Causes and consequences of energy availability and … · 2017. 11. 30. · Causes and consequences...
Transcript of Causes and consequences of energy availability and … · 2017. 11. 30. · Causes and consequences...
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