By Dr. Steve Adudans
More often than not, whenever people complain about a shortage of drugs in the health facilities, not much thought is given to medical oxygen. A shortage of oxygen threatens the lives of millions suffering from life-threatening diseases and injuries.
The oxygen availability gap is colossal: while it is a ubiquitous drug in developed countries, 25% of health facilities in sub-Saharan Africa never have oxygen available, while 32% have an irregular supply. As a result, the use of the available oxygen is restricted to surgeries and a small number of very ill patients.
So critical is oxygen in emergency care,that without it, pregnant women, newborns and children under the age of five, risk death. Lack is often the norm, rather than the exception, and where it is available, in short and irregular supply, it is often too expensive. Our medical practitioners should not have to make difficult decisions on which patients receive oxygen and which do not, just because there is not enough oxygen available at the facility.
In Kenya, 42% of children prescribed oxygen were unable to get it. According to the Kenya Demographic Health Survey (KDHS) 2014, the Infant Mortality Rate is 39 deaths per thousand while the Under 5 Mortality Rate (U5MR) is 52 deaths per thousand; chest infections are reported as the major contributor to these deaths-an issue that could be solved through a reliable supply of oxygen.
The specific issues that cause the prevalent lack of access are many: first, the distances between hospitals and the source of oxygen can be vast. Oxygen cylinders must be picked up at an oxygen generation plant in a major city and transported hundreds of kilometers. This adds delays and significant cost.
Second, local alternatives to oxygen cylinders require a steady power source and are prone to maintenance issues. One in three concentrators recently sampled at Kenyan hospitals were broken or unusable. Third, oxygen is expensive when sold by the tank. Locally, oxygen at an average Sh1000 per liter. This is 13 times the average US price. The cost is driven by the lack of competition and by the high cost of transportation.
The other challenge in the sector is that because oxygen is not treated as essential drug by some health facilities, most workers to not undergo continuous training on the benefits of oxygen as well as how, when, and how much oxygen to administer to patients in different scenarios. Given that access to oxygen is so sparse, health workers are not as familiar with its use as they could be. The consequences can often be shocking.
In August 2017, 64 children died in a hospital in north India due to lack of oxygen while their horrified parents stood watching. The disruption in that case was caused primarily due to lack of financial resources. This problem is severe in developing countries, with nearly half of these deaths concentrated in sub-Saharan Africa.
One of the initiatives worth emulating is the partnership between Siaya County government and Hewa Tele, a locally registered social enterprise set up with a key mandate to ensure oxygen is available.Under the ‘Hewa Tele’ (abundant air) project, General Electric (GE) Foundation, the Centre for Public Health and Development, Siaya County and the National Government contributed the KSh 50 million to install the medical oxygen manufacturing plant at Siaya County Referral Hospital.
The outcome has been impressive. The hospital has enough oxygen for its needs and excess to sell to private hospitals to raise money to maintain the plant. Initially, the hospital was purchasing 299 liters of oxygen per month, but this shot up to 2,309 liters of oxygen per month when the facility was installed giving it an increment of 672 percent.
The model developed is simple: build an oxygen plant within the county hospital, and generate enough oxygen to supply the host hospital itself and to fill tanks to distribute to local rural health clinics or dispensaries.
Oxygen tanks are now just shipped a few kilometers to rural facilities with charges that are 30% less than the current monopolist suppliers. This enables these clinics access to an essential medicine that they could never afford or would never reach them. These hub-and-spoke programs also assure proper use by deploying experts to train health professionals on the optimal use of oxygen for the best possible patient care.
Dr. Adudans is the Executive Director, Centre for Public Health and Development , is a Kenyan- and US-registered non-governmental organization engaged in developing, testing, and scaling health system innovations in response to identified challenges in the Eastern African region