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)
Abstract
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
About this Master's Thesis
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