Oxygen resources: COVID-19 and beyond

Oxygen access has been a long-neglected element of health system planning, despite being an essential treatment for a range of diseases. In low- and middle-income countries, many health facilities are unequipped to meet the rising demand. Almost half of all hospitals in these areas have an inconsistent supply of medical oxygen, or lack it entirely. Even fewer have functional pulse oximeters—devices that measure blood oxygen levels and help health workers to determine delivery and dosages.

More than ever, timely and robust planning for reliable oxygen delivery is needed to protect and save lives.

This page brings together resources to support countries in planning and executing a respiratory care strategy in the context of COVID-19. We encourage you to disseminate this resource widely and submit additional materials that should be added to this page by sending an email to oxygen@path.org. We will continue to update the page on a regular basis.

Last updated: May 10, 2023

NEW! Access to Oxygen (A2O2) Resource Library

This resource library is designed as a central place to host global and country-specific tools, guidance, data, publications, policies, protocols, and advocacy resources to support countries in accelerating strong and sustainable oxygen systems. It is intended as a living resource—recently upgraded to include user scenarios to provide a starting point for exploring the library, an updated and more user-friendly search experience, and now three times as many resources. (relaunched May 2023)

Centralized procurement mechanism for oxygen compressor service kits

This centralized procurement mechanism aggregates demand for oxygen compressor service kits across low- and middle-income countries and fulfills demand in a timely manner using advanced purchases of RIX Industries oxygen compressor service kits. This mechanism is a pilot aimed to test whether and how centralized procurement mechanisms can alleviate spare part access challenges for oxygen compressors. (published January 2023)

Next Generation Pulse Oximeters: Technology and market landscape

This report aims to assess the potential of multimodal pulse oximeters to improve the integrated diagnosis and treatment of illnesses for patients presenting at health facilities in low- and middle-income countries, with a focus on maternal and child health applications. Understanding technological challenges, existing and pipeline products, and market challenges is key for facilitating equitable access to these tools through market-based interventions. (published September 2022)

Sub-Saharan Africa Respiratory Care Equipment Distributors

This interactive tool and brief highlights the outcomes of an initial landscape of respiratory care equipment distributors across sub-Saharan Africa—which is intended to provide market insights into distributors in the region who can provide quality products and after-sales support and aims to alleviate sourcing challenges during demand surges. It can serve as a starting point for potential buyers seeking to rapidly identify local vendors for respiratory care equipment and/or after-sales services in sub-Saharan Africa. (updated November 2021)

Business Models in Respiratory Care

It is critical that decision-makers and implementers understand the complexities of the oxygen ecosystem, the various business models that comprise it, and how they impact patient access. This brief introduces the oxygen ecosystem that business models operate within and then outlines four types of business models: bulk supply agreements, cash-and-carry filling stations, direct equipment purchases, and equipment leasing. (published October 2021)

Respiratory Care Equipment Procurement Options

This summary brief outlines organizations that play a pivotal role in financing, coordinating, and conducting respiratory care equipment procurements. It aims to increase awareness of the various procurement options available to prospective buyers—such as public procurement entities at national and subnational levels, public and private health facilities, and nongovernmental organizations—in order to inform purchasing decisions. It also aims to strengthen coordination among relevant global stakeholders by increasing understanding of each organization’s offerings and capabilities. (published August 2021)

Oxygen Generation and Storage brief series

This supply intelligence brief series is intended to be a concise primer for decision-makers who govern, lead, support, or manage health systems and their associated facilities. Providing an overview of the key elements that define each technology—as well as key considerations related to COVID-19—it can establish a starting point for understanding the solutions available to meet a health system’s need for medical oxygen and its delivery. (published July 2021)

Respiratory Care Equipment Market Report

This market report serves as a preliminary guide to available suppliers with capacity to provide equipment for respiratory care. It is intended to help buyers conduct an initial assessment of the supplier landscape for each product of interest.

The report covers oxygen concentrators, cylinders, delivery interfaces, handheld pulse oximeters, patient monitors, and vacuum / pressure swing adsorption plants. For each product, the report offers a list of suppliers, a brief overview of critical technical specifications to consider, and a product price range is included. (published December 2020)

COVID-19 Catalog of Training Resources for Health Care Workers

A comprehensive list of training resources aimed to better equip health care workers (HCWs) in low- and middle-income countries who are directly involved in patient care to address the COVID-19 pandemic. The catalog of resources targets training of HCWs at primary and referral levels of care. It addresses topics relevant to COVID-19 response, such as triage, diagnostics, home management, basic respiratory care clinical skills, advanced respiratory care clinical skills, non-respiratory complications clinical skills, maternal health, infection prevention and control, anesthesia, device operation, device maintenance, self-care, and palliative care. Training offered via these resources can be feasibly implemented through in-person or standard online platforms (computer, mobile phone) and does not require complex technologies that may be unavailable in a resource-constrained setting. (updated August 2020)

COVID-19 Facility Assessment Resources

A directory of resources aimed to help assess and plan health facility preparedness for COVID-19. The directory provides access to 1) key tools for conducting facility-based survey for rapid deployment and assessment of biomedical equipment for COVID-19 treatment and response (e.g. the WHO biomedical equipment survey), as well as 2) supportive training resources to navigate those tools. It is intended for health facility administrators, health care workers, procurement officers, biomedical engineers, data mangers, and others involved in assessment and planning for health facility preparedness. (published June 2020)

Country assessment reports

Strengthening Oxygen Data Management Systems: Zambia Oxygen Data Dashboard Report (November 2022)

Assessment Report on the Availability of Oxygen and Biomedical Equipment in Health Facilities: DRC Facility Survey Report (March 2022)

Description of the Procurement and Management Systems for Medical Equipment, Supplies, and Medical Oxygen at Health Facilities in Vietnam (February 2022)

Vietnam Respiratory Care Equipment Supplier Landscape (January 2022)

Medical Oxygen Supplier Landscape in Vietnam (December 2021)

Oxygen and Respiratory Care Equipment for COVID-19 Patient Management in Vietnam (September 2021)

Biomedical Equipment for COVID-19 Case Management: Zambia COVID-19 Treatment Facility Survey Report (May 2021)

Biomedical Equipment for COVID-19 Case Management: Senegal Facility Survey Report (April 2021)

Assessment Report on the Availability of Oxygen and Biomedical Equipment in Health Facilities: City Province of Kinshasa, DRC, Facility Survey Report (April 2021)

Biomedical Equipment for COVID-19 Case Management: Malawi Facility Survey Report (January 2021)

Country guidance, training, and advocacy resources

Strengthening Oxygen Ecosystem for COVID-19 and Beyond in India (July 2022)

Blogs and articles

A2O2 Resource Library: A central platform for all things oxygen blog (May 2023)

Celebrating progress toward better oxygen access: Year 1 of Malawi’s oxygen roadmap article (February 2023)

Procurement to patient: Increasing access to medical oxygen during the COVID-19 pandemic story (June 2022)

By canoe, car, or foot: The journey to high-quality health data article (March 2022)

Closing gaps in oxygen access and respiratory care case study (January 2022)

From production to patient: A roadmap to strengthen oxygen access in Malawi case study (December 2021)

Digital health tools to accelerate action toward child survival article (November 2021)

What pneumonia can teach us about COVID-19 article (November 2021)

Accelerating oxygen access during India's second wave article (September 2021)

Broken equipment and surging demand for oxygen left Tanzania hospitals in a bind article (August 2021)

Expanding access to lifesaving oxygen therapy for infants and children article (August 2021)

Why is delivering medical oxygen so complicated? article (June 2021)

Learning from India: How low- and middle-income countries can scale up access to oxygen during a COVID-19 surge article (June 2021)

A year into COVID-19, medical oxygen scarcity still costing lives article (March 2021)

Pulse oximetry—from Apple Watch to equitable access article (October 2020)

Easing the oxygen shortage for COVID-19 and beyond article (May 2020)

COVID-19 and oxygen: Selecting supply options in LMICs that balance immediate needs with long-term cost-effectiveness article (May 2020)

Advocacy resources

Markets Matter: Closing the Oxygen Gap advocacy campaign (unbranded visuals and messaging)

Oxygen financing: Global Fund opportunities

This factsheet outlines key information and resources for pursuing funding for oxygen and respiratory care systems through the Global Fund via the COVID-19 Response Mechanism and country grants. It is intended for use by applicants, partners, civil society, and others in developing funding requests and/or advocating for prioritization of respiratory care goods and services in Global Fund grants. (published March 2023)

How oxygen matters: Stories of impact across the lifespan

This campaign highlights a collection of experiences where access to oxygen mattered. These stories are told through the eyes of patients, parents, clinicians, health care workers, and others and demonstrate the utility of oxygen therapy across ages, countries, and diseases. (published November 2022)

Improving oxygen delivery: Country progress in the time of COVID-19

This is a set of country-specific and global infographics that provide a snapshot of the milestones that countries we partner with have achieved over the last two years in improving access to oxygen as a critical treatment for COVID-19 and beyond. (published June 2022)

COVID-19 Oxygen Needs tracker

An interactive tool to help advocates, decision-makers, and implementers communicate the urgency of investing in access to medical oxygen and related technologies to meet the needs of COVID-19 in low- and middle-income countries. (updated February 2022)

Resources to support COVID-19 responses in LMICs

Recognizing that guidance has been shared by various agencies but may not be easily accessible to policymakers, practitioners, and other health stakeholders, PATH has compiled this resource page of guidance and model language from across many sources to inform low- and middle- income country responses to COVID-19. (updated May 2020)

Oxygen Is Essential: A Policy and Advocacy Primer

The primer provides the data, messages, and resources to help understand the planning, policies, and technologies involved in oxygen delivery scale-up. The materials are useful to anyone who wants to learn about scaling up access to oxygen and integrating oxygen delivery across national and subnational policies, programs, and health budgets. (published November 2017)

Webinars

Making the Case for Oxygen: Ensuring Continued Investment in Medical Oxygen Systems webinar

In response to surging medical oxygen demand, partners across the globe came together to rapidly scale up access to oxygen for sick COVID-19 patients, but we are at risk of losing this momentum as the pandemic subsides. How can we ensure these gains are not lost? This PATH Live Forum illustrates the real impact of oxygen access and discusses key challenges and solutions associated with building sustainable oxygen systems for pneumonia, COVID-19, and beyond. (November 2022)

Markets Matter: Closing the Oxygen Access Gap webinar

Oxygen is essential therapy for COVID-19 patients struggling to breathe, yet shortages in oxygen supply remain a challenge in low-and middle-income countries because of a web of interrelated issues. Why does oxygen supply disruption happen and how do we solve it? This PATH Live Forum disentangles key challenges impeding access –from demand planning to financing to supply and distribution systems –as well as innovative solutions to solve them for COVID-19 and beyond. (October 2020)

Fact sheets

Strengthening Oxygen Utilization and Respiratory Care Ecosystems (SOURCE) project

The Strengthening Oxygen Utilization and Respiratory Care Ecosystems (SOURCE) project is an initiative led by PATH to improve equitable access to high-quality respiratory care services at all levels of the health care system and ultimately, reduce maternal, child, and overall mortality from hypoxemia-related causes. Working closely with global and country stakeholders, the initiative supports governments and partners in focus geographies to push forward efforts to reinforce oxygen and respiratory care systems as necessary components of national health care systems, pandemic preparedness, and global health architecture.

COVID-19 Respiratory Care Response Coordination project

Photo credit: cover - The World Federation of Societies of Anaesthesiologists; other - PATH