A rural health center in Mateliona Betafo, Madagascar, has transformed healthcare delivery with solar-powered electricity through the World Bank-supported LEAD Project. For nearly seven years, midwives like Lovatiana Rasoarinjanahary worked under unsafe, dim conditions, relying on candles or dying phone batteries. Since June 2024, the center - one of 500 electrified by LEAD - now provides safe, well-lit care, benefiting vulnerable populations. The project improves lighting, refrigeration, and sterilization, enhancing maternal and child healthcare while supporting Madagascar’s goal to double electricity access through cost-effective, off-grid solutions. Lives and communities are brighter and safer with this innovation.
Imagine giving birth in the dark, guided only by the flickering light of small candles, torches, or a phone close to running out of battery power? Picture the dire challenge of suturing a woman under such dim conditions. This was the reality for Lovatiana Rasoarinjanahary, a midwife at the Mateliona Betafo basic health center, some 20 km from the town of Antsirabe, Madagascar. She worked this way for nearly seven years.
“It was very stressful when the deliveries took place at night,” she confides. “We had no electricity and did everything in the dark. It was even more complicated when we had to suture the mother, as visibility was very poor.”
Since June 2024, this hardship has finally become a thing of the past. The health center was equipped with solar kits capable of powering the entire facility, the courtyard, the shared kitchen, and the houses of the health staff living on the center's grounds.
Now, when patients arrive at the center in an emergency at night, we’re no longer afraid to admit them because it’s bright — not like before.
Lovatiana Rasoarinjanahary
Midwife at the Mateliona Betafo
The transformation is evident to the patients as well. Lydia Rasoanandrasana, 20, who recently gave birth to her second child at 1:30 a.m., assisted by Rasazy Lovatiana, shares her experience. “This time, it was really good because we had light. For the birth of my first daughter, it was in the dark, and we had to spend money to buy candles.”
The health center in Mateliona Betafo equipped with solar kits by the World Bank-supported LEAD project. Photo: Tsiky Ranaivoarisoa / World Bank
“The lack of equipment for rural health centers is a major challenge for public health in Madagascar,” explains Tsiry Andriantahiana, LEAD Project Task Team Leader for the World Bank. “By electrifying 500 of the 1,250 non-electrified rural health centers throughout Madagascar, mainly using off-grid technologies, the LEAD Project is making a direct contribution to increasing the quality of health services available to the most vulnerable sections of the population.”
These health centers, located in rural areas and serving an average of 10,000 inhabitants, offer a range of essential services, particularly for children and mothers. By supporting the purchase and installation of larger, stand-alone solar systems in these facilities, the project is enabling better lighting, refrigeration, sterilization, and other services that are significantly improving the quality of healthcare in these areas.
“These 500 basic health centers have been carefully prioritized because of their isolation, the impossibility of reaching them via JIRAMA's (the national electricity company) existing interconnected network or isolated systems, and the importance of their size and services to vulnerable populations, particularly mothers and children,” confirms Barnia Raherinantenaina, LEAD Project Coordinator at the Ministry of Energy and Hydrocarbons.
The LEAD project is also investing in network extension and densification, using state-of-the-art planning tools and low-cost technologies to maximize the number of new connections per dollar spent. With an off-grid component, LEAD has also accelerated the market expansion of off-grid solar technology. The project aims to contribute to the government's objective of doubling access to electricity in the country through efficient and cost-effective investments in on-grid and off-grid solutions. It also seeks to further streamline energy sector governance, with a view to increasing private sector investment in access to electricity.
The impact of these efforts is already being felt. For Lovatiana and her colleagues, the difference is night and day—literally. “Now, we can perform our duties without the added stress of inadequate lighting. Our patients feel safer, and the quality of care has improved dramatically,” she says.
Lovatiana Rasoarinjanahary, a midwife at the Mateliona Betafo basic health center. Photo: Tsiky Ranaivoarisoa / World Bank
The improved conditions have a positive ripple effect on the community. With reliable lighting, the health center can maintain the cold chain for vaccines, ensuring they remain effective. Deliveries and minor operations are now conducted with proper lighting, enhancing the overall safety and efficacy of medical procedures. Patients no longer have to purchase candles, saving them money and reducing fire hazards.
For Lydia and other mothers, the experience of giving birth at the health center has changed for the better. “Having light during delivery makes a world of difference. It’s a much more comfortable and reassuring environment,” Lydia remarks.
Lydia Rasoanandrasana and her second baby at the Mateliona Betafo health center, the night after the birth. Photo: Tsiky Ranaivoarisoa / World Bank
The LEAD Project’s success in electrifying rural health centers showcases the potential of solar energy to transform lives and improve healthcare.
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