Reliable electricity linked with fewer patient deaths in low-resource healthcare facilities

Reliable electricity may be more than an infrastructure challenge for healthcare facilities in low-resource settings—it may be a matter of life and death.

Using survey data that was collected directly from 303 hospitals and reference health centers in the North Kivu, South Kivu, and Haut Katanga regions of the Democratic Republic of the Congo (DRC), monthly health system records, and minute-by-minute power-sensor measurements from a subset of facilities, the researchers found that sufficient and reliable electricity was associated with a 41% reduction in inpatient mortality.

“Reliable electricity is often treated as a prerequisite for healthcare, but this research shows that it is itself a measurable determinant of health,” says Dan Kammen, the Bloomberg Distinguished Professor of Energy and Climate Justice at Johns Hopkins and a core researcher with the Ralph O’Connor Sustainable Energy Institute. “The ability to connect detailed energy data with health system records gives us a much clearer picture of why energy reliability matters—and how investments in energy infrastructure can save lives.”

The study was published September 17 in Proceedings of the National Academy of Sciences of the United States of America. The project is part of a collaboration between the Renewable Energy and Equity Worldwide Laboratory (RENEW) at JHU, Ryan McCord, a postdoctoral researcher in energy economics at Duke University, Laura Kwong, an assistant professor of environmental health sciences at the University of California, Berkeley, and the Research Center for Humanitarian Aid (RCHA) in the DRC.

“We founded RCHA to address two major challenges in the eastern Congo: the lack of coordination between humanitarian interventions and sustainable-development approaches, and the insufficient involvement of local communities in designing research tools and projects,” said Jackson Mughuma, RCHA’s founder and executive director who led research data collection for this project. “Our role as a facilitator and bridge among international researchers, provincial health authorities, hospital staff, humanitarian actors, and private-sector partners demonstrates the value of a model grounded in research, action, and participation.”

Using causal machine learning methods to account for differences among facilities and changes over time, the team estimated that sufficient and reliable electricity—defined as having sufficient capacity and more than 22 hours of electricity per day or 91.7% uptime—had mortality rates of 2.6%. They also found that facilities that were below that reliability threshold – which ranged from 62-74% uptime – had mortality rates in the 4.4 – 4.5% range.

In other words, patients were substantially less likely to die when the facility had sufficient capacity power and no more than about two hours without power each day, a finding that could have implications for organizations such as the World Health Organization (WHO) and World Bank, which use frameworks for assessing the quality and reliability of electricity services.

“This gives us a concrete reliability target that health systems, WHO, and development finance institutions can use when planning electrification investments,” says Sam Miles, a postdoctoral researcher in the Department of Civil and Systems Engineering and the RENEW laboratory. “Electricity in hospitals cannot be treated like background infrastructure—it is a clinically relevant health system input.”

“By partnering with the ministries of health in North Kivu, South Kivu, and Haut Katanga, we had the opportunity to assess just how much electricity impacts health outcomes,” said UC Berkeley’s Kwong. “We thought there would be some effect, and we were shocked that the effect is as large as it is. Healthcare facilities that have power for more than 22 hours per day have an astounding 40% lower mortality than facilities that have power for less than 22 hours a day.”

The researchers found a similar pattern when looking at changes within individual facilities over time: when electricity reliability declined, patient mortality increased. This strengthens the evidence that reliable electricity itself matters for patient outcomes, rather than simply reflecting broader differences between better- and worse-resourced facilities.

“Reliable electricity is essential to preventing avoidable deaths in hospitals, yet we have struggled to make the case for investment because we have lacked the data needed to understand its causal impact on care,” Miles said. “By bringing together engineering, public-health, clinical, and local expertise to collect rare data in an extremely challenging environment, this team is helping build the evidence needed to address a problem that has too often been overlooked.”