Powering Critical Care in Rural Madagascar

Since the start of 2022, Madagascar has been hit by nine cyclones, three of which were Category 4 storms or stronger when they made landfall, with windspeeds measuring at least 130 miles per hour. The deadly storms have wrought severe damage across multiple areas of the island, the world’s fourth-largest, slightly bigger than France in terms of square miles.

Even as the storms have brought acute challenges to the nation, they have also exacerbated preexisting vulnerabilities, particularly concerning the power grid, according to Léa Rahajatiana, deputy director of biomedical services for Pivot, a nonprofit that helps support the government-run healthcare system in Madagascar’s Ifanadiana district. Pivot provides training to clinical staff members, sourcing and financing certain hard-to-obtain medications and funding for other critical needs, amongst other forms of support. Pivot-supported clinics have seen over 1.3 million patient visits since 2014.

Access to power remains an ongoing concern in Ifanadiana, which is located about 260 miles southeast of the capital, Antananarivo, and is home to about 200,000 people, most of whom work as farmers. Rahajatiana said power outages are most common during the rain and cyclone season, starting in November and extending into spring. These cuts can last for up to two weeks, she said.

“The hospital is not spared,” Rahajatiana said. Last year, amidst renovations that went on for two months, power outages occurred about every two days and could last up to 10 hours. Government-allocated fuel needed to run backup generators at the hospital run by Pivot is often insufficient to meet critical needs, Rahajatiana said. Per capita spending on health is among the lowest in the world.

A lack of power makes it impossible to perform just about all surgeries. The nearest hospital is 80 kilometers away. Without electricity, other impacts include patients being forced to use oxygen tanks instead of oxygen concentrators, which pull a continuous supply of oxygen from the air, and closing down the hospital laboratory’s blood bank, which also requires a constant supply of electricity.

To help maintain a steady supply of electricity, Pivot requested and recently received three portable solar generators from Direct Relief, and the units will power the hospital’s operating room, intensive care unit, maternity and neonatology ward, and blood bank. By installing these generators, the hospital will have reliable power during outages and will be able to mitigate the substantial fuel costs of powering diesel generators.

“It’ll simplify things so much,” said Amy Donahue, senior engagement officer at Pivot.

Access to electricity, especially in the wake of powerful storms, has been an increasing focus of safety net healthcare clinics worldwide as they seek to maintain operations. Notable mass blackouts have occurred in recent years across the entire island of Puerto Rico following Hurricane Maria and in several communities across Northern California following wildfires – some of which have been started by power companies. In recognition of this, Direct Relief has started to address this need when requested in Puerto Rico, California, New Orleans, North Carolina, and around the world by providing solar power generators and solar panels.

While having power at the hospital is critical for care, Donahue said it could also have tangential effects, such as helping draw more people to seek preventive care or care at earlier phases of illness since they will know the hospital at least has electricity. Donahue said some local residents perceive the hospital and clinics with trepidation, with some believing that healthcare clinics are “places where people go to die.”

Besides power, Rahajatiana and Donahue identified access to clean water and sheer geographical distance as additional issues Pivot is focused on mitigating. Seventy-five percent of the population in Ifanadiana lives at least a five-kilometer walk from the nearest health facility. There is only one paved road in the district.

In recognition of its ability to help improve health outcomes in Ifanadiana, Pivot is working with local officials to expand its services to the entire Vatovavy region, which Ifanadiana comprises one of three districts. This will increase Pivot’s patient population fivefold, from 200,000 to 1 million people, and geographic coverage will triple.

Even as those challenges endure, another storm season will arrive in a few months, and with it, power outages. Rahajatiana said solar power will enable doctors, nurses, and patients to focus on healing rather than electrical infrastructure issues.

With access to resilient power sources, clinicians will be more free to focus on their jobs – instead of having to plan for when lights go out.

“Hospital patients and services will no longer suffer from power cuts,” Rahajatiana said.

In addition to solar backup power units, Direct Relief has provided medication support to Pivot, including more than 215,000 defined daily doses of medication, since 2018.