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Earthquakes are a major natural calamity with pervasive effects on human life and nature. Similar effects are mimicked by man-made disasters such as fuel crises and power outages in developing countries. Natural and man-made disasters can cause intangible human suffering and often leave scars of lifelong psychosocial damage. Lessons from these disasters are frequently not implemented. The main objective of this study was to review the effects of the 2015 earthquakes, fuel crisis, and power outages on the health services of Nepal and formulate recommendations for the future. The impacts of earthquakes on health can be divided into immediate, intermediate, and long-term effects. Power outages and fuel crises have health hazards at all stages. It is imperative to understand the temporal effects of earthquakes, because the major needs soon after the earthquake (emergency care) are vastly different from long-term needs such as rehabilitation and psychosocial support. In Nepal, the inadequate and nearly nonexistent specialized health care at the peripheral level claimed many lives during the earthquakes and left many people disproportionately injured. Preemptive strategies such as mobile critical care units at primary health centers, intensive care training for health workers, and alternative plans for emergency care must be prioritized. Similarly, infrastructural damage led to poor sanitation, and alternative plans for temporary settlements (water supply, food, settlements logistics, space for temporary settlements) must be in place where the danger of disease outbreak is imminent. While much of these strategies are implementable and are often set as priorities, long-term effects of earthquakes such as physical and psychosocial supports are often overlooked. The burden of psychosocial stresses, including depression and physical disabilities, needs to be prioritized by facilitating human resources for mental health care and rehabilitation. In addition, inclusion of mental health and rehabilitation facilities in government health care services of Nepal needs to be prioritized. Similarly, power outages and fuel crises affect health care disproportionately. In the current context where permanent solutions may not be possible, mitigating health hazards, especially cold chain maintenance for essential medicines and continuation of life-saving procedures, are mandatory and policies to regulate all health care services must be undertaken. (Disaster Med Public Health Preparedness. 2017;11:625–632)

Health systems in Sub-Saharan Africa have changed profoundly over the last 20 years. The economic crisis of the 1980s and 1990s rattled public health care systems, which were largely holdovers from the colonial and postcolonial eras. The later wave of structural adjustments and public sector reforms wrought further change. As African economies opened to market based approaches, the private sector became a sizable source of health care service. Today about half the health expenditures in Africa are private, and private providers play a major role in the delivery of outpatient services. This is draws on the lessons, knowledge, and data gathered by the World Bank's Africa Region Human Resources for Health Program. For the first time, the various complexities of Human Resources for Health (HRH) labor markets are addressed comprehensively in one volume. Given the increasing demand in countries for strong health workforces that can help achieve universal health coverage; we hope this book will be beneficial to researchers, policy makers, and practitioners who are trying to develop evidence-based HRH interventions to achieve this end.

Modern energy enables health service delivery. Access to electricity is, however, unreliable in many health facilities in developing countries. Little research has explored the relationships between energy and service delivery. Based on extensive literature searches and iterative discussions within the research team, we first develop a conceptual framework of the role of energy in health facilities. We then use this framework to explore how characteristics of electricity supply affect distinct energy uses in health facilities (e.g. lighting), and how functional or non-functional lighting affects the provision of night-time care services in Malawi. To do so we apply descriptive statistics and conduct logistic and multinomial regressions using data from the Service Provision Assessment (SPA) of the Demographic and Health Surveys (DHS) for all health facilities in Malawi in 2013/2014. The conceptual framework depicts the pathways from different energy types and their characteristics, through to distinct energy uses in health facilities (e.g. medical devices) and health-relevant service outputs (e.g. safe medical equipment). These outputs can improve outcomes for patients (e.g. infection control), facilities (e.g. efficiency) and staff (e.g. working conditions) at facilities level and, ultimately, contribute to better population health outcomes. Our exploratory analysis suggests that energy uses were less likely to be functional in facilities with lower-quality electricity supply. Descriptive statistics revealed a critical lack of functional lighting in facilities offering child delivery and night-time care; surprisingly, the provision of night-time care was not associated with whether facilities had functional lighting. Overall, the DHS SPA dataset is not well-suited for assessing the relationships depicted within the framework. The framework conceptualizes the role of energy in health facilities in a comprehensive manner. Over time, it should be empirically validated through a combination of different research approaches, including tracking of indicators, detailed energy audits, qualitative and intervention studies.

Background Primary care networks (PCNs) are increasingly being adopted in low- and middle-income countries (LMICs) to improve the delivery of primary health care (PHC). Kenya has identified PCNs as a key reform to strengthen PHC delivery and has passed a law to guide its implementation. PCNs were piloted in two counties in Kenya in 2020 and implemented nationally in October 2023. This protocol outlines methods for a study that examines the impact, implementation experience and political economy of the PCN reform in Kenya. Methods We will adopt the parallel databases variant of convergent mixed methods study design to concurrently but separately collect quantitative and qualitative data. The two strands will be mixed during data collection to refine questions, with findings triangulated during analysis and interpretation to provide a comprehensive understanding of PCN implementation. The quantitative study will use a controlled before and after study design and collect data using health facility and client exit surveys. The primary outcome measure will be the service delivery readiness of PHC facilities. We will use a random sample of 228 health facilities and 2560 clients in four currently implementing PCNs, four planning to implement and four control counties at baseline and post-implementation. We shall undertake a preliminary cross-sectional analysis of the data at baseline from October to December 2023, followed by a difference-in-difference analysis at the endline from October to December 2024 to compare the outcome differences between the intervention and control counties over a 12-month period. The qualitative study will include a cross-sectional process evaluation and political economy analysis (PEA) using document reviews and approximately 80 in-depth interviews with national and sub-national stakeholders. The process evaluation will assess the emergence of PCN reforms, the implementation experience, the mechanism of impact and how the context affects implementation and outcomes. The PEA will examine the interaction of structural factors, institutions and actors/stakeholders’ interests and power relations in implementing PCNs. We will also examine the gendered effects of the PCNs, including power relations and norms, and their implications on PHC from the supply and demand sides. We shall undertake a thematic analysis of the qualitative data. Discussion This evaluation will contribute robust evidence on the impact, implementation experience, political economy and gendered implications of PCNs in a LMIC setting, as well as guide the refining of PCN implementation in Kenya and other LMICs implementing or planning to implement PCNs to enhance their effectiveness.

Developing and underdeveloped countries face innumerable problems related to the accessibility and quality of energy that put the lives of patients, health-care infrastructures, and health workers at risk. Current approaches, such as grid power, unsustainable energy sources such as diesel or gas, and mobile health clinics, have proven insufficient to address this issue. In response, access to reliable health care and electricity has undergone multiple transformations in the last decade, especially in remote and rural areas. Good health and clean energy are two of the 17 United Nations Sustainable Development Goals, originally designed to be a “shared blueprint for peace and prosperity for people and the planet, now and into the future.” Unfortunately, little is known about the interaction between health-care access and energy access in developing and underdeveloped countries, mainly in remote or rural areas. For this reason, this study conducts a review of the literature, including current approaches, challenges, and opportunities for the implementation of solar energy in health centers. As a result, several challenges and opportunities in three impact areas are presented: (1) operational, (2) environmental, and (3) economic. This study delivers detailed information that allows the implementation of solar energy in the health-care sector (in a more effective manner) by sharing best practices.

Background The onus of providing affordable access to specialist services in rural India primarily lies with publicly funded rural hospitals, also known as community health centres (CHCs). However, no studies have attempted to measure the change in the shortage and distributional inequalities of specialists in the publicly funded rural hospitals of Uttar Pradesh (India). This study attempts to fill that gap. Methods The study uses data from the three latest rounds of the District-Level Household Survey, covering a period of 10 years spanning from 2002 to 2012. Shortages were measured against the Indian Public Health Standards for CHCs, and inequalities were measured using Gini and Theil indices, with the latter decomposed to reveal the source of the inequalities. Negative binomial regression was applied to examine the association between facility characteristics and the availability of specialists in CHCs. Results The current shortage of specialists stands at 80.7% of the total requirement. Currently, 62.1% of CHCs are functioning without a specialist. The distribution of specialists across CHCs has become progressively uneven over the study period, as shown by the rise in the Gini index (from 0.41 in 2002–2004 to 0.74 in 2012–2013). Decomposition analysis reveals that the contribution of within-district inequalities to overall inequality remains high (85.4% of total inequality). About 50% of within-district inequality is contributed by only 20 districts, most of which belong to eastern and central Uttar Pradesh. The analysis of factors affecting the distribution of the current specialist workforce revealed that the number of available specialists at a CHC is positively associated with the availability of residences for doctors and regular electricity supply, and negatively associated with CHC location and the distance of the CHC from the district headquarters. Conclusion The findings suggest that Uttar Pradesh not only needs to recruit more specialists, but it also requires proper implementation of deployment and retention policies to ensure equitable access to specialist care for rural populations. Ensuring the availability of quality accommodations and basic amenities at all CHCs, as well as adequate transport and rural allowance, could help increase the chances of specialists staying in rural and far-off CHCs.

Access to therapeutic oxygen remains a challenge in the effort to reduce pneumonia mortality among children in low- and middle-income countries. The use of oxygen concentrators is common, but their effectiveness in delivering uninterrupted oxygen is gated by reliability of the power grid. Often cylinders are employed to provide continuous coverage, but these can present other logistical challenges. In this study, we examined the use of a novel, low-pressure oxygen storage system to capture excess oxygen from a concentrator to be delivered to patients during an outage. A prototype was built and tested in a non-clinical trial in Jinja, Uganda. The trial was carried out at Jinja Regional Referral Hospital over a 75-day period. The flow rate of the unit was adjusted once per week between 0.5 and 5 liters per minute. Over the trial period, 1284 power failure episodes with a mean duration of 3.1 minutes (range 0.08 to 1720 minutes) were recorded. The low-pressure system was able to deliver oxygen over 56% of the 4,295 power outage minutes and cover over 99% of power outage events over the course of the study. These results demonstrate the technical feasibility of a method to extend oxygen availability and provide a basis for clinical trials.

This study presents a comprehensive assessment of lighting conditions in the Intensive Care Units (ICUs) of two major hospitals in the Democratic Republic of Congo (DRC): Hospital du Cinquantenaire in Kinshasa and Jason Sendwe Hospital in Lubumbashi. A mixed-methods approach was employed, integrating continuous illuminance monitoring with structured staff surveys to evaluate visual comfort in accordance with the EN 12464-1 standard for indoor workplaces. Objective measurements revealed that more than 52.2% of the evaluated ICU workspaces failed to meet the recommended minimum illuminance level of 300 lux. Subjective responses from healthcare professionals indicated that poor lighting significantly reduced job satisfaction by 40%, lowered self-rated task performance by 30%, decreased visual comfort scores from 4.1 to 2.6 (on a 1–5 scale), and increased the prevalence of well-being symptoms (eye fatigue, headaches) by 25–35%. Frequent complaints included eye strain, glare, and discomfort with posture, with these issues often exacerbated during the rainy season due to reduced natural daylight. The study highlights critical deficiencies in current lighting infrastructure and emphasizes the need for urgent improvements in clinical environments. Moreover, inconsistent energy supply to these healthcare settings also impacts the assurance of visual comfort. To address these shortcomings, the study recommends transitioning to energy-efficient LED lighting, enhancing access to natural light, incorporating circadian rhythm-based lighting systems, enabling individual lighting control at workstations, and ensuring a consistent power supply via the integration of solar inverters to the grid supply. These interventions are essential not only for improving healthcare staff performance and safety but also for supporting better patient outcomes. The findings offer actionable insights for hospital administrators and policymakers in the DRC and similar low-resource settings seeking to enhance environmental quality in critical care facilities.

The unavailability of a constant power supply has been a major problem in remote communities in Africa as it impedes the proper operation of healthcare facilities in these locations. This has deprived inhabitants of free access to good healthcare services, thereby resulting in an increase in maternal and child mortality rates in rural communities in Africa. Therefore, in order to address this problem and render a life-saving intervention for rural dwellers and to also improve their healthcare service delivery, this paper focuses on the optimal configuration of a hybrid energy system for the rural electrification of community healthcare facilities. It presents an analysis of an off-grid hybrid energy system comprised of diesel generators, wind turbines and solar PV with a battery storage system to meet the energy demand of healthcare facilities in a remote community in Nigeria. In this study, hybrid energy systems are considered owing to the high reliability and availability of the intensity of solar radiation and wind speeds in Nigeria. An optimization model was developed which seeks to minimize the operational cost of hybrid energy systems. The proposed model was implemented using four case studies and solved using algebraic modeling language. The results obtained from the sensitivity analysis indicate that the configuration that includes solar PV, wind turbines, a battery storage system and a diesel generator provides the optimum power required for a rural healthcare center with a suitable energy cost and emission reduction from the system of diesel generators.