| Infrastructure enhancement |
The provision of the solar panels has indeed impacted positively on the three health facilities. For community members in Soo are now more willing to support the health sector in finding decent accommodation for staff who accept posting to their community. In Soo [CHPs], for example, a midwife has accepted posting to the place. As soon as community members heard this information, they have volunteered to build a small staff accommodation for the midwife to make her stay more comfortable (Health staff, Ghana).
You see a hole that has been dug close by (pointing the research team to the dugout pit)? Measures have been taken to dig a well to supply water to them (staff) up there by tapping into the solar energy to pump water to the facility when it is done. […]. The MP of the area is the one who has decided to do that for the facility. This would improve water situation in the facility to do their work and relieve mothers the stress of providing their own water when they seek healthcare, especially during delivery service […] (Community member, Aowin district, Ghana).
The electrification of this health facility has opened doors for the construction of a theatre, ward and other equipment in the future. In addition, someone can even invest in a canteen to provide cold drink to patients (FGD participant, Swazi health centre II, Uganda).
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| Resource and equipment allocation |
[…] Now they are calling for more equipment … you see we use the steam broiler now they say they want autoclave. I asked them if the solar can provide the power for the autoclave. So, we went to ask for the price of a small one for them, so that it does not consume a lot of energy […] (District Director, Ghana).
Districts and other facilities can now start planning for equipment like centrifuges, oxygen, etc. Even partners may be willing to provide equipment because they know they will be put to use since there is adequate energy (Key informant, MoH, Uganda).
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| Health worker quality of life |
In the days when the facility had no electricity, they [providers] did not have any form of entertainment. It was one of the reasons they decided not to be at post most of the time…. For some of them, their spouses have joined them because the facility now has electricity […] (Health worker, Northern region, Ghana).
Accommodation is bad, because all the staff don’t have accommodation. And the other health workers house has a very big crack. You can even see it there on the side, it has a very big crack, almost breaking away (Health team member, Uganda).
In fact, a positive thing I have seen with the coming of the solar is that now they (providers) are more stationary in the facility […] because they can now charge their phones in the facility and to communicate with their families. Therefore, they no longer travel to the city, often leaving the facility unattended, because they had to charge their phones. […] means that they are now happy to stay there [facility] and work (District Director, Ghana).
Lighting has really improved service provision. The provision of electricity made life of health workers easy and gave them the confidence to come and work here. It has also boosted the confidence of the sick people in the health facility. These factors have, in turn, increased the number of patients accessing care from here (Local council chairperson, Ibanda district, Uganda).
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| Community trust and satisfaction with health workers |
[…] The providers have stopped their behaviors of refusing to wake up at night to attend to you or asking you to call the security man who might be sleeping or might not have come to work due to ill health to confirm your identity to them […] These days when you knock on their door at night, they would immediately look through the window if they identify you as a community member immediately they come out to attend to you (Community member, Ghana).
… In the past when Kpanashie [healthcare facility] did not have electricity, the healthcare providers stored their vaccines and medicines in the nearest community and picked them up when they needed them. So, when you go there to vaccinate your child, they would tell you to return for the vaccination another time. ‘[…] Now with that the solar, they [health worker] have been given a fridge to store their drugs. So, when you take the child there for vaccination, they don’t turn the child away (Community member, Ghana).
The services related to maternal health at this facility started improving following the coming of this solar because, you would find the health worker going to help a mother deliver lighting using a torch but when the solar became available the services have improved and more women are coming to the health facility. The midwives that are here and help the mothers a lot when the solar services was installed at the facilities, the people have benefited by not traveling long distances looking for other health facilities (Village health team, Ibanda district).
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| Community trust and satisfaction with health services |
The electricity is important. Some time ago my child was admitted at Mampong the drip on him was not finished because there was no light. I was even afraid of the unknown when I was sleeping there. So, I told the nurses to discharge us. I went home to sleep and sent him back for care again the next morning. If the light had been there, like it is now, I could have slept there […] (Mother, Ghana).
I am attracted to come back to this health care facility since health workers no longer use torches to deliver mothers due to availability of electricity. Availability of energy has provided enough light to us as mothers to have safe deliveries (Mother, Uganda).
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| Health system barriers |
Medications are very essential. When you go to the ‘doctor,’ you know they have to give you medication. But you would go there and still come home to buy all the medications, so the medicines are our problem, the solar has not changed the situation (Community member, Ghana).
The other challenge is that the facility is small, especially the maternity ward. The room is so small, congested. If women come to deliver and they are 2 or 3, they can’t find where to deliver from. It is a small facility. And the midwife cannot do anything, so she has to get one off the bed and put on another one. That is one of the biggest challenges in the maternal services. And that makes some of them to go to other places (Village Health Team Member, Uganda).
Sustainable energy will improve service delivery, greatly of course when staffing and drugs are also enough, if we had enough staff, enough drugs, and then electricity, then water, and transport! (HFMC chairman, Uganda).
You come to the facility, and they tell you that there are no drugs; you are pregnant, and you have to move and go and look for the drugs. You don’t even find a single drug. A month passes and you come, second month and come back, but there is no drug available all this time. So, what do we do? (Community Member, Uganda).
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| Electricity as a catalyst for strengthening access to medicines and medical devices |
In the past when they did not have electricity, the providers had to come all the way here (the DHMT) to pick their vaccines for the day in order to provide immunizations at CWC (child Welfare Clinic) and also vaccinate pregnant women. They also had to return any unused vaccines at the end of the day because they had no fridges in the facilities. Now that they have the solar, they have been provided with small fridges to enable them keep vaccines in their facilities. This has minimized the need to travel all the way to District (District Health Administration) for all these reasons (DHMT member, Ghana).
We used to keep our drugs in Ishongolo (nearby health facility with hydroelectricity), but we now have a fridge. Therefore, we are able to keep drugs. We are now told by the health care providers that drugs, which require to be kept in cold conditions are now stored well because of the electricity (Local leader, Uganda).
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