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Access to energy is essential for resilient health systems; however, strengthening energy infrastructure in rural health facilities remains a challenge. In 2015–19, ‘Powering Healthcare’ deployed solar energy solutions to off-grid rural health facilities in Ghana and Uganda to improve the availability of maternal and child health services. To explore the links between health facility electrification and service availability and use, the World Health Organization (WHO), in partnership with Dodowa Health Research Centre and Makerere University School of Public Health, carried out an implementation research study. The objectives of this study were to (1) capture changes in service availability and readiness, (2) describe changes in community satisfaction and use and (3) examine the implementation factors of sustainable electrification that affect these changes. Data were collected through interviews with over 100 key informants, focus group discussions with over 800 community members and health facility assessment checklist adapted from the WHO’s Service Availability and Readiness Assessment tool. Implementation factors were organized using Normalization Process Theory constructs. The study found that access to energy is associated with increased availability of health services, access to communication technologies, appropriate storage of vaccines and medicines, enhanced health worker motivation and increased community satisfaction. Implementation factors associated with improved outcomes include stakeholder engagement activities to promote internalization, provision of materials and information to encourage participation, and establishment of relationships to support integration. Barriers to achieving outcomes are primarily health systems challenges—such as drug stockouts, lack of transportation and poor amenities—that continue to affect service availability, readiness and use, even where access to energy is available. However, through appropriate implementation and integration of sustainable electrification, strengthened energy infrastructure can be leveraged to catalyze investment in other components of functioning health systems. Improving access to energy in health facilities is, therefore, necessary but not sufficient for strengthening health systems.

BackgroundThe Sustainable Development Goals call for the effective governance of shared natural resources in ways that support inclusive growth, safeguard the integrity of the natural and physical environment, and promote health and well-being for all. For large-scale resource extraction projects -- e.g. in the mining sector -- environmental regulations and in particular environmental impact assessments (EIA) provide an important but insufficiently developed avenue to ensure that wider sustainable development issues, such as health, have been considered prior to the permitting of projects.MethodsIn recognition of the opportunity provided in EIA to influence the extent to which health issues would be addressed in the design and delivery of mining projects, an international and intersectoral partnership, with the support of WHO and public funds from Canadian sources, engaged over a period of six years in a series of capacity development activities and knowledge translation/dissemination events aimed at influencing policy change in the extractives sector so as to include consideration of human health impacts.ResultsEarly efforts significantly increased awareness of the need to include health considerations in EIAs. Coupling effective knowledge translation about health in EIA with the development of networks that fostered good intersectoral partnerships, this awareness supported the development and implementation of key pieces of legislation. These results show that intersectoral collaboration is essential, and must be supported by an effective conceptual understanding about which methods and models of impact assessment, particularly for health, lend themselves to integration within EIA.ConclusionsThe results of our partnership demonstrate that when specific conditions are met, integrating health into the EIA system represents a promising avenue to ensure that mining activities contribute to wider sustainable development goals and objectives.

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