Indicator 2: Basic infrastructure

For health facilities to provide good-quality EmONC, they must have basic infrastructure, including at a minimum: uninterrupted electricity and water services in key locations where EmONC is delivered. While many countries are on the road to having sustained supplies of electricity and water in health facilities, recent studies have found that one-fifth of health facilities lack basic water services and more than 1 billion people worldwide are still served by health facilities with unreliable or no electricity.¹²³ Only half of hospitals in sub-Saharan African countries have access to reliable electricity.⁴ A lack of water and electricity inhibits health facilities from providing safe services, including their ability to prevent health-care-associated infections, and to run critical life-saving medical devices / equipment.⁵⁶ Health providers who work in health facilities without reliable access to light and electricity are less satisfied with their jobs and feel less confident in providing high-quality care.⁷

The numerator for this indicator is the number of facilities that have electricity and water services on the day of the assessment in the maternity unit, the surgical unit, the SNCU, the NICU and the ICU (the units or departments that are assessed will depend on the designated EmONC level of the facility). Further instructions on how to collect and analyze these data can be found on the Collecting data on the availability of electricity and water worksheet.

The denominator for this indicator is the total number of facilities that are being assessed.

This indicator is typically expressed as a percentage (e.g., 80% of facilities have basic infrastructure).

To monitor whether facilities have electricity and water, facilities should be assessed and the indicator calculated on an annual basis.

The benchmark for this indicator is 100% of facilities have the minimum required basic infrastructure.

Electricity and water are needed for the delivery of good-quality EmONC. Therefore, when this indicator is less than 100%, interventions are needed to ensure all EmONC facilities have electricity and water in all key facility locations.

Disaggregation of this indicator by geographical area, level of facility, EmONC classification, and/or managing authority may uncover systemic problems.

Reliable access to electricity and water are elemental. But, there are many other aspects of infrastructure that are required for the delivery of good-quality, safe EmONC services. Other elements that can be assessed and monitored, especially once the availability of electricity and water is sustained, include: the minimum number of delivery beds as per FIGO recommendations;⁸ minimum number of SNCU beds as per NORMs recommendations; device/equipment to heat/cool maternity units, SNCUs and operating theater; infection prevention including functioning autoclave; cold storage for drugs; beds for women and babies to stay together in SNCUs; restrooms for women in the maternity ward and for families in the SNCUs.

• WHO. Assessment tool on infection prevention and control minimum requirements for primary health care facilities. Geneva: World Health Organization, 2023.
• WHO. Assessment tool on infection prevention and control minimum requirements for secondary health care facilities. Geneva: World Health Organization, 2023.
• WHO. Assessment tool on infection prevention and control minimum requirements for tertiary health care facilities. Geneva: World Health Organization, 2023.