News publications and other organizations are encouraged to reuse Direct Relief-published content for free under a Creative Commons License (Attribution-Non-Commercial-No Derivatives 4.0 International), given the republisher complies with the requirements identified below.

When republishing:

  • Include a byline with the reporter’s name and Direct Relief in the following format: "Author Name, Direct Relief." If attribution in that format is not possible, include the following language at the top of the story: "This story was originally published by Direct Relief."
  • If publishing online, please link to the original URL of the story.
  • Maintain any tagline at the bottom of the story.
  • With Direct Relief's permission, news publications can make changes such as localizing the content for a particular area, using a different headline, or shortening story text. To confirm edits are acceptable, please check with Direct Relief by clicking this link.
  • If new content is added to the original story — for example, a comment from a local official — a note with language to the effect of the following must be included: "Additional reporting by [reporter and organization]."
  • If republished stories are shared on social media, Direct Relief appreciates being tagged in the posts:
    • Twitter (@DirectRelief)
    • Facebook (@DirectRelief)
    • Instagram (@DirectRelief)

Republishing Images:

Unless stated otherwise, images shot by Direct Relief may be republished for non-commercial purposes with proper attribution, given the republisher complies with the requirements identified below.

  • Maintain correct caption information.
  • Credit the photographer and Direct Relief in the caption. For example: "First and Last Name / Direct Relief."
  • Do not digitally alter images.

Direct Relief often contracts with freelance photographers who usually, but not always, allow their work to be published by Direct Relief’s media partners. Contact Direct Relief for permission to use images in which Direct Relief is not credited in the caption by clicking here.

Other Requirements:

  • Do not state or imply that donations to any third-party organization support Direct Relief's work.
  • Republishers may not sell Direct Relief's content.
  • Direct Relief's work is prohibited from populating web pages designed to improve rankings on search engines or solely to gain revenue from network-based advertisements.
  • Advance permission is required to translate Direct Relief's stories into a language different from the original language of publication. To inquire, contact us here.
  • If Direct Relief requests a change to or removal of republished Direct Relief content from a site or on-air, the republisher must comply.

For any additional questions about republishing Direct Relief content, please email the team here.

Powering Critical Care in Rural Madagascar

Solar power units to help keep critical hospital operations available for 200,000 people.



Ifanadiana, Madagascar, is a community that has intermittent power and recently received solar back-up power units from Direct Relief to maintain continuous health operations at a local hospital. (Photo courtesy of Pivot)

Since the start of 2022, Madagascar has been hit by nine cyclones, three of which were Category 4 storms or stronger when they made landfall, with windspeeds measuring at least 130 miles per hour. The deadly storms have wrought severe damage across multiple areas of the island, the world’s fourth-largest, slightly bigger than France in terms of square miles.

Even as the storms have brought acute challenges to the nation, they have also exacerbated preexisting vulnerabilities, particularly concerning the power grid, according to Léa Rahajatiana, deputy director of biomedical services for Pivot, a nonprofit that helps support the government-run healthcare system in Madagascar’s Ifanadiana district. Pivot provides training to clinical staff members, sourcing and financing certain hard-to-obtain medications and funding for other critical needs, amongst other forms of support. Pivot-supported clinics have seen over 1.3 million patient visits since 2014.

Access to power remains an ongoing concern in Ifanadiana, which is located about 260 miles southeast of the capital, Antananarivo, and is home to about 200,000 people, most of whom work as farmers. Rahajatiana said power outages are most common during the rain and cyclone season, starting in November and extending into spring. These cuts can last for up to two weeks, she said.

“The hospital is not spared,” Rahajatiana said. Last year, amidst renovations that went on for two months, power outages occurred about every two days and could last up to 10 hours. Government-allocated fuel needed to run backup generators at the hospital run by Pivot is often insufficient to meet critical needs, Rahajatiana said. Per capita spending on health is among the lowest in the world.

Léa Rahajatiana reviewing hospital inventory (Photo courtesy of Pivot)

A lack of power makes it impossible to perform just about all surgeries. The nearest hospital is 80 kilometers away. Without electricity, other impacts include patients being forced to use oxygen tanks instead of oxygen concentrators, which pull a continuous supply of oxygen from the air, and closing down the hospital laboratory’s blood bank, which also requires a constant supply of electricity.

To help maintain a steady supply of electricity, Pivot requested and recently received three portable solar generators from Direct Relief, and the units will power the hospital’s operating room, intensive care unit, maternity and neonatology ward, and blood bank. By installing these generators, the hospital will have reliable power during outages and will be able to mitigate the substantial fuel costs of powering diesel generators.

“It’ll simplify things so much,” said Amy Donahue, senior engagement officer at Pivot.

Access to electricity, especially in the wake of powerful storms, has been an increasing focus of safety net healthcare clinics worldwide as they seek to maintain operations. Notable mass blackouts have occurred in recent years across the entire island of Puerto Rico following Hurricane Maria and in several communities across Northern California following wildfires – some of which have been started by power companies. In recognition of this, Direct Relief has started to address this need when requested in Puerto Rico, California, New Orleans, North Carolina, and around the world by providing solar power generators and solar panels.

Ifanadiana District Hospital (Photo courtesy of Pivot)

While having power at the hospital is critical for care, Donahue said it could also have tangential effects, such as helping draw more people to seek preventive care or care at earlier phases of illness since they will know the hospital at least has electricity. Donahue said some local residents perceive the hospital and clinics with trepidation, with some believing that healthcare clinics are “places where people go to die.”

A doctor examines a pediatric patient at Ifanadiana District Hospital (Photo courtesy of Pivot)

Besides power, Rahajatiana and Donahue identified access to clean water and sheer geographical distance as additional issues Pivot is focused on mitigating. Seventy-five percent of the population in Ifanadiana lives at least a five-kilometer walk from the nearest health facility. There is only one paved road in the district.

In recognition of its ability to help improve health outcomes in Ifanadiana, Pivot is working with local officials to expand its services to the entire Vatovavy region, which Ifanadiana comprises one of three districts. This will increase Pivot’s patient population fivefold, from 200,000 to 1 million people, and geographic coverage will triple.

Even as those challenges endure, another storm season will arrive in a few months, and with it, power outages. Rahajatiana said solar power will enable doctors, nurses, and patients to focus on healing rather than electrical infrastructure issues.

With access to resilient power sources, clinicians will be more free to focus on their jobs – instead of having to plan for when lights go out.

“Hospital patients and services will no longer suffer from power cuts,” Rahajatiana said.

In addition to solar backup power units, Direct Relief has provided medication support to Pivot, including more than 215,000 defined daily doses of medication, since 2018.

Giving is Good Medicine

You don't have to donate. That's why it's so extraordinary if you do.