Table 2 Localized solutions to rising petroleum prices in the health sector in LMICs

1. Health infrastructure, supplies, & equipment

• Build infrastructure using locally available materials

• Reduce reliance on disposable materials and move toward sterilizing reusable ones on-site

• Substitute local goods when possible, including those made from traditional materials (bandages, etc.) of known safety and efficacy

2. Transportation and referral system

• Create a strategic fuel reserve to power emergency vehicles

• Identify alternative means of transport for referral systems (local ambulance schemes, animal-powered referrals, etc.)

• Use distance technology e.g. cell phone-based monitoring systems when feasible and appropriate

3. Energy for health services

• Identify and utilize local energy resources (solar roof panels, hydropower, wind power)

• Utilize architectural design allowing for natural lighting, heating & cooling

• Adopt energy efficient technologies & reserve fuel supplies to ensure supply chains for goods whose production cannot be localized

4. Human resources policy

• Scale up task-shifting to CHWs and increase roles for local health workers

• Provide incentives for health workers to stay in rural communities

• Scale-up training activities and training of trainers at the lowest levels of the health system

• Localize supervisory structures and/or provide non-petroleum based forms of transportation for supervisory visits

5. Health systems organization

• Create satellite health facilities or health posts in rural or peripheral areas

• Clarify and improve upon decentralization policies using evidence-based practices

• Empower local governance by creating village health committees, health facility oversight boards, and financing and procurement systems that can support and monitor implementation of health services