Power supply and ultrasound functionality in Malawi: findings from the 2019 harmonised health facility assessment

Ultrasound sonography is a critical diagnostic tool, yet access remains limited in Malawi. This study assessed the relationship between electricity supply and ultrasound availability and functionality using data from 596 health facilities in the 2019 Harmonised Health Facility Assessment. Only 9.9% of facilities had ultrasound equipment available, with 93% of that equipment functional. Facilities powered by non-grid sources were 86% less likely to be functional (PR: 0.14; 95% CI: 0.02-0.49) compared to those with a stable grid supply. Ultrasound functionality was particularly low in primary-level facilities and those owned by the government. Spatial analysis revealed that most facilities without ultrasound were located in energy-constrained areas. While electricity access is necessary, it is insufficient on its own. Results support the need for stronger alignment between the health and energy sectors, as well as the potential for targeted deployment of handheld ultrasound in low-resource, off-grid settings.