Photovoltaic stand-alone systems are largely regarded as a viable option for decentralized rural electrification in developing countries. However, literature review reveals lack of documented experiences with installed PV systems such as Solar home systems as well as general problems with system maintenance and battery up keeping. This paper presents results from monitoring 31 stand-alone PV systems in remote health posts of North Gondar Zone in Ethiopia from installation until system failure; several systematic factors were found to have contributed to failure: lack of clear responsibility for the systems due to regular job rotation among health workers and lack of upfront, gender sensitive training, lack of equipment for maintenance work, very slow and unreliable chain of information in case of system failure and costly double tracking of energy supply. Nonfunctioning PV systems were found to threaten the technology'’s reputation by word of mouth. The results gained in this research provide important lessons for future programs of rural electrification by means of PV systems: they stress the importance of awareness building amongst funding agencies as well as the imperative of intense and sensitive training for users, especially women, and advocate for considering living conditions of users in system design.