Javadi Dena, Ssempebwa John, Isunju John Bosco, Yevoo Lucy, Amu Alberta, Nabiwemba Elizabeth, Pfeiffer Michaela, Agyepong Irene, Severi Luc
Alliance for Health Policy and Systems Research, World Health Organization, 20 Ave Appia, Geneva 1211, Switzerland.
Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Hill Road, Kampala, Uganda.
Health Policy Plan. 2020 Nov 1;35(Supplement_2):ii124-ii136. doi: 10.1093/heapol/czaa077.
Access to energy is essential for resilient health systems; however, strengthening energy infrastructure in rural health facilities remains a challenge. In 2015-19, 'Powering Healthcare' deployed solar energy solutions to off-grid rural health facilities in Ghana and Uganda to improve the availability of maternal and child health services. To explore the links between health facility electrification and service availability and use, the World Health Organization (WHO), in partnership with Dodowa Health Research Centre and Makerere University School of Public Health, carried out an implementation research study. The objectives of this study were to (1) capture changes in service availability and readiness, (2) describe changes in community satisfaction and use and (3) examine the implementation factors of sustainable electrification that affect these changes. Data were collected through interviews with over 100 key informants, focus group discussions with over 800 community members and health facility assessment checklist adapted from the WHO's Service Availability and Readiness Assessment tool. Implementation factors were organized using Normalization Process Theory constructs. The study found that access to energy is associated with increased availability of health services, access to communication technologies, appropriate storage of vaccines and medicines, enhanced health worker motivation and increased community satisfaction. Implementation factors associated with improved outcomes include stakeholder engagement activities to promote internalization, provision of materials and information to encourage participation, and establishment of relationships to support integration. Barriers to achieving outcomes are primarily health systems challenges-such as drug stockouts, lack of transportation and poor amenities-that continue to affect service availability, readiness and use, even where access to energy is available. However, through appropriate implementation and integration of sustainable electrification, strengthened energy infrastructure can be leveraged to catalyze investment in other components of functioning health systems. Improving access to energy in health facilities is, therefore, necessary but not sufficient for strengthening health systems.
获得能源对于有韧性的卫生系统至关重要；然而，加强农村卫生设施的能源基础设施仍然是一项挑战。在2015年至2019年期间，“为医疗供电”项目在加纳和乌干达的离网农村卫生设施中部署了太阳能解决方案，以改善孕产妇和儿童保健服务的可及性。为了探索卫生设施电气化与服务可及性及使用之间的联系，世界卫生组织（世卫组织）与多杜瓦卫生研究中心和马凯雷雷大学公共卫生学院合作开展了一项实施研究。本研究的目标是：（1）记录服务可及性和准备情况的变化；（2）描述社区满意度和使用情况的变化；（3）研究影响这些变化的可持续电气化实施因素。通过与100多名关键信息提供者进行访谈、与800多名社区成员进行焦点小组讨论以及采用世卫组织服务可及性和准备情况评估工具改编的卫生设施评估清单来收集数据。使用标准化过程理论结构来组织实施因素。研究发现，获得能源与卫生服务可及性增加、通信技术可及性、疫苗和药品的适当储存、卫生工作者积极性提高以及社区满意度增加有关。与改善结果相关的实施因素包括促进内化的利益相关者参与活动、提供材料和信息以鼓励参与以及建立支持整合的关系。实现结果的障碍主要是卫生系统方面的挑战，如药品短缺、缺乏交通和设施简陋，即使在有能源供应的地方，这些挑战仍继续影响服务的可及性、准备情况和使用。然而，通过可持续电气化的适当实施和整合，可以利用加强的能源基础设施来催化对运转良好的卫生系统其他组成部分的投资。因此，改善卫生设施的能源供应对于加强卫生系统是必要的，但并不充分。
