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

Improving Maternal and Child Health in Difficult Environments: The Case For “Cross-Border” Health Care

Gijs Walraven and colleagues discuss maternal and child health programs in adjacent geographical areas in difficult environments in Afghanistan, Pakistan, and Tajikistan

Health Facilities in the Border Districts of Afghan Badakhshan, the Northern Areas of Pakistan, and Gorno-Badakhshan in Tajikistan

<p>Health Facilities in the Border Districts of Afghan Badakhshan, the Northern Areas of Pakistan, and Gorno-Badakhshan in Tajikistan</p

Electricity sources and continuity by covariate (in percent).

<p>Electricity sources and continuity by covariate (in percent).</p

Lighting functionality in the delivery area in facilities offering night-time care and delivery services (in %).

<p>Lighting functionality in the delivery area in facilities offering night-time care and delivery services (in %).</p

Information and communication technologies and medical devices: Odds ratios and 95% confidence intervals of energy source and continuity.

<p>Information and communication technologies and medical devices: Odds ratios and 95% confidence intervals of energy source and continuity.</p

Descriptive statistics of all variables included in the data analysis.

<p>Descriptive statistics of all variables included in the data analysis.</p

Water source, sanitation facilities and ventilation in the medication storage room: odds ratios and 95% confidence intervals of energy source and continuity.

<p>Water source, sanitation facilities and ventilation in the medication storage room: odds ratios and 95% confidence intervals of energy source and continuity.</p

Lighting in outpatient and child delivery areas: Odds ratios and 95% confidence intervals of energy source and continuity.

<p>Lighting in outpatient and child delivery areas: Odds ratios and 95% confidence intervals of energy source and continuity.</p