Access to reliable electricity has been identified as critical for health care facilities. Without it, many lifesaving interventions cannot be undertaken (WHO, 2014). Having electricity also allows the maintenance of essential equipment for medical tasks, such as sterilizers, refrigerators, and equipment to maintain the cold chain of medicines and vaccines. These practices are related to the quality of the services provided and might reduce mortality (Chen, Chindarkar, & Xiao, 2019; Irwin, Hozha, & Grepin, 2019; World Bank, 2008). Besides the well-functioning of essential equipment, electricity allows facilities to have laboratories and implement reliable tests that impact diagnostic quality (Irwin, Hozha, & Grepin, 2019). Access to electricity has been related to the ability to attract better-skilled providers, which results in better health outcomes such as improved survival rates, particularly for children and pregnant women (Kruk, et al., 2018; Irwin, Hozha, & Grepin, 2019; Lenz, Munyhirwe, Peters, & Sievert, 2016; Chaindhury & Hammer, 2003). Finally, extended hours of operation are only feasible if facilities have access to a source of energy, which contributes to the continuous provision of services as these should be available beyond the daylight hours (WHO, 2014). Extended hours also increase the number of patients that come into facilities and their perceived quality of health service delivery (Chen, Chindarkar, & Xiao, 2019; Irwin, Hozha, & Grepin, 2019).

Long travel times to health facilities as well as transportation restrictions are also significant barriers to health care access, especially for low-income populations. Large distances, the lack of transport availability, and deficient road conditions inevitably delay medical attention, which threatens the lives of people who need it, especially for urgent care (Syed, Gerber, & Sharp, 2014; Kaibung, Mavole, & Okuku, 2017). For instance, pregnant women in remote areas are less likely to receive medical attention, and several maternal deaths might be prevented if access to emergency childbirth care was ensured (Babinard & Roberts, 2006). Remote areas might also face lower availability and retention of medical providers (Ojakaa, Olango, & Jarvis, 2014). In addition, lack of transportation or poor road quality conditions might negatively influence the availability of medicines. Without accessibility, meeting the demands for medicines could be more complicated and, therefore, medicines might be restocked less frequently, affecting the availability of drugs in the health centers (Hall, Radebe, & Roberts, 2006; Kaibung, Mavole, & Okuku, 2017).

Finally, having access to the internet and ICT improves access to medical knowledge, to other peers and experts, and access to patients. Connectivity and mobile and internet infrastructure have been proven pivotal in the COVID-19 context, enabling medical services even at a distance through telemedicine. Furthermore, ICT and internet access also allow facilities to access worldwide information that can be used, from learning opportunities to external consultations to discussing diagnostics with experts (Bukachi & Pakenhan-Walsh, 2007). Finally, given its massification power, ICT also enables the broadcasting of information on a large scale, which can be valuable for health promotion (Dutta, Gupta, & Sengupta, 2019).

ICT might also be beneficial for increasing the efficiency of facilities when used for administrative tasks. For example, using ICT may help to reduce drug stock-out, time spent on paperwork, and patients’ waiting time (Achampong, 2012; Nilseng, et al., 2014; Githinji, et al., 2013; Kaibung, Mavole, & Okuku, 2017). Access to ICT and the internet might then improve the efficiency of medical personnel by ensuring a better supply of needed inputs such as medicines or vaccines, enhancing their knowledge by having access to information and freeing up time previously spent on manual tasks.

The quality of care comprises a large variety of inputs, processes, and outputs. For this work, we focus our attention on the dimensions for which we have data to test our hypotheses, as access to infrastructure and ICT. We acknowledge this scope omits other dimensions of quality that might be equally relevant but expect that future research can explore this further once the data to do so becomes available.

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