How Energy Access Impacts Primary Healthcare: Evidence from India

Abstract

Background: Basic primary healthcare provides a critical safety net for the poor, but it is not always accessible. Unfortunately, primary health systems worldwide suffer from major gaps in infrastructure and human resources. One key infrastructure gap is access to reliable electricity, absence of which can significantly affect the quantity and quality of healthcare services being delivered at rural primary health facilities. However, absence of granular empirical evidence is a barrier for quantitatively understanding the significance of energy access as one of the determinants of access to reliable primary healthcare. Methods: We study the linkages between energy access and primary health services in extra-urban parts of India by focusing on the Primary Health Centers (PHCs), which are the main points of comprehensive primary care in the Indian public health system. Using data from District Level Household and Facility Survey, we develop zero-inflated negative binomial models with state-level fixed effects to estimate the relationship between levels of electricity access and the quantity of basic health services delivered at the PHCs. Findings: We find that lack of electricity access is associated with a significant and large decrease in the number of deliveries (64 percent), number of in-patients (43 percent), and number of out-patients (40 percent). We further find that lower level of energy access at primary health centers disproportionately affects women’s access to safe and quality healthcare. Interpretation: The evidence presented makes a strong case for rural health system policies to pay much more attention to understanding and integrating reliable energy access as an enabler of more equitable access to primary healthcare.