Electricity Access, Sources, and Reliability at Primary Health Centers in India and Effect on Service Provision: Evidence from Two Nation-wide Surveys

BACKGROUND: A large number of government primary health-care facilities (GPHCFs) in India do not have access to the regular electricity supply. OBJECTIVES: To assess the status and change in electricity access, sources, and reliability at primary health centers (PHCs) in India; and to understand the effect of regular electricity supply on health services provision and on workforce availability and retention. MATERIALS AND METHODS: Secondary analysis of data from the lastest two rounds of district-level household survey (DLHS) in India, conducted in 2007–2008 and 2012–2013. RESULTS: Data of 8619 PHCs from DLHS-3 and 8540 PHCs from DLHS-4 were analyzed. The proportion of PHCs with access to electricity increased from 87% to 91%. However, regular electricity supply was available at only 50% of PHCs in 2012–2013, which was an increase from 36% such PHCs in 2007–2008. PHCs with regular electricity supply provided services to 50% more beneficiaries (deliveries and vaccination) than PHCs without regular or no electricity (P ≤ 0.001). Increased access to regular electricity was associated with improved availability and retention of health staff (P = 0.001). CONCLUSION: Government policies should aim to ensure access to regular electricity-supply-beyond just connection from grid-at all GPHCFs, including health sub-centers, PHCs, and community health centers. Indicators on electricity access at GPHCFs could be standardized and integrated into regular health and facility-related surveys as well as in the existing dashboards for real-time data collection. Health policy interventions should be informed by regular data collection and analysis. Improving access to regular electricity supply at GPHCFs can contribute to achieve the goals of National Health Policy of India. This will also help to advance universal health coverage in the country. There are lessons from this study, for other low and middle income countries, on improving health service provision at government health care facilities.