Increasing Access to Safe Oxygen

It is one of the World Health Organization’s (WHO’s) 30 essential medicines contributing to treatment across age groups for a wide range of conditions, including severe pneumonia, newborn conditions, and obstetric emergencies. Oxygen therapy can also be critical for patients with noncommunicable diseases, such as asthma and heart failure, and during pandemic disease outbreaks.

Despite the urgent need, however, reliable access to oxygen, paired with pulse oximetry, remains inadequate across many health facilities in low- and middle-income countries (LMICs) for many reasons, including production and distribution shortages and inappropriate delivery to patients. Limited data, perceptions about costs, poor understanding of the impact on health outcomes, and the complexity of integration and maintenance across the health system all contribute to lack of prioritization of oxygen at the national and subnational levels.

PATH is improving access to oxygen on multiple fronts that span advocacy and policy, market dynamics, and biomedical engineering. We work in close collaboration with country and industry partners, as well as global organizations and international agencies. Our integrated approach includes steps to understand, support, innovate, advocate, and convene to ensure that everyone has access to this essential treatment.

Through in-depth technology assessments and market analysis, we work to understand key barriers to oxygen access on the ground, in partnership with ministries of health and members of the private sector.

Resources:

• Assessment and recommendations to increase access to oxygen and pulse oximetry in Kenya.
• Market assessment and recommendations to increase access to oxygen and pulse oximetry in India.
• Market assessment and recommendations to increase access to oxygen and pulse oximetry in Indonesia.
• Pneumonia market landscape analysis in the Democratic Republic of the Congo.
• Analyse du Paysage du Marché de la Pneumonie en République Démocratique du Congo.

Scaling up access to oxygen is one of the most effective and critical actions decision-makers can take to improve health outcomes and save lives. PATH, in partnership with stakeholders in India, Kenya, Senegal, and Malawi, developed The Oxygen Delivery Toolkit, which provides resources to help stakeholders, decision-makers, and implementers understand, plan, and manage oxygen delivery scale-up and help advocates communicate the need for oxygen and reliable access to this essential treatment.

Resources:

• The Oxygen Delivery Toolkit: Resources to plan and scale medical oxygen
• Oxygen Generation and Storage brief series and Business Models in Respiratory Care brief
• Increasing access to safe oxygen and maternal, newborn, and child health devices fact sheet
• Strengthening access to respiratory care in West Africa fact sheet
• Procurement to patient: Increasing access to medical oxygen during the COVID-19 pandemic story
• A Toolkit for Procuring Quality-Assured Basic Neonatal Resuscitation Commodities

We work to accelerate global progress against pneumonia and other respiratory challenges by harnessing an integrated array of cost-effective solutions that can target diseases from multiple angles, including vaccines, access to appropriate diagnostic tools, and treatments. Read more about how we are ushering in a new era of pneumonia control.

We develop important technology innovations, such as a low-cost bubble continuous positive airway pressure (bCPAP) kit and an oxygen blender. bCPAP can provide infants with the air pressure needed to support their breathing, and when combined with an oxygen blender, it can deliver critically needed oxygen at appropriate, safe concentrations. These interventions can mean the difference between life and death and between healthy infant development and lifelong neurological damage or blindness.

In addition to technical innovations, we work to establish system innovations. We have evaluated the concept of providing oxygen as a public utility and developed it as an innovative model for increasing access to oxygen in LMICs, which you can read more about in the resource list below.

Resources:

• Oxygen as a Utility report.
• Technology Landscape: Oxygen Concentrators.
• Development of a Reliable, Robust, and Scalable Oxygen Concentrator for Low-Resource Settings.
• Design for Reliability: Ideal Product Requirement Specifications for Oxygen Concentrators for Children With Hypoxemia in Low-Resource Settings.

We are implementing a comprehensive advocacy approach to increase access to oxygen in LMICs, including:

• Supporting normative policy change and implementation by WHO and national governments. In 2017 we led the effort to list oxygen in the WHO Essential Medicines Lists (EML) for adults and EML for Children (EMLc). The updated EML/EMLc now specify oxygen as a treatment for hypoxemia, resolving any ambiguity about its role as an essential medicine.
• Developing a suite of evidence-based materials to help advocates and policymakers drive change at the national and subnational levels. We applied our technical advocacy approach to develop Oxygen Is Essential: A Policy and Advocacy Primer. This primer equips advocates and decision-makers with the essential information and guidance to support their efforts to strengthen oxygen delivery systems.
• Raising awareness about the importance of oxygen through advocacy campaigns and tools, such as the Markets Matter: Closing the Oxygen Gap campaign, HO2PE: Oxygen gives life campaign and the COVID-19 Oxygen Needs Tracker.
• Working with global health donors to increase funding for medical oxygen and pulse oximetry scale-up around the world.

Resources:

• Markets Matter: Closing the Oxygen Gap advocacy campaign resources (non-branded)
• Making medical oxygen availability a national health priority in Uganda.
• Proposal for inclusion of oxygen as a medical gas on the World Health Organization Model List of Essential Medicines.
• Improving Access to Essential Oxygen Therapy and Pulse Oximetry for Childhood Pneumonia Treatment.
• Improving oxygen delivery: Country progress in the time of COVID-19 country and global infographics

In 2015, PATH convened a first-of-its-kind forum of industry representatives—nine oxygen concentrator manufacturers and three pulse oximeter manufacturers—to gauge interest in and challenges with doing business in low-resource settings. This meeting teed up broader industry engagement, including the 2017 A2O2: Accelerating Access to Oxygen convening. PATH brought together a large coalition of country decision-makers, industry representatives, global health partners, and financiers for the A2O2 convening. Over the course of the three-day meeting, stakeholders discussed barriers to reliable oxygen delivery systems, shared opportunities to address them, and agreed on a common path forward to improve access to safe oxygen delivery.

Resources:

• Accelerating Access to Oxygen Convening Summary.
• Ensuring Oxygen and Pulse Oximetry Access for Treatment of Children in Low-Resource Settings: Consultation With Manufacturers of Oxygen Concentrators and Pulse Oximetry.