Causes and consequences of energy availability and environmental health conditions in Malawian health care facilities

Frances Reuland, Ryan McCord, Nikki Behnke, Lauren Joca, Lydia Abebe, Ryan Cronk, Irving Hoffman, Jamie BartramUniversity of North Carolina Gillings School of Global Public Health

Acknowledgments: This work was supported by funding from Procter & Gamble. The conceptual framework is an adapted version of a model created by Laura Suhlrie. Additional acknowledgements to Katie Connolly, Innocent Mofolo, Holystone Kafanikhale, and Jennifer Mmodzi. References: 1. Malawi Service Provision Assessment 2013-14 [SPA20]. Available from: https://dhsprogram.com/pubs/pdf/SPA20/SPA20%5BOct-7-2015%5D.pdf. 2. Access to modern energy services for health facilities in resource-constrained settings: a review of status, significance, challenges and measurement; World Health Organization. 2014. Available from: http://apps.who.int/iris/bitstream/10665/156847/1/9789241507646_eng.pdf

QualityVoltage and fluctuations

ReliabilityTiming and duration

of shortages

.

AvailabilityCapacity, timing, and duration

Ø Semi-structured interviews conducted with facility administrators, environmental health officials, health care providers, patients, and facility cleaners

The complete framework also considers…Political• Governance • Policies• Laws and RegulationsEconomic• Markets• AffordabilityGeographic• Infrastructure• Facility settingEnvironmental• ClimateEpidemiological• Disease Burden

Ø WHO guidelines served as a base for quantitative survey; questions covered water, sanitation, hygiene, IPC, ventilation, vector control, energy availability, and solid waste and wastewater management

Ø Water samples collected from the main water source used for deliveries in the HCFs using AquagenxCompartment Bag Test to determine microbial safety; Swab samples taken of mattresses, light switches, sink handles, delivery equipment using Hygiena ATP Monitor to assess cleanliness and sterilization

Research Overview

MethodsØ Quantitative and qualitative data collected from 44 health

care facilities from the northern, central, and southern regions of Malawi

The premise…Ø Sufficient, reliable energy and adequate environmental

health conditions are fundamental for safe and effective patient care in health care facilities

Ø In low- and middle-income countries HCFs often face intermittent electrical services, impacting patient and provider safety, and health service delivery

Research objectives…Ø The status of energy and environmental health

conditions in Malawian HCFs Ø The relationship between sufficient, reliable energy and

the adequacy of environmental health conditions Ø The causes and consequences of insufficient energy

conditions in HCFs

Ø The HCFs were different types; three were central hospitals, 14 were district hospitals, 14 were health centers and 13 were health posts or dispensaries

Energy types

Characteristics of energy supply

Energy uses

Off-Grid

Facility Outputs and Outcomes

Sterilization

Working Conditions

Health service delivery

Patient satisfaction

80% use electric autoclave to clean critical medical equipment

1 in 5 facilities “failed” ATP test for sterility of delivery medical equipment

~40% of facilities had no back-up supply

60% of facilities needed their generators in the past week

35% of the generators were not usable

Security

Continuous access to safe drinking waterEnvironmental

Health OutcomesFunctional, safe waste disposal

Improved air quality

“You know when it is hot… air borne diseases can easily affect us. But maybe there is a fan

diseases like TB and the like are minimized… When it is well ventilated, you can be very

attentive to what a client complains and we can make decisions properly.”

--medical provider

“We usually have problems with electricity. Electricity Supply Corporation of Malawi has …actually improved

but it was a big concern because we were actually running a day or two without energy despite we have

installed solar systems but they are not bright enough.”–facility administrator

“[Blackouts are] a problem when there is a patient. We advise the patients to bring a candle in case. I cannot do

a delivery in a dark room. So if there is a delivery at that time and its dark, we [use] torches on my phone because some

patients can come without a candle, so it’s a problem.”--medical provider

“We just need to have an alternative once the electricity goes out… we have a big genset out there. It has been nonfunctional for over six months now.”

–facility administrator

75% of assessed facilities must ration back-up supply use

Safe medical equipment

reuse

Infection Control

82% connected to the grid

>70% said energy interruptions affect services available to patients

Grid