Assessing the impacts of sufficient and reliable electricity in low-resource healthcare facilities

Health systems across sub-Saharan Africa often lack the electricity needed for lighting, medical, diagnostic, and sterilization equipment, and refrigeration. More than one billion people globally rely on facilities with no electricity or a highly unreliable supply. Using survey data, sensor data, and monthly health system records from 303 facilities across three provinces of the Democratic Republic of the Congo, we provide estimates of the impact of having sufficient and reliable power on inpatient mortality rates, patient utilization rates, and staffing. Using longitudinal targeted maximum likelihood estimation and two-way fixed effects models, we find that facilities with sufficient and reliable power ([Formula: see text]22 h of power/day) experience a 41% reduction in mortality (a 1.8 percentage point reduction from control facilities, where mortality rates average 4.5%). For a subset of facilities where we measure reliability over time, we find that during months where the uptime [Formula: see text]22 h/d, mortality rates are 1.8 percentage points lower, suggesting that sustaining reliable power is also important. In facilities with reliable power there is also a 17% increase in the number of outpatients and a 24% increase in the number of days nurses work. Our results underscore the critical role of electricity as a foundational health system input with large impacts on patient survival and service quality, and demonstrate the potential of low-cost survey tools for capturing reliability in data-scarce settings.