Power Supply and Ultrasound Functionality in Malawi: Findings from the 2019 Harmonised Health Facility Assessment
1
Department of Global Health, University of Washington, Seattle, Seattle, United States
2
Department of Political Science, Emory University, Atlanta, United States
3
International School, Bellevue, United States
4
Bergen Centre for Ethics and Priority Setting, University of Bergen, Bergen, Norway
5
Department of Planning and Policy Development, Malawi Ministry of Health, Lilongwe, Malawi
6
Department of Clinical Services, Malawi Ministry of Health, Lilongwe, Malawi
7
Evans School of Public Policy and Governance, University of Washington, Seattle, Seattle, United States
Popul. Med. 2026;8(Supplement Supplement 1):A764
ABSTRACT
INTRODUCTION:
In low and middle-income countries, only 19% of patients access appropriate diagnostics at the primary level, and Malawi has one of the lowest household electricity access rates globally at 25.9%. The successful adoption of health innovations, such as integrating ultrasound into routine care, depends on adequate resources, with power supply as a core material requirement. Despite ultrasound's influence on clinical decision-making, access remains limited in Malawi. This study examined electricity supply's association with the availability and functionality of ultrasound in Malawi’s health facilities, focusing on primary care, and considers handheld ultrasound to close diagnostic gaps.
METHODS:
We conducted a cross-sectional study using data from 596 facilities in the 2019 Harmonised Health Facility Assessment. This secondary analysis included 543 primary-level, 47 secondary-level, and 6 tertiary-level facilities deemed appropriate for ultrasound services. Electricity supply, the primary independent variable, was constructed using information on the facility’s main power source, grid reliability, and backup power. Ultrasound availability and functionality were derived from equipment inventory observations and coded as binary outcomes. Adjusted Poisson regression models with robust standard errors estimated associations between electricity type and each ultrasound outcome, adjusting for region, urbanicity, facility level, and ownership.
RESULTS:
Ultrasound availability was low, with only 9.9% of facilities reporting equipment on site. Among these, 93% had functional machines. Facilities using non-grid electricity were 86% less likely to have functional ultrasound (PR: 0.14; 95% CI: 0.02–0.49) compared with those with stable grid access. Primary-level and government-owned facilities showed the lowest availability and functionality. Spatial mapping indicated that facilities without ultrasound were concentrated in energy-constrained areas.
CONCLUSIONS:
Electricity access is necessary but insufficient to support ultrasound readiness. Stronger coordination between the health and energy sectors is needed, together with targeted deployment of handheld ultrasound solutions in off-grid and unstable-grid settings.
In low and middle-income countries, only 19% of patients access appropriate diagnostics at the primary level, and Malawi has one of the lowest household electricity access rates globally at 25.9%. The successful adoption of health innovations, such as integrating ultrasound into routine care, depends on adequate resources, with power supply as a core material requirement. Despite ultrasound's influence on clinical decision-making, access remains limited in Malawi. This study examined electricity supply's association with the availability and functionality of ultrasound in Malawi’s health facilities, focusing on primary care, and considers handheld ultrasound to close diagnostic gaps.
METHODS:
We conducted a cross-sectional study using data from 596 facilities in the 2019 Harmonised Health Facility Assessment. This secondary analysis included 543 primary-level, 47 secondary-level, and 6 tertiary-level facilities deemed appropriate for ultrasound services. Electricity supply, the primary independent variable, was constructed using information on the facility’s main power source, grid reliability, and backup power. Ultrasound availability and functionality were derived from equipment inventory observations and coded as binary outcomes. Adjusted Poisson regression models with robust standard errors estimated associations between electricity type and each ultrasound outcome, adjusting for region, urbanicity, facility level, and ownership.
RESULTS:
Ultrasound availability was low, with only 9.9% of facilities reporting equipment on site. Among these, 93% had functional machines. Facilities using non-grid electricity were 86% less likely to have functional ultrasound (PR: 0.14; 95% CI: 0.02–0.49) compared with those with stable grid access. Primary-level and government-owned facilities showed the lowest availability and functionality. Spatial mapping indicated that facilities without ultrasound were concentrated in energy-constrained areas.
CONCLUSIONS:
Electricity access is necessary but insufficient to support ultrasound readiness. Stronger coordination between the health and energy sectors is needed, together with targeted deployment of handheld ultrasound solutions in off-grid and unstable-grid settings.
| eISSN: | 2654-1459 |
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