PATH's work in medical oxygen

Oxygen therapy is an essential treatment for a wide range of conditions across all age groups, including COVID-19, severe pneumonia, newborn conditions, and obstetric emergencies. The need for medical oxygen has been on the rise for more than a decade, with diseases requiring oxygen for treatment—such as pulmonary and cardiovascular disease and asthma—accounting for a larger share of the burden.

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. 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. Closing the oxygen access gap will require an integrated set of solutions and investment in strengthening oxygen delivery systems.

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, biomedical equipment surveys, and market analysis, we work to understand key barriers to oxygen access and pulse oximetry on the ground, in partnership with ministries of health and members of the private sector.

Resources:

• Next Generation Pulse Oximeters: Technology and market landscape.
• Respiratory Care Equipment Market Report.
• Improving access to MNCH medical devices: Summary of research and recommendations from the Market Dynamics for Medical Devices project.
• Biomedical equipment survey reports for Democratic Republic of Congo, Malawi, Senegal, Vietnam, and Zambia.

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. We support countries to equitably improve access to sustainable, high-quality oxygen therapy and pulse oximetry at all levels of the health care system in order to reduce maternal, child, and overall mortality from hypoxemia-related causes. We also support the development of tools and resources to help decision-makers, implementers, and advocates to plan, manage, and communicate the value of scaling up oxygen delivery systems and access to oxygen and pulse oximetry.

• The Oxygen Delivery Toolkit: Resources to plan and scale medical oxygen.
• The Access to Oxygen (A2O2) Resource Library.
• Oxygen Generation and Storage brief series and Business Models in Respiratory Care brief.
• 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 and a Pulse Oximetry Primer. These primers equip advocates and decision-makers with the essential information and guidance to support their efforts to strengthen medical oxygen and pulse oximetry scale-up.
• Raising awareness about the importance of oxygen through advocacy campaigns, such as the Markets Matter: Closing the Oxygen Gap, HO2PE: Oxygen gives life, and How oxygen matters: Stories of impact across the lifespan campaigns. Our COVID-19 Oxygen Needs Tracker brought attention to the urgency for investment in medical oxygen to meet the needs of the COVID-19 pandemic.
• Working with global health donors to increase funding for medical oxygen and pulse oximetry scale-up around the world.

Resources:

• WHO Resolution: Increasing access to medical oxygen.
• Oxygen financing: Global Fund opportunities brief.
• Improving oxygen delivery: Country progress in the time of COVID-19 country and global infographics.
• Improving Access to Essential Oxygen Therapy and Pulse Oximetry for Childhood Pneumonia Treatment.

In 2015, we convened a first-of-its-kind forum of industry representatives for oxygen concentrators and pulse oximeters 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. We brought together a large coalition of country decision-makers, industry representatives, global health partners, and financiers to discuss 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. In 2023, we co-organized a World Health Assembly side event with WHO and Unitaid to mark the adoption of the “Increasing Access to Medical Oxygen” resolution and introduce the Global Oxygen Alliance (GO2AL) as two important steps in recognizing and reaffirming the critical role of medical oxygen in building resilient health systems.

Resources:

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