Oxygen resources: Sustainable access to save lives

Related program: Market dynamics

Oxygen is a lifesaving therapy for millions who struggle to breathe, yet reliable access remains inadequate across many health facilities throughout the globe. Closing the oxygen access gap will require an integrated set of solutions and investment in strengthening oxygen systems.

Equitable oxygen access has been a long–neglected element of health system planning, despite being an essential treatment for a range of diseases, including COVID-19. 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.

In addition to PATH's other work in oxygen, this page brings together resources to support countries in planning and scaling up a sustainable oxygen ecosystem to improve access and support universal health coverage. 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.

FEATURED RESOURCE:

Pulse oximetry primer

For health care providers to make a correct diagnosis, they must be equipped with the right tools, including access to pulse oximetry. These devices are essential for alerting health workers to hypoxemia and the need for urgent treatment, including referral to higher-level facilities and access to oxygen. This primer is a summary of resources to help decision-makers, implementers, and advocates understand the planning, policies, and technologies involved in pulse oximetry scale-up.

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Last updated: May 30, 2024

Technical resources and tools

  1. Pressure swing adsorption plants: Common issues and solutions to prevent future disrepair

    This report summarizes an analysis conducted on common issues and causes of failure across the pressure swing adsorption (PSA) plant life cycle—from planning and decision–making to installation, training, and operations or maintenance—and recommends ways to improve their management (published November 2023). Learn more

  2. Market intelligence for sustaining oxygen generation plant investments

    This brief summarizes a series of analyses to better characterize the oxygen generation plant market by estimating total cost of ownership, evaluating the feasibility of standardizing plant sizes; and estimating the size of market as a whole (published October 2023). Learn more

  3. 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 (relaunched May 2023). Learn more

See more global technical resources and tools

Centralized procurement mechanism for oxygen compressor service kits

This centralized procurement mechanism aggregated demand for oxygen compressor service kits across low– and middle–income countries and fulfilled demand in a timely manner, using advanced purchases of RIX Industries oxygen compressor service kits (updated December 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 (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. This landscape 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 (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.
  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).

Oxygen delivery toolkit: Resources to plan and scale medical oxygen

Reliable access to oxygen, paired with pulse oximetry, remains inadequate across many health facilities in low- and middle-income countries. Reasons for this are many, including limited data, perceptions about costs, poor understanding of the impact on health outcomes, and the complexity of integration and maintenance across the health system. This toolkit provides materials to help decision-makers, implementers, and advocates plan, manage, and communicate the value of scaling up oxygen delivery systems and access to oxygen and pulse oximetry (published May 2020).

Optimizing oxygen access and reliability: Opportunities for scaling access and applications to other medical devices

Oxygen scale–up requires coordination across seven interrelated areas—policy and political commitment, financing, baseline assessment, quantification, procurement, distribution and management, and training. Within each area, there are decision points and actions to take, informational tools that can help countries achieve success in that area, and examples from illustrative countries. This report outlines tools and recommendations that exist for each area and also introduces the Oxygen Delivery Toolkit: Resources to plan and scale medical oxygen (published May 2020).

Oxygen as a utility report

This innovative model to provide oxygen services as a utility is a potential new way forward, developed to address many of the issues that limit oxygen access. This approach brings the essential players—health systems, oxygen suppliers, manufacturers and/or distributors, and financial partners—into a unified system to ensure reliable service provision that is driven by increased public–private investment (published March 2020).

Technology landscape: Oxygen concentrators

This table shows the landscape of commercially available stationary and portable oxygen concentrators and related devices (published October 2015).

Design for reliability: Ideal product requirement specifications for oxygen concentrators for children with hypoxemia in low-resource settings

This document provides guidance to developers and manufacturers on the key performance requirements and potential design approaches for the development of a reliable, robust, and scalable oxygen concentrator that is appropriate for treatment of pediatric patients with hypoxemia in low–level facilities in low–resource settings (published May 2015).

Country assessments, guidance, and resources

Advocacy and communications resources

  1. Pulse oximetry primer

    Pulse oximeters are essential for alerting health workers to hypoxemia and the need for urgent treatment, including referral to higher-level facilities and access to oxygen. This primer is a summary of resources to help decision-makers, implementers, and advocates understand the planning, policies, and technologies involved in pulse oximetry scale-up (published May 2024). Learn more

  2. Medical oxygen and pulse oximetry financing: The Pandemic Fund opportunities

    This factsheet outlines key information and resources for pursuing funding for medical oxygen and pulse oximetry through The Pandemic Fund. It is intended for use by beneficiaries, partners, civil society, and others, in developing funding requests and/or advocating for prioritizing medical oxygen and pulse oximetry in future Pandemic Fund proposals (published April 2024). Learn more.

  3. WHO resolution: Increasing access to medical oxygen

    This brief summarizes the newly–adopted WHO resolution, which recognizes the critical role of medical oxygen in resilient health systems planning, and in achieving the Sustainable Development Goals for health. It outlines high–impact actions that global stakeholders and national governments need to prioritize to scale up access to medical oxygen across the globe (published May 2023). Learn more

See more advocacy resources

Markets matter: Closing the oxygen gap advocacy campaign (unbranded visuals and messaging).

Oxygen financing: Global Fund opportunities

This factsheet outlines key information for pursuing funding for oxygen 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 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).

HO2PE: Oxygen gives life

This campaign aims to bring the issue of oxygen access to the forefront of discussions on newborn, child and maternal health, and increase awareness on the importance of oxygen treatment and its impact on saving precious breath and life around the world (July 2018).

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).

Advocate for oxygen

Oxygen is listed on the WHO’s Model List of Essential Medicines (EML). This infographic, aimed at advocates and decision–makers, describes the “what,” “where,” “how,” and “how much” behind oxygen programs and urges countries to align national policies to prioritize oxygen therapy across the entire health system (August 2017).

Summary: Proposal for inclusion of oxygen as a medical gas on the World Health Organization Model List of Essential Medicines

This summary highlights the proposed addition of oxygen as a medical gas to the WHO Model List of Essential Medicines and the List of Essential Medicines for Children to clarify its importance as a medicine for the management of hypoxemia (December 2016).

Blogs and articles

See more blogs and articles

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)

Ushering in a new era of pneumonia control article (November 2019)

Access to safe oxygen will help countries breathe easier article (December 2017)

Breathing for beginners article (December 2016)

Oxygen is a matter of life and breath article (November 2016)

5 pneumonia solutions to get excited about article (November 2015)

Designing a device to save newborn lives: thinking big while thinking small article (September 2015)

Press releases

Events and webinars

Harnessing partnerships to increase access to medical oxygen: a focus on Africa side event

This Conference on Public Health in Africa (CPHIA) side event showcased the Global Oxygen Alliance's (GO2AL’s) new strategy and efforts and featured Africa-based panelists on how to build stronger oxygen ecosystems through effective partnerships (November 2023).

See more events and webinars

Increasing access to medical oxygen: Actions to ensure sustained gains side event

This World Health Assembly (WHA) high–level side event marked the adoption of the “Increasing Access to Medical Oxygen” WHA resolution, and introduced the Global Oxygen Alliance (GO2AL) as two important steps in recognizing and reaffirming the critical role of medical oxygen in building resilient health systems (May 2023).

Making the case for oxygen: Ensuring continued investment in medical oxygen systems webinar

In response to the surging demand of medical oxygen, 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).

Zambia oxygen summit

Zambia Ministry of Health, in collaboration with Zambia National Public Health Institute and PATH, cohosted a virtual summit aimed at obtaining stakeholder input and recommendations to improve the government’s oxygen escalation plan for acute respiratory care among COVID–19 patients (February 2021).

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).

Accelerating access to oxygen convening

This convening was a three–day meeting that aimed to foster information sharing and active dialogue on oxygen access between key stakeholders, including country decision–makers, global health partners, financiers, and manufacturers (July 2018).

Ensuring oxygen and pulse oximetry access for treatment of children in low-resource settings: Consultation with manufacturers of oxygen concentrators and pulse oximetry

This consultation brought together developers, manufacturers, and organizations interested in expanding access to pulse oximetry and oxygen concentrators in low–resources settings, to discuss key issues like barriers to access, market size, and maintenance (December 2015).

PATH oxygen concentrator project: Expert advisory group meeting

An expert advisory group meeting was held at PATH to build consensus among knowledge leaders and active researchers on approaches to improve oxygen concentrators to treat pediatric patients with hypoxemia or severe respiratory distress in low–resource settings (August 2014).

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