Energy access in Malawian healthcare facilities: consequences for health service delivery and environmental health conditions.

Many healthcare facilities (HCFs) in low-income countries experience unreliable connectivity to energy sources, which adversely impacts the quality of health service delivery and provision of adequate environmental health services. This assessment explores the status and consequences of energy access through interviews and surveys with administrators and healthcare workers from 44 HCFs (central hospitals, district hospitals, health centres and health posts) in Malawi. Most HCFs are connected to the electrical grid but experience weekly power interruptions averaging 10 h; less than one-third of facilities have a functional back-up source. Inadequate energy availability is associated with irregular water supply and poor medical equipment sterilization; it adversely affects provider safety and contributes to poor lighting and working conditions. Some challenges, such as poor availability and maintenance of back-up energy sources, disproportionately affect smaller HCFs. Policymakers, health system actors and third-party organizations seeking to improve energy access and quality of care in Malawi and similar settings should address these challenges in a way that prioritizes the specific needs of different facility types.

The role of energy in health facilities: A conceptual framework and complementary data assessment in Malawi.

BACKGROUND: Modern energy enables health service delivery. Access to electricity is, however, unreliable in many health facilities in developing countries. Little research has explored the relationships between energy and service delivery. METHODS: Based on extensive literature searches and iterative discussions within the research team, we first develop a conceptual framework of the role of energy in health facilities. We then use this framework to explore how characteristics of electricity supply affect distinct energy uses in health facilities (e.g. lighting), and how functional or non-functional lighting affects the provision of night-time care services in Malawi. To do so we apply descriptive statistics and conduct logistic and multinomial regressions using data from the Service Provision Assessment (SPA) of the Demographic and Health Surveys (DHS) for all health facilities in Malawi in 2013/2014. RESULTS: The conceptual framework depicts the pathways from different energy types and their characteristics, through to distinct energy uses in health facilities (e.g. medical devices) and health-relevant service outputs (e.g. safe medical equipment). These outputs can improve outcomes for patients (e.g. infection control), facilities (e.g. efficiency) and staff (e.g. working conditions) at facilities level and, ultimately, contribute to better population health outcomes. Our exploratory analysis suggests that energy uses were less likely to be functional in facilities with lower-quality electricity supply. Descriptive statistics revealed a critical lack of functional lighting in facilities offering child delivery and night-time care; surprisingly, the provision of night-time care was not associated with whether facilities had functional lighting. Overall, the DHS SPA dataset is not well-suited for assessing the relationships depicted within the framework. CONCLUSION: The framework conceptualizes the role of energy in health facilities in a comprehensive manner. Over time, it should be empirically validated through a combination of different research approaches, including tracking of indicators, detailed energy audits, qualitative and intervention studies.