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Review
Open Access

Limited electricity access in health facilities of sub-Saharan Africa: a systematic review of data on electricity access, sources, and reliability

Heather Adair-Rohani, Karen Zukor, Sophie Bonjour, Susan Wilburn, Annette C Kuesel, Ryan Hebert and Elaine R Fletcher
Global Health: Science and Practice August 2013, 1(2):249-261; https://doi.org/10.9745/GHSP-D-13-00037
Heather Adair-Rohani
aWorld Health Organization, Department of Public Health and Environment, Geneva, Switzerland
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  • For correspondence: adairrohanih@who.int
Karen Zukor
aWorld Health Organization, Department of Public Health and Environment, Geneva, Switzerland
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Sophie Bonjour
aWorld Health Organization, Department of Public Health and Environment, Geneva, Switzerland
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Susan Wilburn
aWorld Health Organization, Department of Public Health and Environment, Geneva, Switzerland
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Annette C Kuesel
aWorld Health Organization, Department of Public Health and Environment, Geneva, Switzerland
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Ryan Hebert
bWE CARE Solar, Berkeley, CA, USA
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Elaine R Fletcher
aWorld Health Organization, Department of Public Health and Environment, Geneva, Switzerland
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    Table 1. UN Interagency List of Essential Devices for Reproductive Health Requiring Electricity
    Essential DevicesFirst-Level ClinicReferral-Level Facility (Non-Hospital)
    Doppler✓✓
    Scanner, ultrasound✓
    Sterilizer, steam ∼24–40 L✓
    Sterilizer, steam ∼39–100 L✓
    Vacuum extractora✓
    Breast pumpa✓
    Anesthesia/Resuscitation Equipment
    Free-standing anesthesia system✓
    Newborn incubator✓
    Patient monitor✓
    Nebulizer, atomizer, with electric compressor✓
    Phototherapy unit✓
    Pulse oximeter portable unit✓
    Resuscitation table (newborn)✓
    Resuscitation ventilator (adult/child)✓
    Electric baby warmer✓
    • Facility appliances, such as electric lights, communication equipment, water pumps, and refrigeration, are not included in the table.

    • ↵a Manual version sometimes available.

    • Source: Adapted from the “Interagency List of Essential Medical Devices for Reproductive Health.”5

    • View popup
    Table 2. Electricity Access for Health Care Facilities in Selected sub-Saharan African Countries, by Facility Type
    Percentage With:
    Country, Year (No. of Facilities)No ElectricityGenerator OnlyCentral, Solar, or Other SupplyaReliable Electricity
    Ethiopia, 2008 (N = 797)20
    All facilities14581–
    Hospital1296–
    Other facilities15679–
    The Gambia, 2004 (N = 12)19
    All facilities0336725
    Hospital0208040
    Other facilities0435714
    Ghana, 2002 (N = 428)22
    All facilities31–––
    Hospital6–––
    Other facilities34–––
    Kenya, 2010 (N = 695)15
    All facilities2627215
    Hospital229624
    Other facilities2827014
    Namibia, 2009 (N = 411)23
    All facilities419449
    Hospital0010064
    Other facilities529347
    Nigeria, 2011 (N = 121)21
    All facilities30–––
    Hospital0–––
    Other facilities32–––
    Rwanda, 2007 (N = 538)17
    All facilities1867641
    Hospital2108852
    Other facilities1957540
    Sierra Leone, 2011 (N = 106)27
    All facilities35105414
    Hospital049623
    Other facilities37105314
    Tanzania, 2006 (N = 611)24
    All facilities5024719
    Hospital269223
    Other facilities5224519
    Uganda, 2007 (N = 491)25
    All facilities5814115
    Hospital159416
    Other facilities6013815
    Zambia, 2005 (N = 430)26
    All facilities2017846
    Hospital279233
    Other facilities2117847
    • Because of rounding, the sum of the percentages in the first 3 columns (no electricity, generator only, and central, solar, or other supply) may not total 100.

    • ↵a Includes facilities that reported use of a combination of multiple power sources (for example, central supply and generator).

    • View popup
    Table 3. Energy Access Among Health Care Facilities (Mean), by Facility Type, Selected sub-Saharan African Countriesa
    Energy AccessFacility Type
    All FacilitiesHospitals OnlyOther Facilities Besides Hospitals
    Access to electricity, %
    (N = 11 countries)
    749972
    Source of electricity, %
    (N = 9 countries)
    Generator only768
    Central, solar, or other689365
    Reliable electricity, % of electrified facilities
    (N = 8 countries)
    283426
    • ↵a Data for access to electricity are averages among 11 countries (Ethiopia, The Gambia, Ghana, Kenya, Namibia, Nigeria, Rwanda, Sierra Leone, Tanzania, Uganda, and Zambia); for source of electricity, among 9 countries (excludes Ghana and Nigeria); and for reliable electricity, among 8 countries (excludes Ethiopia, Ghana, and Nigeria).

    • View popup
    Table 4. Source of Electricity for Health Care Facilities, by Type of Facility, Sierra Leone, 2012
    Facility Type
    Electricity SourceAll FacilitiesHospitals OnlyOther Facilities Besides Hospitals
    Central grid, %135812
    Generator, %259522
    Solar system, %364336
    Other,a %152115
    • The total sum of sources for a particular type of facility do not add up to 100% because each facility could report more than one electricity source.

    • ↵a Flashlights were the most typical response for “other” sources of electricity, reflecting a blurring of the lines between actual electricity sources and specific devices, which needs refinement in future surveys.

    • View popup
    Table 5. Trends in Electricity Access in Health Care Facilities, by Facility Type, Kenya and Rwanda
    All FacilitiesHospitals OnlyOther Facilities Besides Hospitals
    Country and YearPercentageAnnual Percentage ChangePercentageAnnual Percentage ChangePercentageAnnual Percentage Change
    Kenya
    2004651.5980631.5
    2010749872
    Rwanda
    2001584921525
    2007829881
    • View popup
    Table 6. Reliability of Electricity in Electrified Facilities, by Facility Type and Primary Electricity Source, Liberia, 2011-2012
    Facility Type and Primary Electricity SourceElectrified Facilities Reporting Reliable Electricity Accessa
    20112012
    n/N (%)n/N (%)
    Hospital
    Generator16/18 (89%)118/20 (90%)
    Community/ shared1/1 (100%)1/1(100%)
    Health center
    Generator13/14 (93%)13/20 (65%)
    Solar10/14 (71%)5/6 (83%)
    Community/shared–1/1 (100%)
    Health clinic
    Generator59/100 (59%)61/116 (52%)
    Solar99/109 (91%)119/146 (81%)
    Community/shared1/1 (100%)3/3 (100%)
    • Data are among all public health facilities but not private facilities.

    • ↵a The 2011 survey defined reliability by whether electricity was available “during all required operational hours,” whereas the 2012 survey asked whether electricity was available “on the day of the survey.”

Additional Files

  • Tables
  • GHSP-D-13-00037 Supplementary Material

    This appendix table contains a mapping of the types of survey questions on energy access most commonly posed by health facility surveys, such as the Service Provision Assessment (SPA) and Service Availability and Readiness Assessment (SARA). The table groups the survey questions into 3 electricity access issues: (1) access to electricity, (2) source of electricity, and (3) reliability of electricity. The table highlights the lack of uniformity in how different surveys and countries define energy access.

    Files in this Data Supplement:

    • Supplementary Material - Adair-Rohani, et al. doi: 10.9745/GHSP-D-13-00037 Service Availability and Readiness Assessment (SARA) A methodology for measuring health systems strengthening
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Global Health: Science and Practice: 1 (2)
Global Health: Science and Practice
Vol. 1, No. 2
August 01, 2013
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Limited electricity access in health facilities of sub-Saharan Africa: a systematic review of data on electricity access, sources, and reliability
Heather Adair-Rohani, Karen Zukor, Sophie Bonjour, Susan Wilburn, Annette C Kuesel, Ryan Hebert, Elaine R Fletcher
Global Health: Science and Practice Aug 2013, 1 (2) 249-261; DOI: 10.9745/GHSP-D-13-00037

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Limited electricity access in health facilities of sub-Saharan Africa: a systematic review of data on electricity access, sources, and reliability
Heather Adair-Rohani, Karen Zukor, Sophie Bonjour, Susan Wilburn, Annette C Kuesel, Ryan Hebert, Elaine R Fletcher
Global Health: Science and Practice Aug 2013, 1 (2) 249-261; DOI: 10.9745/GHSP-D-13-00037
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