By Dr. Steve Adudans @SteveAdudans

The growing danger of COVID-19 has led the national and county governments to strengthen their healthcare infrastructure. The two centers of power have adopted a raft of measures including releasing emergency packages to prepare a sector which although is crucial, has suffered budget deficits, lack of staff and equipment.

One area that has sent the health sector on overdrive is the provision of oxygen. Critically infected COVID-19 patients need ventilator and oxygen support. Therefore, with the rise in the number of serious patients, the demand for oxygen concentrators is increasing rapidly. It is over a decade since the World Health Organisation recognized medical oxygen as an essential drug yet it remains beyond the reach of desperately vulnerable patients.

In a recent survey of emergency care centers across Kenya, over 30% of the facilities did not have a regular supply of oxygen. Close to 90% of those with oxygen did not have piped oxygen in the emergency department and delivered oxygen directly from the tanks to the patient. Instead of piping oxygen directly to beds, a second-hand pick- up truck will most likely carry the cylinders over bumpy roads from the cities to health facilities in the far-flung parts of the country.

Oxygen therapy is widely used in the management of several chronic and acute health conditions. The therapy may be used in a hospital setting or pre-hospital setting (e.g. in the ambulance) to manage emergencies or in the home, setting to manage long-term health conditions. The mode of delivery and device used for oxygen therapy depends upon several factors including the patient’s specific needs and the opinion of the medical professionals involved.

The rising demand for oxygen is bringing out a stark global truth: even the right to breathe depends on money. In much of the world, oxygen is expensive and hard to get, but in Europe and North America, hospitals treat oxygen as a fundamental need, like water and electricity. It is delivered in liquid form by a tanker truck and piped directly to the beds of coronavirus patients. Running short of a resource that can be pulled from the air is unfathomable. The opposite is true of Kenya and the rest of Africa.

In some health facilities locally, medical personnel are forced to make a tough choice between patients who need oxygen, on who among them is more critical and who can still hang on . We can spare them this dilemma by adopting supply models that have been proven to work locally and internationally.

Some experts put considerable blame on two multinational gas suppliers that dominate the market for oxygen cylinders across much of the continent, saying that their high prices and systems make the treatment unaffordable.

The government must build the technical capacity to be a supplier or intervene through public-private partnerships with local players to reduce the costs. Locally for example, In Kenya, a social enterprise, Hewa Tele, has established three oxygen production plants within government facilities, each serving a cluster of hospitals. The plants have cut hospital purchase costs by around one-third.

The Hewa Tele- government partnership model illustrate just how a big opportunity we have to ride on innovation to tap in to the vast opportunities to reach the most vulnerable. In many rural areas, we can introduce low-cost technologies that concentrate and store oxygen in health centers that lack electricity.

The outbreak of the COVID-19 pandemic is unrivaled in the history of public health. However, it presents a golden opportunity to address medical oxygen as one of the defining health equity issues of our age. The need is self-evident. What has been missing is political goodwill, policies and cooperation – and those are deficits we can fix.

Dr Adudans is the Executive Director Center for Public Health and Development.