{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T19:02:42Z","timestamp":1789671762892,"version":"4.0.1"},"reference-count":43,"publisher":"National Academy of Sciences","issue":"38","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100025967","name":"The Link Foundation | Link Foundation Energy Fellowships","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/100025967","id-type":"DOI","asserted-by":"publisher"}]},{"name":"The James and Katherine Lau Foundation","award":["1--49119-15312-44-3DCFAC-EVDMK"],"award-info":[{"award-number":["1--49119-15312-44-3DCFAC-EVDMK"]}]},{"name":"The Karsten Family Foundation","award":["1--48306-15312-44--EVDMK"],"award-info":[{"award-number":["1--48306-15312-44--EVDMK"]}]},{"name":"The Zaffaroni Family Foundation","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":["www.pnas.org"],"crossmark-restriction":true},"short-container-title":["Proc. Natl. Acad. Sci. U.S.A."],"published-print":{"date-parts":[[2026,9,22]]},"abstract":"<jats:p>\n                    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 (\n                    <jats:inline-formula>\n                      <mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" display=\"inline\" overflow=\"scroll\">\n                        <mml:mo>&gt;<\/mml:mo>\n                      <\/mml:math>\n                    <\/jats:inline-formula>\n                    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\n                    <jats:inline-formula>\n                      <mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" display=\"inline\" overflow=\"scroll\">\n                        <mml:mo>&gt;<\/mml:mo>\n                      <\/mml:math>\n                    <\/jats:inline-formula>\n                    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.\n                  <\/jats:p>","DOI":"10.1073\/pnas.2538126123","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T18:07:04Z","timestamp":1789668424000},"update-policy":"https:\/\/doi.org\/10.1073\/pnas.cm10313","source":"Crossref","is-referenced-by-count":0,"title":["Assessing the impacts of sufficient and reliable electricity in low-resource healthcare facilities"],"prefix":"10.1073","volume":"123","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9373-872X","authenticated-orcid":false,"given":"Ryan","family":"McCord","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00py81415","id-type":"ROR","asserted-by":"publisher"}],"name":"Sanford School of Public Policy, Duke University","place":["Durham"]},{"id":[{"id":"https:\/\/ror.org\/00py81415","id-type":"ROR","asserted-by":"publisher"}],"name":"Nicholas Institute for Energy, Environment & Sustainability, Duke University","place":["Durham"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel B.","family":"Miles","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00za53h95","id-type":"ROR","asserted-by":"publisher"}],"name":"Ralph O\u2019Conner Sustainable Energy Institute, Johns Hopkins University","place":["Baltimore"]},{"id":[{"id":"https:\/\/ror.org\/02wt5sv47","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Civil and Systems Engineering, School of Advanced International Studies","place":["Baltimore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jackson M.","family":"Mughuma","sequence":"additional","affiliation":[{"name":"Research Centre for Humanitarian Aid","place":["North Kivu, Democratic Republic of Congo"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2984-7777","authenticated-orcid":false,"given":"Daniel M.","family":"Kammen","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00za53h95","id-type":"ROR","asserted-by":"publisher"}],"name":"Ralph O\u2019Conner Sustainable Energy Institute, Johns Hopkins University","place":["Baltimore"]},{"id":[{"id":"https:\/\/ror.org\/02wt5sv47","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Civil and Systems Engineering, School of Advanced International Studies","place":["Baltimore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura H.","family":"Kwong","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01an7q238","id-type":"ROR","asserted-by":"publisher"}],"name":"Division of Environmental Health Sciences, School of Public Health, University of California Berkeley","place":["Berkeley"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"341","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"e_1_3_4_1_2","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.10.078741"},{"key":"e_1_3_4_2_2","unstructured":"World Health Organization \u201cEverybody\u2019s business: Strengthening health systems to improve health outcomes: WHO\u2019s framework for action\u201d (Tech. 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