Many interventions seeking to improve maternal and neonatal mortality assume the existence of reliable energy infrastructure, and separately public will for such interventions, that simply don't exist. If a provider can't see to perform simply medical tasks because of unrealiable electricity, increasing the availability of skilled care providers or medical supplies can accomplish only so much. Likewise, if women (or other primary health decision makers) refuse to attend the health center to utilize such interventions, would good are they? Light the Night is a project on which Safe Mothers, Safe Babies is working with several partners to utilize solar technology to strengthen both the demand for and quality of rural obstetric care. The installation of stand-alone solar systems is paired with participatory demand-generation activities, responding to direct requests from community members who identified the lack of electricity, knowledge, and demand as some of the primary barriers to good maternal and child health.

Maternal mortality claims the lives of approximately 360,000 women each year, while millions more are injured. Millions of newborns are stillborn or die within the first week of life. The majority of conditions that cause these deaths and injuries could be prevented if pregnant women could safely and easily access timely and appropriate obstetric care. In most places of the developing world--which is where the majority of these deaths occur--access to such care is lacking, which has prompted numerous interventions seeking to improve the number of skilled care providers and availability of obstetric care supplies. Yet, these interventions assume the existence of reliable energy infrastructure that quite frequently does not exist. Without reliable electricity, care providers labor to provide care by the dim glow of kerosene lanterns, candles, flashlights, or cell phones. Surgeons struggle to conduct life-saving obstetric surgeries, and quite frequently, they are canceled. Likewise, without substantial effort to strengthen the demand for such interventions, they are often underutilized and much less effective than they could or should be.

Light the Night is the venue through which Safe Mothers, Safe Babies is seeking to pair solar technology and demand-strengthening activities to increase the demand for and quality of rural obstetric care services. One pilot program was conducted in a health center that serves a little less than 50,000 people; the marriage of demand-generation and solar installation increased the average monthly rates of health center delivery, HIV/STD testing, and prenatal care by over 100%. This success led us to develop plans for employing the process in an additional 8 rural health centers and 2 hospitals, which will take place from December 2011 to May 2012. In those health centers that are NGO-funded (as opposed to government), payment of 1/3 the money saved monthly from electric bills will be placed in a special health center account to fund the cost of other interventions, in one instance a motorcycle ambulance program to reduce the barrier to accessing care. Our partners on the project include a U.S.-based solar company, Humless, Inc., that makes lithium-ion solar units, and a U.S.-based nonprofit called WE CARE Solar, which developed a highly efficient, stand-alone solar electric system packaged in a suitcase. Light the Night is innovative in that it is the only program we know of using solar power to strengthen not only the quality of care provided, but also the demand for and utilization of such services.

By pairing demand-strengthening activities with the installation of solar power, both the demand for obstetric interventions and the quality of care provided can be strengthened simultaneously. In particular, following Safe Mothers, Safe Babies' model of participatory development and engagement, the catchment areas of each health center or hospital that receive a solar unit are engaged in the process of defining maternal and child health, prioritizing local challenges, and devising low or no-cost ways to address them, particularly for those barriers related to lack of demand or utilization of services. Following these demand-strengthening activities, and other related projects that simultaneously allow us to increase knowledge of the soon-to-be-installed solar technology, the solar unit is installed in the health center and education provided to the health center staff regarding optimal usage, care, and repair. By pairing demand and supply side interventions, the utilization and quality of services both increase, which contributes to further increases in the utilization of services as word spreads that the quality of care has improved.

Light the Night is targeting rural health center and hospitals, in particular those that have the capability of performing emergency obstetric surgery or identifying and referring such complicated cases to facilities that do perform such surgeries.