Energy security as a crucial component of health infrastructure: global evidence and actions

Energy security, defined as the availability of reliable, clean, and sustainable energy necessary to ensure the continuous operation of health-care facilities, is essential for delivering safe and effective health care. Yet, it is rarely measured, financed, or governed as a component of core health infrastructure. Evidence from nearly a thousand hospitals shows that power outages were common, especially in lower-income settings, disrupting surgery, diagnostics, cold chains, and digital records, with reports of direct patient harm and environmental costs. This Viewpoint highlights four potential solutions. First, measure energy security with a simple, service-oriented indicator set that tracks outage frequency and duration, clinical disruption, and harm. Second, ensure a minimum energy service for essential care, including operating theatres, maternity services, intensive care units, oxygen, and vaccine cold chains, by protecting critical circuits and embedding these standards in national health plans and SDG7 strategies. Third, build clean resilience by shifting from diesel-only back-up to context-appropriate onsite renewables with storage, integrated with stable grids and smart switching. Fourth, ensure financing by ring-fencing both capital and maintenance budgets, using asset registers, uptime targets, performance-based service contracts, and local technical capacity for operation and repair. These strategic actions would enable clinical teams globally, especially in the Global South, to consistently deliver safe and effective care while simultaneously decarbonising health systems and communities.