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A Comprehensive Approach to Medical Oxygen Ecosystem Building: An Implementation Case Study in Kenya, Rwanda, and
Victoria Smith1, Alana Changoor2, Chloe McDonald3
1Assist International, Ripon, CA, USA. vsmith@assistinternational.org.
Insights
A sustainable social enterprise model improved medical oxygen access in underserved regions. This initiative established localized production, significantly increasing oxygen availability for critical care in low-resource settings.
Area of Science:
- Global Health
- Health Systems Strengthening
- Medical Technology
Background:
- Access to essential medical oxygen is limited in resource-constrained settings due to supply chain fragmentation and high costs.
- Hypoxemic conditions in children under 5, obstetric complications, and surgical needs highlight the critical demand for reliable oxygen supply.
- Existing infrastructure challenges hinder consistent medical oxygen availability in underserved communities.
Purpose of the Study:
- To evaluate the effectiveness of a social enterprise model for sustainable medical oxygen production and distribution in resource-limited areas.
- To assess the feasibility and cost-effectiveness of establishing localized pressure swing adsorption (PSA) oxygen plants as regional supply hubs.
- To improve access to affordable medical oxygen for healthcare facilities serving large populations, including vulnerable groups.
Main Methods:
- Implementation of a social enterprise model involving partnerships with NGOs, foundations, and Ministries of Health.
- Establishment of decentralized pressure swing adsorption (PSA) oxygen generation plants at major referral hospitals.
- Utilization of revenue from cylinder distribution to subsidize ongoing operational costs and ensure sustainability.
Main Results:
- Four PSA plants were successfully established and sustained in Kenya, Rwanda, and Ethiopia since 2014.
- Over 209,000 oxygen cylinders were delivered to 183 healthcare facilities by October 2022.
- The model provides sustainable medical oxygen to over 33 million people, including 5 million children under 5, at an estimated cost of US$7.34 per patient in Ethiopia.
Conclusions:
- The social enterprise model demonstrates a viable and sustainable approach to increasing medical oxygen availability in underserved regions.
- Decentralized PSA plants can effectively serve as regional hubs, overcoming traditional supply chain limitations.
- This initiative significantly enhances healthcare capacity by ensuring reliable access to life-saving medical oxygen for millions.
Abstract:
Medical oxygen is an essential treatment for life-threatening hypoxemic conditions and is commonly indicated for the clinical management of most leading causes of mortality in children aged younger than 5 years, obstetric complications at delivery, and surgical procedures. In resource-constrained settings, access to medical oxygen is unreliable due to cost, distance from production centers, undermaintained infrastructure, and a fragmented supply chain. To increase availability of medical oxygen in underserved communities, Assist International, the GE Foundation, Grand Challenges Canada, the Center for Public Health and Development (Kenya), Health Builders (Rwanda), and the National Ministries of Health and Regional Health Bureaus in Kenya, Rwanda, and Ethiopia partnered to implement a social enterprise model for the production and distribution of medical oxygen to hospitals at reduced cost. This model established pressure swing adsorption (PSA) plants at large referral hospitals and equipped them to serve as localized supply hubs to meet regional demand for medical oxygen while using revenues from cylinder distribution to subsidize ongoing costs. Since 2014, 4 PSA plants have successfully been established and sustained using a social enterprise model in Siaya, Kenya; Ruhengeri, Rwanda; and Amhara Region, Ethiopia. These plants have cumulatively delivered more than 209,708 cylinders of oxygen to a network of 183 health care facilities as of October 2022. In Ethiopia, this model costs an estimated US$7.34 per patient receiving medical oxygen over a 20-year time horizon. Altogether, this business model has enabled the sustainable provision of medical oxygen to communities with populations totaling more than 33 million people, including an estimated 5 million children aged younger than 5 years.
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