The COVID pandemic brought into focus the life-saving role of medical oxygen – but the stock of oxygen is still severely limited in low- and middle-income countries, and many don’t know how much oxygen they need.

Despite wide-ranging efforts to improve access to oxygen and oxygen delivery devices over the past four years, services in low- and middle-income countries remain severely limited, according to a study by the World Health Organization (WHO), published in October 2023.

WHO investigators estimate that non-invasive advanced respiratory support is needed for around 1% to 3% of patient beds, and for 2%–25% of those on ventilators, depending on the region. The world health body has cautioned that these are preliminary trends and not the final findings.

But basic oxygen and the oxygen delivery devices are severely limited in many countries, as is data about the need.

“Pre-pandemic oxygen needs and post-pandemic oxygen needs are likely to be similar with appropriate adjustments for population growth over time,” Lisa Smith who leads the Market Dynamics programme at the global health non-profit PATH, told Health Policy Watch.

“Oxygen needs to continue to be a central focus of reliable healthcare access. Initiatives that promote its improved access mustn’t slow now that the pandemic is passed. Instead, there should be sustained investment that ensures countries are resilient in the face of efficient spread of disease and with that, unexpected fluctuations in oxygen demand,” she said.

The WHO convened a three-day meeting in May in Dakar, Senegal, where participants shared best practices and gaps that the pandemic period revealed, and the challenges in scaling up their national plans. WHO aims to come up with a template that will allow member states to develop their own evidence-based national plans.

Discussions at the meeting addressed the need for technical support for countries to improve their safety standards to prevent accidents and fires. They also covered issues such as sustainable financing, better workforce planning, and public-private partnership potential to improve access.

Lack of data on the need

The key issue highlighted was the lack of understanding of just how much oxygen is needed, and where the need is.

“The data just almost doesn’t exist,” said Nahreen Ahmed, Medical Director of non-profit MedGlobal that works in crisis and conflict zones. “And there’s almost always a shortage of human resources. And because of that, there isn’t somebody that’s actually allocated to collect this data and then there isn’t like a system that it goes. I think if there was a general registry of some kind that was always available for this information to enter into, I think that would probably help,” she said.

She also highlighted that just as the pandemic where the need for oxygen went up dramatically, in conflict zones the need fluctuates wildly depending on whether it is a period of stability or conflict.

“It’s a two-part question, really, what’s the baseline use? And then what is the anticipated need when there is an escalation of something whether it’s a natural disaster, epidemic, conflict, something like that,” Ahmed said.

A representative from India shared that the multiple platforms developed to gauge oxygen use during the pandemic are no longer used as hospitals don’t feel the need to spend time entering the data. He added that multiple platforms meant that the data was duplicated – highlighting not just the need for better technology but also better coordination.

The trackers developed during the pandemic are no longer helpful now.

“The needs tracker does not estimate oxygen requirements for all treatment indications (it is currently COVID-19-specific). If it did, the total figures would be higher, however the trend in need since the pandemic would still show a decline until it levelled off/returned to typical fluctuations due to disease seasonality,” Smith told Health Policy Watch about the PATH tracker.

During the pandemic, WHO officials made the case to re-think oxygen as a health tool that requires a sustainable supply at the country level, as Health Policy Watch reported earlier.

Power cuts, fire hazards

Representatives of developing countries highlighted how the lack of basics like a reliable power source affects an oxygen plant’s ability to supply high-quality oxygen.

“If we expect to have an uninterrupted supply of medical oxygen we have to have an uninterrupted supply of power in order to produce it,” said Jim Stunkel, Vice President of Technical Services at global non-profit Assist International. He added that the solutions might have to be beyond the traditional grid. “Grid may not be it. I was so impressed by those that are innovating, looking forward to green solutions and solar solutions,” he said.

Across the world health facilities have been employing green solutions to run basic facilities, and while the usage for oxygen plants is currently limited, the meeting shone light on the potential to expand access of green energy sources.

Another challenge is the fire hazard posed by a sudden scale-up of oxygen in a health facility, and the need for improved safety protocols. During the pandemic, several catastrophic fires broke out in health facilities around the world, killing hundreds of people.

Image Credits: Unsplash, PATH, WHO, Twitter.