title: Limited electricity access in health facilities of sub-Saharan Africa: a systematic review of data on electricity access, sources, and reliability.
abstract: BACKGROUND
  Access to electricity is critical to health care delivery and to the overarching goal of universal health coverage. Data on electricity access in health care facilities are rarely collected and have never been reported systematically in a multi-country study. We conducted a systematic review of available national data on electricity access in health care facilities in sub-Saharan Africa.
  
  
  METHODS
  We identified publicly-available data from nationally representative facility surveys through a systematic review of articles in PubMed, as well as through websites of development agencies, ministries of health, and national statistics bureaus. To be included in our analysis, data sets had to be collected in or after 2000, be nationally representative of a sub-Saharan African country, cover both public and private health facilities, and include a clear definition of electricity access.
  
  
  RESULTS
  We identified 13 health facility surveys from 11 sub-Saharan African countries that met our inclusion criteria. On average, 26% of health facilities in the surveyed countries reported no access to electricity. Only 28% of health care facilities, on average, had reliable electricity among the 8 countries reporting data. Among 9 countries, an average of 7% of facilities relied solely on a generator. Electricity access in health care facilities increased by 1.5% annually in Kenya between 2004 and 2010, and by 4% annually in Rwanda between 2001 and 2007.
  
  
  CONCLUSIONS
  Energy access for health care facilities in sub-Saharan African countries varies considerably. An urgent need exists to improve the geographic coverage, quality, and frequency of data collection on energy access in health care facilities. Standardized tools should be used to collect data on all sources of power and supply reliability. The United Nations Secretary-General's "Sustainable Energy for All" initiative provides an opportunity to comprehensively monitor energy access in health care facilities. Such evidence about electricity needs and gaps would optimize use of limited resources, which can help to strengthen health systems.
authors.affiliation: World Health Organization, Department of Public Health and Environment , Geneva , Switzerland.
authors.forename: Heather
authors.initials: H
authors.lastname: Adair-Rohani
authors.affiliation: World Health Organization, Department of Public Health and Environment , Geneva , Switzerland.
authors.forename: Karen
authors.initials: K
authors.lastname: Zukor
authors.affiliation: World Health Organization, Department of Public Health and Environment , Geneva , Switzerland.
authors.forename: Sophie
authors.initials: S
authors.lastname: Bonjour
authors.affiliation: World Health Organization, Department of Public Health and Environment , Geneva , Switzerland.
authors.forename: Susan
authors.initials: S
authors.lastname: Wilburn
authors.affiliation: World Health Organization, Department of Public Health and Environment , Geneva , Switzerland.
authors.forename: Annette C
authors.initials: AC
authors.lastname: Kuesel
authors.affiliation: WE CARE Solar , Berkeley, CA , USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Hebert
authors.affiliation: World Health Organization, Department of Public Health and Environment , Geneva , Switzerland.
authors.forename: Elaine R
authors.initials: ER
authors.lastname: Fletcher