Sustainable access to medical oxygen key

 “We rushed my mother to all the major hospitals in Kampala and Wakiso districts but failed to get Oxygen. We had to make our way to Jinja City in Eastern Uganda to share a cylinder,” says Samson Kakeeto.
“When I heard that our neighbours, a wealthy family, were struggling to find oxygen to save their parents, I knew there was no hope for the rest of us. They lost their parents on the same day,” recalls Boniface Karuhanga.

The Covid-19 pandemic is remembered for exposing a number of inefficiencies in access to medicine in Uganda. But prominent among them was the overwhelming lack of medical oxygen. The lack of oxygen hit the poor and wealthy alike. 
According to a 2023 report by Access To Medicine Foundation---an independent non-profit organisation that seeks to transform the healthcare ecosystem by motivating and mobilising companies to expand access to their essential healthcare products in low- and middle-income countries--- a number of medical facilities in low to middle income countries such as Uganda do not have reliable access to medical oxygen, which is a lifesaving treatment for a number of diseases such as pneumonia and tuberculosis. Oxygen is also essential for daily medical procedures, for example during surgery and childbirth. 

A key role for gas companies
Given the essential nature of medical oxygen and the fact that just a handful of gas companies produce the vast majority of the global supply of medical liquid oxygen, it is critical to the wellbeing of people living in low and middle-income countries (LMICs) that these companies scale up access to this product as a priority. 
“Medical gases are a small part of these companies’ business, yet society needs them to ensure this vital lifeline is available both during emergencies and to meet the daily medical oxygen needs of all health systems,” Jayasree K. Iyer, the chief executive officer Access to Medicine Foundation, says.

Areas for company action
Based on analysis of the issue and what actions have been taken so far, the report identifies priority areas for action that companies can focus on to provide access to medical liquid oxygen in LMICs, both in emergencies and to provide routine delivery. Each area is explored in depth to include examples of what companies are currently doing, as well as recommendations for what companies can do to better address access: 

• Prioritise, measure and report progress on medical liquid oxygen.
• Enable improved affordability for different populations and health systems.
• Provide sustainable supply of medical liquid oxygen.
• Develop and maintain long-term partnerships to close access gaps.
• Support health systems and the human resources required to operate and maintain medical liquid oxygen systems and administer oxygen therapy.

Why do we need oxygen?

There are two sources of oxygen according to Dr Moses Ocan, a lecturer at Makerere College of Health Sciences department of pharmacology and therapeutics and researcher at Training Health Researchers into Vocational Excellence (THRiVE) Consortium. 
The oxygen concentrators consist of a cabinet that houses the compressor and filters, tubing, a nasal cannula and or face mask. The concentrator draws air from the atmosphere and passes it through a series of filters to remove dust, bacteria and any other particles and does not require refilling.
“It can be set up by an expert and the unit is plugged into a power source, turned on and the oxygen flow is adjusted as prescribed by the doctor. The nasal cannula or mask is applied to the patient. The challenge with this oxygen source is that it needs a reliable power supply or the patient can die during a power outage. The reason this type of oxygen is not so commonly used in the country is because of the unreliable power supply,” says Ocan.
He remarks that the most reliable and common source of therapeutic oxygen are the oxygen cylinders because they do not need a power source but most of the hospitals in the country do not have enough supply of the oxygen cylinders.

The challenge has always been scarcity and when there is disease outbreak such as the Covid-19, oxygen cylinders are out of stock. A 20-litre cylinder can cost as high as Shs700,000 and maintaining the oxygen heads (regulators with their humidifiers) is also challenging because they break easily yet they are expensive to buy. On average, replacing an oxygen head costs about Shs400,000.
The oxygen you need to help you breathe depends on the level of saturation per individual and it is adjustable by qualified personnel according to Dr Ocan. 
“You need an oximeter to help measure the oxygen saturation. If it is below 60 percent, such a patient needs to be in the intensive care unit. Above 70, the patient can be administered from home but the main point should be the patient’s ability to breathe. Majority of the patients are unable to breathe on their own below 60 percent oxygen saturation and they need life support.”

He adds that, “while at home, ensure that the patient has the right oxygen and that you are monitoring the oxygen levels all the time. If the saturation goes above 96, you need to disconnect and reconnect if it goes below 95 percent.”
Dr Sabrina Kitaka, who treated covid-19 infected children at Mulago National Referral Hospital, however, warns that if a patient is required to use oxygen, it means that the patient is ill and needs to be monitored in a hospital. 
Misuse of oxygen can harm the patient so oxygen therapy should be restricted to hospital care and must be supervised by a nurse or doctor.