The power of health in the Democratic Republic of the Congo: Electricity quality and reliability in medical facilities of North Kivu Province

High-quality reliable electricity is essential for health service delivery, yet current World Health Organization (WHO) and World Bank Multi-Tier Framework (MTF) indicators rely on binary, recall-based survey metrics that fail to capture the incidence, duration, voltage or frequency of electricity in low- and middle-income country (LMIC) health facilities. Between 2022 and 2024, we deployed real-time, cellular-connected sensors in 25 health facilities across North Kivu Province, Democratic Republic of Congo (DRC), to continuously monitor outages, “uptime,” and the percentage of time electricity supply fell within ±10 % of nominal voltage and ± 5 % of nominal frequency. Facilities experienced an average of 0.67 outages per day (min–max: 0–2.04), with a median duration of 2.01 h (0.03–10.9). Voltage compliance averaged 73.9 % (10.0–99.6 %) and frequency compliance 82.1 % (9.3–99.7 %). Sixteen facilities achieved ≥99 % uptime, the upper threshold mapping to the WHO's current definition of reliable electricity. Uptime varied widely (46.7–100 %), underscoring the limitations of a reliable/not-reliable approach. Compared to those in Nigeria and Kenya, North Kivu facilities experienced fewer outages but substantially longer durations, with better voltage quality than Nigeria but worse frequency quality. By demonstrating the feasibility of continuous, auditable monitoring in a conflict-affected LMIC, this study shows how sensor-based metrics provide more sensitive and clinically relevant indicators of electricity performance than WHO and MTF frameworks. These findings support updating global electrification metrics to incorporate real-time uptime, voltage, and frequency indicators that better capture risks to biomedical equipment and patient outcomes.