The effect of power outages on in-facility mortality in healthcare facilities: Evidence from Ghana

Abstract

The World Bank estimates that at least 25 countries in the Sub-Saharan region of Africa experience chronic power outages. However, the implications of power shortages are often discussed within the context of industrial and economic disruptions, with little attention given to the health impact. Using a nationally representative data of healthcare facilities from the 2012 Ghana Access, Bottlenecks, Cost and Equity (ABCE) Health Facility Survey, this study aims to assess the impact of power outages on in-healthcare facility mortality in Ghana, a country that has experienced worsening energy crises in the last few decades. Findings revealed a positive association between the frequency of power outages and in-facility mortality, with the risk for mortality estimated to increase by 43% for each day the power was out for over 2 h. Further, when compared to an urban healthcare facility experiencing the same frequency of power outages, the risk of mortality was found to be lower in the rural facility. These findings call for a concerted effort among all stakeholders to ensure the availability of consistent power supply in healthcare facilities, in order to provide the necessary environment for the successful provision of healthcare for the citizens of Ghana.

Conceptualising the effect of access to electricity on health in low- and middle-income countries: A systematic review

“…The authors observed a statistically significant, positive association, with the risk of in-facility mortality increasing by approximately 43% for every day with a power outage of 2 or more hours (Apenteng et al, 2018). Interestingly, the risk of in-facility mortality was lower in rural health facilities compared to urban with the same power outage frequency, potentially because health care workers in rural facilities are more accustomed to operating without electricity (Apenteng et al, 2018).…”

“…Mortality. Just one study examined the effect of poor electricity reliability on mortality, with Apenteng, Opoku, Ansong, Akowuah, and Afriyie-Gyawu (2018) using a longitudinal study design to assess the association between the frequency of power outages in health facilities in Ghana and the total number of in-facility deaths (Apenteng et al, 2018). The authors observed a statistically significant, positive association, with the risk of in-facility mortality increasing by approximately 43% for every day with a power outage of 2 or more hours (Apenteng et al, 2018).…”

“…Just one study examined the effect of poor electricity reliability on mortality, with Apenteng, Opoku, Ansong, Akowuah, and Afriyie-Gyawu (2018) using a longitudinal study design to assess the association between the frequency of power outages in health facilities in Ghana and the total number of in-facility deaths (Apenteng et al, 2018). The authors observed a statistically significant, positive association, with the risk of in-facility mortality increasing by approximately 43% for every day with a power outage of 2 or more hours (Apenteng et al, 2018). Interestingly, the risk of in-facility mortality was lower in rural health facilities compared to urban with the same power outage frequency, potentially because health care workers in rural facilities are more accustomed to operating without electricity (Apenteng et al, 2018).…”

“…Institutional-level changes. The majority of the reliability studies included in this review focused on power outages occurring at the healthcare institution level and the effect that these may have on service delivery and patient outcomes, with most noting increased patient morbidity and mortality during blackouts (Apenteng et al, 2018;Bhattacharyya et al, 2015;Dabaro, 2017;Desalegn et al, 2016;Erim et al, 2012;Forrester et al, 2017;Köroglu et al, 2019). This was likely due to decreases in the quality of care delivered during power outages, potentially resulting from poor lighting and the inability to operate electrical medical devices, perform administrative tasks, and maintain necessary refrigeration and sterilisation procedures.…”

“…A study by Dabaro identified electricity interruptions as a significant barrier to diagnosis, forcing physicians to rely on less precise methods such as clinical history rather than laboratory tests (2017), while another by Desalegn et al observed that blackouts often rendered sample specimens unusable, resulting in repeated testing and delayed diagnosis and treatment (2016). These impacts may be further exacerbated by an increased demand for healthcare during a blackout because of power outage-related morbidity, putting constraints on limited resources and further reducing the quality of care (Apenteng et al, 2018). Alternatively, anticipated declines in healthcare quality during a power outage may prevent individuals from seeking care altogether, a mechanism proposed by Köroglu et al to explain the reduced likelihood of women giving birth in healthcare institutions with increasing power outage frequency and duration (2019).…”