The Impact of Packaged Solar Installations and Infrastructural Repairs on Healthcare Utilization in Health Facilities in the Democratic Republic of Congo Open Access

Hoffman, Adela (2016)

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Background/Introduction: Given the Democratic Republic of Congo's (DRC) tumultuous economic and violent history, there is currently a lack of adequate health infrastructure particularly in terms of energy access at health facilities. Furthermore, there is a gap in existing literature on the impact and evaluation of improved energy access and its relationship to health service delivery and utilization. Finally, IMA World Health requires an assessment to determine the impact on health-seeking behavior from their investment in solar energy in the DRC through the ASSP Project.

Objective: The purpose of this Master's thesis is to document any changes in utilization of health services at the health center level pre and post solar panel installations in order to measure the health impact of increasing access to solar energy at health facilities in the DRC.

Methods: In order to assess the impact of solar installations on health service utilization in the pre-2006 re-classification provinces of Equateur, Province Orientale, Maniema and Kasai Occidental, a counterfactual analysis was conducted to measure the difference between utilization patterns at the health zone level. Seasonally adjusted trend extrapolations using a regression of historical utilization data was used as the counterfactual scenario (the absence of solar intervention) for each health zone. Using STATA software, a difference-in-differences analysis was employed in order to measure the statistical significance of any observable change.

Results: The results of this analysis suggest an association exists between the implementation of the packaged solar installation/renovation intervention and health care utilization. Overall, the association appears to improve the average monthly health care utilization across all health zones analyzed.

Conclusion: This analysis has made headway in attempting to demystify the relationship between solar energy availability and healthcare utilization. Limited research and studies measuring the relationship between the two exist to date and this analysis, albeit limited, has made an attempt to quantify the relationship between solar energy installations and healthcare utilization.

Table of Contents

Chapter 1: Introduction 1

Historical Context 1

Population Health Demographics 2

Energy Provision at Health Facilities 4

IMA World Health ASSP Project Overview 5

Problem Statement 6

Purpose Statement 7

Research Question 7

Significance 7

Chapter 2: Literature Review 9

Energy as Necessary Infrastructure 9

Photovoltaic (PV) Systems 10

Existing Data Collection Tools 11

Current Status of Energy Coverage in Health Facilities 12

Research Linking Increased Energy Access to Health Outcomes 14

Chapter 3: Methods 17

Population and Sample 17

Figure 1: Map of ASSP Program Provinces, Democratic Republic of Congo 18

Research Design and Procedure 18

Table 1: List of ASSP Health Zones Analyzed by Province, Democratic Republic of Congo 19

Limitations 21

Chapter 4: Results 23

Utilization Trends: All Health Zones 23

Utilization Trends: ≥60% of Health Zones Receiving Intervention 24

Figure 2: Scenario Comparison of Utilization for Ndesha Health Zone, DRC 25

Figure 3: Scenario Comparison of Utilization for Muetshi Health Zone, DRC 25

Figure 4: Scenario Comparison of Utilization for Kakoka Health Zone, DRC 26

Figure 5: Scenario Comparison of Utilization for Bena Tshadi Health Zone, DRC 27

Figure 6: Scenario Comparison of Utilization for Tshikaji Health Zone, DRC 28

Average Monthly Utilization: Two Scenarios 29

Table 2: Average Monthly Utilization Before and After Packaged Solar Panel Installation and Renovation Intervention and Difference-in-Differences Impact 29

Net Impact: Difference-in-Differences Analysis 30

Average Monthly Utilization: Actual Scenario 31

Table 3: Actual Scenario Average Monthly Utilization Before and After Packaged Solar Panel Installation and Renovation Intervention 31

Chapter 5: Discussion 33

Chapter 6: Recommendations 37

Conclusion 40

References: 41

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