Association for Public Policy Analysis & Management

In low-income countries, maternal and perinatal mortality rates remain high, and poor quality of maternity care is a major driver of this excess mortality. Many primary health facilities lack access to electricity, yet little evidence exists regarding the extent to which inadequate and unreliable light contribute to poor quality care.

We conducted a stepped-wedge cluster-randomized trial with 30 rural maternity facilities in Uganda. The intervention was the installation of a “Solar Suitcase”, a complete solar electric system that provides essential lighting and power for charging small medical devices. We used direct clinical observation of deliveries to measure the quality of intrapartum care and light sensors to measure brightness of light.

We observed 1,118 births. The intervention increased the number of daily minutes of light by 141 (95%CI 8 to 274). Prior to the intervention, when maternity providers worked at night, they performed 42% of essential care actions and accumulated an average of 76 minutes of delays in care. After installation, quality increased by 4 percentage points (95%CI 1-8) and delays in care decreased by 10 minutes (95%CI -16 to -3). The areas of care in which reliable light had the largest impacts were infection control, prevention of postpartum hemorrhage, and newborn care.

Reliable light is an important driver of timely and adequate health care. Investment in modern and renewable energy systems for health facilities is a critical priority; however, quality may remain low even in the presence of reliable light, suggesting a broader approach to high-quality health systems is necessary.