOC’s large-scale health reconstruction
and rehabilitation programs to overcome these barriers and to promote the use of solar
heating designs throughout China’s rural health system and public building program.
The project addresses the GEF Operational Program Number 5 “Removal of barriers to
energy efficiency and energy conservation”. Greenhouse gas emissions from coal
heating of health clinics will be reduced by overcoming the barriers to large-scale
implementation of passive solar heating in health clinics built by the GOC Ministry of
Health. The project will address the three primary barriers identified above and will
demonstrate the cost benefit of passive solar heating in health clinics. This will lead to
widespread adoption of cost effective passive solar health clinic designs.
The proposed project supports the Government of China’s (GOC’s) priorities in the
health sector and relates to one of its priority greenhouse gas (GHG) control options.
Displacement of coal is the primary mechanism for controlling GHG emissions in China
and improved building energy efficiency has been identified as a priority for China in
several GOC-supported studies2.
The proposed energy efficient building design concept has been validated by three
prototype passive solar clinics, which were developed under the Health VIII Project, in
collaboration with the World Bank’s Asia Alternative Energy Program (ASTAE) for
proof-of-concept purposes. Three Chinese design institutes designed the prototypes with
technical assistance from an international passive solar building design consultant. Built
in 1999-2000, their performance is currently being monitored. The initial feedback from
clinic operators and users is very positive. An on-going evaluation of the prototypes will
feed into the detailed design of this proposed follow-on demonstration project. It would
construct about 30 pilot, energy-efficient, passive solar health clinics in three heavy coalusing provinces, develop Chinese passive solar building design and construction capacity,
and disseminate passive solar clinic and public building designs and their performance
widely throughout rural China. This would improve health clinic performance, reduce
coal consumption for heating, and thus avoid substantial CO2 emissions.
See Issues and Options in Greenhouse Gas Emissions Control, 1994, a joint study of China’s (former)
State Planning Commission and National Environmental Protection Agency, as well as the UNDP and the
World Bank.
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Current situation
Township Health Centers (THCs) in China provide basic health services for nearly 80%
of the rural population. The functions of THCs are primary care and referral, maternal
and child health, first aid, common disease diagnosis and treatment, disease prevention
and information collection, as well as supervision of village health workers. However, in
the poorer rural areas, bad conditions in the THCs, such as dirt, cold, poor indoor air
quality and obsolete equipment, have severely affected their service function.
In order to improve the facilities, improve health service delivery, and to assure basic
health services for the poor rural population, the Government of China has implemented
the Health VIII project in 71 counties in 7 provinces (Qinghai, Gansu, Shanxi, Henan,
Anhui, Guizhou, Chongqing). In addition to rural health resources planning, establishing
information systems, improving health services, and more effective disease intervention,
the Health VIII project is also building or rehabilitating 1102 Township Health Centers
(of which, 104 will be in Qinghai; 199 in Gansu; and 136 in Shanxi). These proposed
new buildings must meet the basic requirements stipulated in Health VIII “Criteria for
Township Health Center Construction” such as: properly laid-out, properly equipped,
healthy, safe and sanitary.
Most of the first THCs constructed under the Health VIII project, like older clinics, have
experienced severe heating problems, particularly those in the 3 coldest provinces of
Qinghai, Gansu and Shanxi, where heating is required for over 6 months of the year.
Coal is not locally available and transportation is difficult to these remote communities.
In addition, coal is expensive, which increases operating costs and limits service when
coal supplies are low. As a result of coal supply problems, the THCs are often too cold to
provide adequate health services. Another issue is the poor indoor air quality of the
THCs as a result of burning coal in poorly-designed coal stoves. The typical THC has a
coal stove in each room for cooking and heating. The stoves are poorly vented and the
threat of carbon monoxide and increased particulate levels qualifies many of the THCs as
“Sick Buildings”, making the indoor environment unsafe. In some counties, the high
fluoride content of the coal adds to the health problems caused by indoor pollution.
In 1999, with the help of the World Bank, FLO used grant money from the Asia
Alternative Energy Program to build three prototype passive solar heated clinics in
Huzhu county (Qinghai province), Tanchang county (Gansu province) and Tianzhen
county (Shanxi province) to test if they are a cost-effective answer to the heating, indoor
pollution and coal supply problems from which traditional clinics suffer.
During this prototype phase, three design institutes, local solar experts and consultants
were trained in energy-efficient passive solar building design. The prototypes provided
valuable hands-on experience for the three concerned design institutes, builders, and local
officials. Each prototype received widespread publicity and their performance impressed
users and both county and local officials. Significant reductions in coal consumption,
and hence in emissions of CO2, other gases, and in particulates, were also achieved.
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Preliminary results from prototype passive solar THCs.
The three prototype passive solar THCs, and three comparable non solar THCs, are
currently being monitored for indoor temperature, indoor air quality, passive solar system
performance and energy consumption. The measurement of indoor temperature, indoor
air quality, passive solar system performance and weather conditions is done with data
recorders that are read monthly. The energy data is collected from utility bills and
purchase records.
Based on the data available as of December 31, 2001, the prototype passive solar THCs
are performing well and are demonstrating significantly better indoor comfort, indoor air
quality and lower coal consumption than the conventional options. Specifically:
 Indoor temperatures in the passive solar THCs are typically comfortable during sunny
days without the need for a fire in the coal stove.
 The non solar THCs usually burn coal all day to maintain comfort. Carbon monoxide
sensors were installed in all 6 THCs to measure the CO indoors. The non solar THCs
had more incidents of high CO, which was directly related to the coal stove use.
 The energy consumption data does not cover a full winter at this time. However, it is
estimated that the passive solar THCs are using about 40% to 60% less coal for
heating than the non solar THCs.
The 3 prototype designs have provided valuable hands-on design experience for the
concerned design institutes, revealed implementation constraints, and offered some
valuable design and construction lessons that will be applied in this next proposed
demonstration/barrier removal phase, to be supported by this project. The primary issues
that were identified and would be addressed in the project are:
1. More consultation with users and staff during design development.
2. Space allocation and functionality – appropriate design reduces heating needs.
3. Quality control during construction.
4. Complexity of the designs. Simple designs work better.
5. Overhangs should be reduced in the colder climates.
6. Suitability of materials. Some materials used in the prototypes are not suited
for direct solar exposure and high heat.
7. Occupant training. Occupants must be trained in how to operate the buildings
to achieve maximum performance. This should start at the design stage.
In addition, there is a clear need to develop a greater range of clinic sizes and design
types, to reflect the varied conditions and needs of different townships in different areas.
For example, a 100% solar design is required for townships that have poor coal supply
and little or no electric service. In other words, more refined design tools should be and
will be introduced during the proposed project so that the designs can be better
engineered for specific climates.
Expected project outcomes, with underlying assumptions and context
This project will demonstrate and disseminate passive solar clinic designs, increase
Chinese capacity to incorporate passive solar heating into clinic design and construction
activities, and stimulate wide replication of passive solar building designs. This will be
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achieved by constructing and disseminating the designs and performance of 30 passive
solar health clinics and developing extensive capacity to construct them. As passive solar
heated health clinics use up to 80% less coal than is typically used for clinic heating, their
popularization will avoid significant greenhouse gas emissions.
The proposed project will target 33 counties located in colder provinces (Gansu, Qinghai,
and Shanxi), in which 300-400 health clinics will be rehabilitated or reconstructed under
the Health VIII Project. Assuming the pilot passive solar buildings perform as promised,
is anticipated that a significant proportion of the new or rehabilitated clinics will adopt
the passive solar design. The results of this proposed project would also be disseminated
to counties beyond those covered in the Health VIII Project. Efforts will also be made to
encourage application of the technology to other public buildings being constructed in
these areas (e.g., secondary schools, clinics not covered by the Health VIII Project, other
institutional and community buildings).
China’s provincial and county health bureaus, under supervision of MOH, currently
manage over 50,000 THCs and build or upgrade approximately 3-4,000 THCs per year.
Over the next 5 years, 15,000-20,000 THCs will be built. The energy efficient, passive
solar features to be developed in this project should be widely adopted in this building
program. If 80% of the new THCs built in the next 5 years incorporate the energy
efficient, passive solar features to be developed in this project, the coal savings would
total approximately 95,000-130,000 tons, resulting in CO2 emissions reduction of
approximately 190,000-260,000 tons per year. Also, the coal savings would result in
reduction of other pollutants such as NOx (600-800 tons per year), SO2 (1,600-2,100 tons
per year), CO (5,000-7,000 tons per year), and T.S.P (6,000-8,000 tons per year).
Other potential non-energy benefits include: increased utilization and quality of care in
THCs, which contribute to increased impact of the central health related strategies of
Health VIII project, and reduced risks of indoor air pollution.
Activities and financial inputs needed to enable changes
The proposed Passive Solar Health Clinic Project consists of 5 major components.
1.
2.
3.
4.
5.
Design and technical assistance
Construction of demonstration clinics
Monitoring and evaluation
Outreach, promotion and training
Capacity building
1. Design and Technical Assistance
An international passive solar consultant would work with the three design teams and the
architectural consultant for the Health VIII project to develop a range of standard, passive
solar design prototypes for Gansu, Shanxi and Qinghai Provinces. The prototypes will
include designs for small, medium and large health clinics. The prototypes will also
include designs with and without grid electric power. They will include at least one small
or medium design that is 100% solar heated.
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Convenient, computerized passive solar design tools are available to assist the design
teams in predicting the performance of the passive solar THCs before construction. The
US Department of Energy passive solar design tool “Energy 10” is representative of these
programs. Through a review of potentially appropriate tools, one will be selected and
then adapted for use in China and applied to the design of the passive solar THCs.
Design workshops will be held with the design teams in Beijing. The design workshops
will include, at a minimum, the three solar project design teams, the national solar expert
from the China Academy of Building Research, the international expert from the Health
VIII project, a representative from China National Health Economics Institute (local
project manager), an experienced THC medical director and the international passive
solar consultant. During the first workshop, the experience of the three pilot THCs will
be analyzed and new schematic designs and critical design details will be developed.
The objective of the design workshops will be to develop standard health clinic designs
that have the following characteristics:
 Incremental cost is minimized
 Thermal performance is maximized
 Size and functionality is appropriate for the needs of the community
 Cost efficient to operate
 Good indoor environmental quality
 Good daylight and ventilation
 Simple design to minimize construction impacts
 Uses local materials as much as possible
 Traditional design elements appropriate for the community
In addition to developing the prototype designs, the team will review the standard clinic
design guidelines and recommend changes that are appropriate to the passive solar
clinics. The new passive solar standard details will be included in the standard clinic
designs book.
Methodologies for passive solar clinic life cycle cost analysis, monitoring and evaluation
and for quality control will also be developed.
Follow up workshops will be conducted after the first year (first construction season) to
disseminate results and review proposed designs for the second year.
The incremental cost for this activity is US$150,000.
2. Passive Solar THC Construction,
Demonstration projects will be selected from among the proposed THCs to be built under
the Health VIII project. Sites will be selected in the three target provinces of Qinghai,
Gansu, and Shanxi that represent a variety of size and functional requirements. A mix of
large, medium and small clinics will be selected that is representative of the clinics to be
built by the Health VIII project. In addition to the test sites, existing baseline buildings
will be identified in each area for performance comparison. Baseline data for existing
THCs providing similar services in similar climate zones will be collected so that the
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impacts of the passive solar demonstrations can be measured. Data collected will
include: number and size of rooms, services provided, coal consumption, cost of heating,
indicators of building winter temperatures, numbers of patients treated, revenues, staff
turnover, indoor and outdoor temperatures, etc. Structured interviews and focus groups
will be used to learn views of government leaders, health staff and patients.
The standard approaches developed in Task 1 will be used to design the passive solar
demonstration THCs. A total of about 30 demonstration health clinics will be built from
the standard designs. Careful records will be maintained so that the standard designs can
be modified, based on feedback received during the design and construction phases.
The quality control aspects of the construction are critical to the successful performance
of the buildings. Under the Health VIII project regulations, the provincial design unit and
county quality supervision station are to supervise construction quality. Before the
demonstration project starts construction, each county quality supervision team will
participate in a quality control workshop conducted by the national and international
passive solar experts to review the critical aspects of the designs, to answer any questions
about the designs and to go over the quality control procedures and documentation
requirements.
During construction, each building will be photographed at different stages of
construction (during inspections) to document construction details that will not be visible
after completion. This information will be used later in the workshops. Photographs will
be sent to the international and national passive solar consultants for review.
After completion, each building will receive a full building commissioning, including
visual inspections, systems testing for proper operation and a blower door test to measure
building air tightness. The blower door test uses a fan to pressurize the building and by
measuring the pressure and air flow through the blower door, the air leakage rate for the
building can be measured. Also during the blower door pressurization, air leakage points
can be identified with a smoke stick and sealed on the spot. This procedure can
significantly tighten the building and improve its thermal performance and comfort. This
test can be performed by the international passive solar consultant who will also train the
national consultants.
As part of the final building commissioning, the occupants of the building will be trained
in the proper operation and maintenance of the building. The occupants will learn how to
operate the passive solar building to get the best performance and to maintain the highest
level of comfort. During the prototype phase it was found that the building occupants did
not understand how the building was designed to function and therefore were not getting
the most out of the design. With good occupant control, the passive solar buildings will
perform very well. This training will be assessed and reinforced with 1-2 follow up visits,
within the project period.
The incremental cost for this activity is US$200,000, including quality control activities.
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3. Monitoring and Evaluation
A monitoring plan will be developed for each building by the international passive solar
consultant. Each pilot building will be instrumented and monitored in the same way as
the first three prototype buildings were monitored. The monitoring will include:
 Indoor temperature and humidity in several zones.
 Outdoor temperature, humidity and horizontal solar radiation.
 Energy consumption (electric and coal if used and associated heating costs).
 Carbon monoxide (if coal space heaters are used).
 Temperatures in the solar energy system such as the sunspace, rock bed, floor, etc.
In addition, data on numbers of patient visits, revenues, cost of heating etc. will be
recorded. Simple surveys by questionnaire and focus group discussions with patients and
health staff will be used to assess their views on the quality of the THC and what
additional improvements in services and THC environment conditions they would like to
see. It will be important to know the patients’ views of the importance of building
comfort among factors that affect their decision to visit the THCs. The views of health
staff and managers on their work environment and its impact on service quality will also
be valuable.
The instrumentation will be installed during the final commissioning and blower door
tests. Data collection will be done locally and e-mailed to the national and international
consultants for analysis. The data will be used to evaluate the prototype designs, to make
design improvements and to evaluate the buildings’ economics. Weather data will also
be gathered and put into a weather database that will help design solar buildings in the
region. Currently, very little weather or solar data exists for these counties.
The incremental cost for this activity is US$175,000.
4. Outreach, Promotion and Training
The experience gained during the project will be well documented and disseminated in
order to promote the rapid adoption of cost effective passive solar designs. The main
components of the Outreach, Promotion and Training component are:
(1) Document the pilot designs with good illustrative graphics, photographs and a
narrative describing the design concept, key features, and performance aspects of the
building, including life cycle cost analyses and qualitative evaluations. Use this
documentation to develop a book of Passive Solar Health Clinic Designs. Encourage the
Ministry of Health and provinces to adopt the designs developed in this project as
standard health clinic designs, along with the revised THC design guidelines.
A dissemination plan for this book and the guidelines will be developed and costed.
(2) Conduct a follow up workshop with the original design teams to review the lessons
learned during the project. The original design teams will then become valuable resources
for passive solar design expertise
(3) Develop a Power Point presentation on Passive Solar Designs, with the demonstration
buildings as examples, and present at a national workshop. The workshop will include
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modules for government officials, designers and contractors. A small core of master
trainers will be selected and trained in the use of the modules. Trainers can then be
trained to deliver the workshops all over the country.
(4) The book of standard health clinic design details (book 98J3 (2)) will be reviewed and
revisions suggested to promote good thermal design details.
(5) The results of the project will be presented to the Ministry of Construction and MOH
for their consideration. The MOC will conduct a national publicity campaign to
influence other sectors, such as schools, housing and municipal buildings. The MOH and
the provincial Departments of Health will use the results of the pilot to encourage the
remaining new THCs to be constructed under the Health VIII Project to adopt passive
solar designs. A range of options will be explored to enable the most cost effective
elements of passive solar design to become “mainstreamed” into government programs.
The incremental cost for this activity is US$125,000.
5. Capacity Building
One of the primary objectives of this project is to develop the in-country capacity to
design and construct cost-effective passive solar buildings. The main elements of the
capacity building component of this project are:
(1) Passive solar design workshops for architects and engineers, and general workshops
on the benefits of passive solar design for officials and administrators. The members of
the solar design teams will conduct the workshops and the demonstration projects will be
used as the prime examples.
(2) Workshops to train architects and engineers in the use of the selected design tool
(such as Energy 10) and train trainers to conduct such workshops in the colder provinces
where THCs are being rehabilitated/built.
(3) An outreach program targeted at design and construction professionals involved in
health center construction.
The incremental cost for this activity is US$100,000
Sustainability/replication and risk
1. Sustainability and replication
Replication and sustainability of passive solar building designs hinges on achieving low
incremental construction cost and proven performance. Typically, operating costs are
borne locally while capital costs are paid from local, provincial/central government
budgets. With passive solar buildings, operating costs will be lower and revenues may be
higher, but capital cost may be slightly higher. And the benefits of reduced operating
cost are usually not realized by the provincial/central government. Therefore containing
the construction cost, which the project will do, will be critical to the replication and
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sustainability of passive solar buildings. The incremental capital cost and effectiveness
of different passive solar features will be carefully assessed to find optimal combinations.
Various options to minimize the incremental cost, such as marginally reducing the overall
building size, will be identified and tested.
The performance of the passive solar THCs in terms of comfort and energy savings will
determine the local desirability of the new designs and ultimately the popularity of the
technology. Therefore the performance of the buildings is also a critical factor.
These issues will be addressed first in the design phase and then in the construction phase
of the project. The international passive solar expert will review the designs and
computer simulation analysis will predict the thermal performance before the buildings
are constructed. The designs will be simplified and well detailed to minimize cost and
quality control issues. In keeping with the Health VIII Project guidance, the THCs size
and functionality will be evaluated for appropriateness. This will help keep costs under
control and minimize incremental cost of the passive solar THCs. During construction,
quality control activities will assure designed performance is achieved and budgets are
maintained. The extensive M&E and dissemination programs will produce and widely
distribute the key performance data.
2. Critical Risks
Risk
a. Design flaws cause poor
performance and cost
overruns
b. Poor construction quality
Risk
Rating
M
M
c. Poor operation and
maintenance of THC
S
d. Cost over runs
S
e. Reluctance to adopt new
designs
M
Risk Minimization Measure
Design review by international passive solar
expert and performance modeling before
approval to begin construction
Simplified design and additional on site
quality control activities
Early involvement of THC staff in the design.
Operation and maintenance manual and
training of THC operators.
OA/QC plan, Simplified design and
additional quality control activities
Early consultation on acceptability of design
features. Assure high performance and low
cost to reinforce commitment by the Health
VIII and MOH. Disseminate and promote
widely.
Stakeholder involvement and social assessment.
Stakeholders include MOH, FLO; MOF, SDPC; Provincial and county health bureaus;
THC health workers; patients and their families, local govt.
The process of implementing the Health VIII project, which this demonstration program
will complement, is highly participatory. It includes community visits, site inspections,
and informal and formal consultations at each level (province, county and village) by
FLO/WB/national and international consultants. User feedback indicates that (a)
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comfort, especially heating, is a critical factor in effective service delivery and in
decisions to seek care at a THC; and that (b) the cost of coal, inefficiency of small coal
burners, and problems with smoke and dust currently make it very difficult to overcome
this problem in existing health clinics the northern areas.
Under the civil works component of Health VIII, guidelines and procedures have been
developed which include site visits and consultation with all relevant stakeholder groups
during design development. Procedures have also been introduced to gauge patient and
community satisfaction and preferences with respect to their health services. National
and provincial experts have been trained in these methods.
During the monitoring of the three prototype passive solar THCs, stakeholders and
beneficiaries have been surveyed and consulted, and their views were taken into account
in preparing this project.
The preparation of this project brief involved several rounds of consultation with
stakeholders at each level, before submission to MOF. World Bank staff responsible for
assisting with the solar energy prototype projects met with Dr. Liu Yunguo, Deputy
Director, and Dr. Zhao Hongwen, project manager from FLO, and Professor Dr. Wang
Lusheng, Deputy Director from China National Health Economic Research Institute of
MOH and civil works expert of Health VIII Project to brief them on the initial results.
On the basis of the experience of the three prototype passive solar THC buildings, it was
agreed that a further expansion of the prototype experience was highly desirable.
In December 23, 1999, FLO/MOH officially submitted the Project Concept paper to
China Ministry of Finance (MOF). China MOF soon delivered the proposal to the World
Bank Resident Mission in China (RMC). Following the approval of a Concept Paper
and PDF A grant, a preparation a work plan was discussed and agreed between the Health
VIII Project, FLO and WB. Two preparatory workshops were held: a Preliminary Design
Workshop in April 2000, and a Final Design (working drawings) and Budgeting
Workshop in June. All the participating THC directors, County Construction Quality
Assurance Station, and Provincial Civil Works Mangers attended the workshops.
Based on the above fact-finding workshops and expert group suggestions, the final
project proposal has been developed.
Incremental cost and environmental benefits assessment
Baseline
The Chinese Ministry of Health (MOH) manages over 50,000 THCs and is currently
building 3,000 to 4,000 new THCs per year. Much of the new construction is in the
colder northwest regions of China. Coal is the primary fuel at all the THCs for heating,
water heating and cooking. As part of the initial phase of this project, a mission was sent
to evaluate the current state of construction of THCs in three northwest provinces. The
mission found that current THCs are very energy inefficient and that there is significant
incidence of severe indoor air pollution problems from poorly vented coal heating stoves.
The major causes of inefficient energy use were poor quality construction, air leakage,
poor windows and doors, and poor insulation and thermal bypasses. As a result of their
13
poor energy efficiency, the THCs are wasting large amounts of coal and the money they
are currently spending on wasted coal could be better spent on improving patient
services. Coal in Qinghai is $35 per ton, in Gansu $34 per ton and in Shanxi $16 per ton.
At the current rate of THC construction, coal consumption by health clinics will increase
by 54,000 to 72,000 tons each year. This would increase atmospheric air pollution by
110,000-145,000 tons of CO2, 320-430 tons of NOX, 860-1,150 tons of SO2, 2,8003,700 tons of CO and 3,200- 4,300 tons of TSP each year.
In addition to inefficient coal use, the THCs currently do not maintain healthy or
comfortable indoor environments. While the THCs are generally clean and well
maintained, building environmental factors as a result of energy inefficiency and coal
burning create unhealthy indoor conditions. The cold and drafty THCs are not healthy
environments for both patients and staff. The poorly vented coal stoves in every room
emit undesirable and toxic products of combustion including carbon monoxide, and in
some areas, fluoride. While the indoor air quality impacts are difficult to quantify,
improving comfort and eliminating indoor pollutants will have a positive impact on the
ability of the THC to serve the community.
Under the baseline scenario, the architects, engineers and contractors building the THCs
will continue to use the same established standard design details mandated by the central
government, and familiar to all the architects and contractors in China, which are very
inefficient from an energy perspective. The insulation details recommended in the
standard designs are inadequate in terms of insulation levels, controlling for thermal
bypasses and quality control during construction. The largest problem is with the thermal
bypasses, which render the insulation useless in many parts of the building by allowing
heat to be conducted around the insulation through the concrete structure. In the baseline
scenario, new health clinics and other rural public buildings in China will continue to be
very inefficient, wasting vast quantities of coal and polluting the atmosphere. Also all the
indoor air quality problems associated with coal stoves in the living space will also apply.
The financial cost of the baseline scenario is the cost of constructing 30 traditionally
designed rural health clinics, which is about $696,000. Its consequences would be
increased coal consumption, more global atmospheric pollution, a financial drain on the
local economy from wasteful coal consumption, with fuel costs taking funds that could be
used for better care. In addition the continued inefficient burning of coal in the clinics
would perpetuate the problems of low clinic utilization and low service quality, as well as
some damage to users’ health from indoor air pollution.
GEF Alternative
The Passive Solar Health Clinic Project’s overall objective is to improve the energy
efficiency of township level health facilities by demonstrating and promoting energy
efficient passive solar health clinic designs and encouraging the adoption of these designs
in the construction of all new public buildings in rural China. The project will do this by
increasing awareness of the benefits of passive solar design through a series of
demonstration projects, increasing national and provincial capacity to design and deliver
energy efficient passive solar buildings, through training architects, engineers and
14
contractors, recommending changes to the published standard design details and through
a M&E and outreach program.
Working with 3 design teams and the national experts, 3 prototype energy efficient
passive solar THCs have been built, one each in Qinghai, Gansu and Shanxi provinces.
A review of the performance of these built prototypes showed that these designs are
operationally and environmentally superior. A design workshop has produced
preliminary designs of approximately 30 new demonstration passive solar THCs that
could be built under this project. The preliminary analysis of these designs and expected
refinements shows that the new THCs would use 80% to 100% less coal than the
traditional THC. Some of the prototypes would explore alternatives to any use of coal
heat, including 100% solar heat.
The solar design teams and the national solar experts will receive extensive training and
first hand experience in the design and construction of some 30 prototype passive solar
THCs, as well as feedback from the data collected from the monitoring. This design and
construction experience, in close cooperation with the Health VIII project, will help to
influence the design of all future THCs built in the northern and western provinces and
the Health VIII project. As a result of this project, up to 80% of all THCs constructed in
the following 5 years should use passive solar prototype designs. This would result in the
construction of about 2,400 to 3,200 new passive solar THCs each year.
The energy efficient passive solar THCs are expected to use 80%-100% less coal than
traditional THCs. If 80% of new THCs incorporate passive solar design features, the coal
consumption savings would be 35,000 to 45,000 tons each year. At this level of coal
consumption savings, the avoided atmospheric air pollution rate would be 70,000-90,000
tons of CO2, 200-275 tons of NOX, 550-750 tons of SO2, 1,800-2,400 tons of CO and
2,000-2,750 tons of TSP each year. These savings accumulate each year as more new
energy-efficient passive solar THCs are built.
It is a goal of this project that the architects, engineers, contractors and other
governmental officials trained and influenced by this project will widely apply the design
principals demonstrated by the passive solar THCs. A key component to the widespread
adoption of these designs is revision of published design guidelines to eliminate thermal
bypasses and ensure proper use insulation in concrete construction. This fundamental
institutional change could have a significant impact on the energy consumption of all new
rural public building construction in China.
The total cost of the GEF Alternative is $1,584,000. Its incremental cost is $888,000, of
which the GEF is asked to contribute $775,000, including the PDF A of $25,000.
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Global
Environmental
Benefits
Domestic
Benefits
Baseline
Alternative
Green House Gas
(GHG) Emissions
from inefficient coal
heaters will continue
to increase as new
coal heated THCs are
built at a rate of 2900
to 4000 THCs per
year
THCs will continue to
pay high coal heating
costs and suffer poor
indoor/outdoor air
quality
Energy efficient, passive
solar designs demonstrate
emissions reductions of
50%-100% (average 80%)
and 80% of all new THCs
adopt the designs over the
next 5 years.
New THCs will have
significantly reduced coal
heating cost and improved
indoor/outdoor air quality.
Clinic utilization and
service quality will
improve, more money will
be available for patient
care and the THC will be
a more healthful
environment.
Increment
(Alternative-Baseline
Annual savings:
Coal: 95,000-130,000
tons; CO2:
190,000-260,000 tons
NOx- 580-780 tons
SO2- 1,500-2,000 tons
CO- 5,000-6,700 tons
T.S.P.-5,800-7,700 tons
The cost of coal heating
the THCs will be
reduced 50-100%.
Reduction of CO and
other products of coal
combustion will
improve indoor air
quality as well as local
air quality.
BUDGET
PROJECT BUDGET
Component
PDF:
Personnel:
Subcontracts:
Training:
Equipment:
Travel:
Evaluation mission(s):
Miscellaneous:
Project total (PDF+project
costs):
GEF
Other
sources
$25,000
$70,000
$290,000
$180,000
$20,000
$50,000
$120,000
$10,000
$775,000
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$18,000
$696,000
$45,000
$5,000
$13,000
$29,000
$2,000
$809,000
Project total
$25,000
$88,000
$996,000
$225,000
$25,000
$63,000
$150,000
$12,000
1,584,000
PROJECT IMPLEMENTATION PLAN
DURATION OF PROJECT (IN MONTHS):
ACTIVITIES
PROJECT-MONTHS
1-2-3-4-5-6-7-8-9-10-11-12-13-14-15-16-17-18-19-20-21-22-23-24
Activity1:
Design and
___| (3 months)
Technical
Assistance
Activity 2:
Prototype
__________| (5 months)
Construction
Activity 3:
________________________________|
Monitoring and
(12 Months)
Evaluation
Activity 4:
___|
____|
_____|
_____
Outreach and
(12 months total)
Promotion
Activity 5:
___| (3 months)
Capacity Building
The design, construction, instrumentation, outreach and capacity building components of
the project will run for one year. The monitoring and analysis will run for one year after
construction is completed. The total project duration is two years.
PUBLIC INVOLVEMENT PLAN
.
Stakeholder identification
The proposed Project’s stakeholders includes its beneficiaries (villagers); health service
providers (village doctors, township and county health officials responsible for provision
of health services); county, provincial, and central government health bureau officials;
and architects, design engineers, civil works contractors, and quality control experts who
will benefit from training and design assistance.
Participative consultations have been held with these groups during preparation of the
Health VIII Project. Detailed consultations with users of the three pilot passive solar
health clinics constructed at the start of this project have shown support for these designs
and for proposed larger-scale GEF demonstration and dissemination project.
Information dissemination and consultation
Three local workshops have been conducted with representatives of the MOH, the design
institutes and local health administrators. The workshops covered design requirements,
preliminary design reviews, construction budgets and construction issues. The results of
these workshops were used in the development of this project.
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The structure of the project allows for ongoing consultation with the local communities.
Feedback from the local THCs will be done by the CHEI for the MOH and will provide
monthly reporting to the project management.
Social and participation issues
Social assessments are planned in the Health VIII Project to analyze the community
response to the improved THC facilities, the impact on the community’s health and
economy, the impact of local energy management and the reduction of coal costs in the
winter. What will the communities do with the energy cost savings and will they transfer
the experience of the THCs to other buildings in the community? The assessment will
also explore the impact on the health of the small communities involved in the project as
a result of improved health care facilities.
MONITORING AND EVALUATION PLAN
The project will be monitored by the Foreign Loan Office (FLO) which is responsible for
the project, and by the China Health Economics Institute (CHEI), along with technical
experts from the World Bank, who will monitor the technical aspects of the project.
The joint objective of the Health VIII project and this project is to increase the utilization
of health services in project areas due to improved infrastructure (civil works, buildings,
etc.). The CHEI will monitor the patient traffic at all the THCs built in the Health VIII
project and quantify the patient visits to the passive solar THCs as compared to the nonpassive solar THCs. If the project is successful, we should see a significant increase in
the patient visits to the passive solar THCs. The CHEI will also assess the patient’s
attitudes and experiences with the new THCs. This feedback will help improve future
designs.
The primary expected outputs of the project that will be carefully monitored are:
(1) Passive solar heating design features are incorporated into newly constructed
township health centers (THCs) beyond the 30 demonstrations supported through this
project. With feedback from the MOH and the Health VIII project, adoption of the new
passive solar THC designs will be tracked. The CHEI will monitor all the projects by the
Health VIII project and the MOH and report the number of THCs that adopt passive solar
designs.
(2) Improved awareness, capacity and willingness to incorporate passive solar heating
design features into THC construction plans. CHEI will track the number of counties that
adopt the passive solar THC designs and the number of design institutes that adopt the
passive solar designs. We will also develop a method to survey other sectors, such as
schools and public buildings, to determine if the passive solar designs have been adopted.
CHEI will collect and report data on performance indicators for the project to the FLO.
Project reviews will occur at the mid point of the project and the end.
As the project progresses, the CHEI will report the projects progress to the Ministry of
Health and the Health VIII project team for evaluation and feedback on a regular basis.
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The World Bank representative will be in regular communication with the Health VIII
project director (in FLO) and World Bank Health VIII Task Team Leader, regarding the
progress of the project. Feedback from the Ministry of Health and the Health VIII project
team and the World Bank technical expert will help direct the project as it develops.
In addition to project monitoring and evaluation activities, the passive solar health clinics
will be monitored and evaluated for energy and comfort under Activity 3. Funds
allocated for monitoring and evaluation activity total US$150,000.
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