Data shows healthcare delivery is strongly linked to electricity availability
Vivek Shastry
Rural health practitioners are critically aware of the challenges of delivering medical services in infrastructure- and electricity-deficit contexts. For instance, pregnant women visiting under-electrified and ill-equipped rural health face the prospect of delivering in an unsafe environment or travel to far off hospitals, costing precious time and money. A similar story has unraveled during the COVID-19 pandemic, with even mildly infected rural individuals having to travel to hospitals in nearby cities, owing to the absence of well-functioning testing, triage, and treatment facilities at the local level. While it is broadly recognized that unreliable electricity at health facilities affects the delivery of basic health services, there still exist many gaps in quantifying the relationship and understanding how additional factors (such as medical equipment or back-up power generation) mediate the connection between electricity access and health services.
In our latest research published by PLOS ONE, we found that Indian primary health centers (PHCs) without access to electricity were associated with substantially lower number of deliveries, in-patient admissions, and out-patients visits as compared to PHCs with regular electricity access. These results were robust to a number of statistical tests and accounted for many factors that are known to affect healthcare delivery, such as location, population, staff, equipment, infrastructure and differences between states. The particularly high impact on the number of deliveries conducted at the PHCs indicates that a disproportionate burden of poor electricity access is borne by women and children.
While our analysis focused on the primary health centers, our findings are equally relevant for the sub-centers, which are more decentralized than PHCs and serve as the first point of contact for much of the rural population. One of the key pillars of Ayushmaan Bharat — the flagship health policy of the Government of India — is the development of sub-centers as Health and Wellness Centers (HWCs). HWCs are envisioned to deliver more comprehensive care, shifting some of the functions to a more local level than the PHCs. However, as of 2020, over 28 percent of the 155,404 rural sub-centers in India were without access to electricity. Based on our findings, decentralizing health services in the absence of reliable energy services will struggle in improving healthcare delivery in rural areas.
There have so far been three broad approaches to bridge these energy gaps in healthcare. The first approach relies on individual solar-powered devices or kits that enable basic but crucial functions such as lighting to perform safe deliveries or storage of vaccines. The second approach focuses on solar powering clinics with standardized off-grid or grid-integrated systems, often to replace inefficient and polluting diesel generators. The third is a need-based holistic design approach that integrates energy efficient medical devices, sustainable building design and renewable energy with the goal of decentralizing as many health services as contextually necessary. The feasibility of any approach depends on the stakeholder ecosystem, financial resources, and political commitment in a given context.
The key point, however, is that we know rural health facilities with poor electricity access deliver substantially lower health services, and several solutions exist to create a more conducive environment for improving health services. Power for All recently published a 10-point action plan for how the ministries of health and energy in India can together leverage decentralized renewable energy as a pathway to achieve universal healthcare for all. IKEA Foundation just committed 2 million euros, part of which will support the development of renewable energy-powered climate-resilient health infrastructure. There are many other examples of innovative partnerships between healthcare and energy practitioners. If we are to truly build back better, many more healthcare policymakers and philanthropic organizations must integrate sustainable energy into policies and investments that aim to equitably strengthen universal access to basic healthcare.
