Frequent and random power outages can mean life and death for patients, but specialised technology can prevent lapses in care, as PARTNERS IN HEALTH writes.
It is 1 am and the power snuffs out at Neno District Hospital in Malawi.
Vital operations grind to a halt. Oxygen production slows. Baby warmers, which regulate the temperature of premature or critically ill infants, will soon grow cold.
Calls are made and hospital staff race in ambulances to the home of an electricity technician for help.
They know the length of time it takes to get the power back on can be the difference between life and death.
Both the Neno District Hospital and Lisungwi Community Hospital are equipped with robust backup generators, installed to combat the frequent and random power outages in Malawi caused by persistent load shedding and an unstable grid.
Healthcare stress
Since Malawi gained independence from Britain in 1964, it has taken on debt to finance social programmes and infrastructure projects. However, climbing out of sovereign debt can be incredibly difficult.
In the 2022/23 fiscal year, the country spent roughly a third of its budget on debt interest payments—leaving key public services underfunded and over 70 percent of the population living below $2.50 a day.
Despite these challenges, the country is working to expand essential infrastructure. In May, Malawi received a grant from the World Bank to expand its energy generation and storage capacity. The Malawi Energy Access Project has increased access to grid power from about 12 percent in 2018 to 25 percent last year.
Still, demand outweighs the load bearing capacity, resulting in frequent outages.
In a period of 53 days, staff at Abwenzi Pa Za Umoyo, as Partners In Health (PIH) is known in the country, counted more than 30 power outages—sometimes multiple times a day.
Still, the process of switching from grid power to generator power requires the help of a specially trained technician. The technician must run between the hospital and the building where the generator is located.
It takes about 10 minutes for the technician to perform the switch, but that’s only if everything goes according to plan.
If it happens in the middle of the night, hospital staff must call the home of a sleeping technician, wake them and have them get in a vehicle back to the facility so the switch can be made.
“The blackouts would come at 1am and then that means looking for a driver to go and pick a staff member up,” said PIH infrastructure manager John Munthali. “The moment they get home, then electricity is back.”
Previously, staff tried to schedule an electricity technician at all hours. However, even with the combined effort of PIH and Ministry of Health and Sanitation, the workforce was spread thin.
And it weighed heavily on staff members, who felt a deep sense of responsibility for ensuring patients’ safety.
“Patients don’t wait for any minute,” said Munthali. “There’d be someone on an oxygen concentrator, babies on life-supporting equipment, blood samples in the laboratory, somebody undergoing a (surgery). There is a whole lot of life and death risk associated, and to put in someone’s hands—it was unfair to both those who would lose life to it and those that were being entrusted with such.”
To combat the temperamental nature of this vital technology, PIH and Ministry of Health staff worked to obtain automatic transfer switches, which are specialised pieces of equipment that switch automatically between grid and generator power without the need for a technician.
Unfortunately, those switches often broke after a week or two of use, unable to handle the extreme load shedding.
“We used to have a lot of power surges that were beyond what the other automatic transfer switches could contain,” said Munthali.
For over a year, PIH staff worked alongside the ministry to procure two robust, durable automatic switches with the support of PIH’s Non-Negotiables Phase 1 grant.
Staff from PIH and the ministry held consultations to determine which technology would be most tailored to the hospitals’ needs, with a specific focus on long-term use that could adapt to changing technology over the next 10 to 20 years.
After more than a year of design consultations and sourcing parts, the partners staff obtained all the necessary components.
They sourced the switches from South Africa and the installation materials locally.
Despite the cost and difficulty sourcing the technology, PIH and the ministry’s staff established ATSes in both hospitals in May and June of 2025, meaning no more middle of the night wake up calls to transfer the power, or lost oxygen production, or interrupted surgeries.
What was once an anxiety-inducing plunge into darkness has changed to a six second blink, as the grid power automatically shifts to generator power.
“It’s quite a relief,” Munthali said, smiling.
The quick shift also means the hospital can produce more oxygen for storage, a vital part of patient care, said PIH biomedical engineer Kingsley Gwesere.
Auto-shift
Countless conditions, including tuberculosis, asthma, heart failure, Covid-19 and pneumonia, require patients to rely on a steady supply of life-saving oxygen.
This seamless transition between grid and generator power means the hospital can continue producing oxygen without interruption.
That additional oxygen could save a patient in need, said electrical engineer Chisomo Jeputala.
He stated: “It also means a reduction in diesel usage. The switch can sense when the grid power comes back on, meaning it can quickly switch away from the diesel generator power.
“This fast switch has eliminated the use of an estimated 409 litres of diesel annually, reducing approximately 1.1 tons of carbon dioxide released into the atmosphere.”
PIH believes that people deserve the highest quality of medical care, starting with those who need it most. Even when facing problems that seem overwhelming, PIH and our partners are committed to navigating them in a thorough, thoughtful, and patient-centred way.—Pih.org
