Power Supply and Ultrasound Functionality in Malawi: Findings from the 2019 Harmonized Health Facility Assessment (HHFA)

Ultrasound sonography (USS) is an essential diagnostic tool with growing relevance in resource-limited health systems. This study examines the association between electricity supply and USS availability and functionality in Malawi’s public and non-public health facilities. Using data from the 2018/2019 Harmonized Health Facility Assessment (HHFA), we conducted a cross-sectional analysis of 596 facilities. Electricity supply was categorized into stable grid, unstable grid, and non-grid. Adjusted prevalence ratios (PR) were estimated using robust Poisson regression. Only 9.9% of facilities had USS available, and of these, 93% had functional equipment. Compared to stable grid facilities, those using non-grid electricity were 85% less likely to have ultrasound available (PR: 0.15, 95% CI: 0.02–0.50) and 86% less likely to have it functional (PR: 0.14, 95% CI: 0.02–0.49). Diagnostic access was also considerably lower in primary-level and government-owned facilities. Spatial mapping revealed that most facilities without USS were primary-level and powered by non-grid or unstable grid sources. While electricity is necessary, it is not sufficient to ensure diagnostic readiness. Findings highlight the need for integrated planning across the energy and health sectors, present an opportunity for stronger government-CHAM collaboration, and support the targeted deployment of handheld ultrasound in energy-constrained settings.