From Covid-19 shortages to fully fledged oxygen plants
Edmand Katwesigye, a staff member, demonstrates how the oxygen plant at Fort Portal Regional Referral Hospital works. PHOTO/ALEX ASHABA
What you need to know:
- Many people died as a result of lack of oxygen in hospitals during the Covid-19 pandemic. Several hospitals in both the public and private sectors struggled to meet the demand for oxygen.
- Taking lessons from this, and with guidance from the World Health Organisation (WHO) the government developed a national oxygen plant to increase access to medical oxygen, as Alex Ashaba & Bill Oketch report.
In 2021, at the height of the Covid-19 pandemic, John Muhumuza, a resident of Fort Portal City, found himself fighting for his life against the virus. What manifested as mild symptoms quickly escalated, leaving him struggling to breathe. “I was rushed to Fort Portal Regional Referral Hospital (FRRH) because I was in urgent need of oxygen support. Every breath felt like a battle yet the hospital did not have enough oxygen to meet the demand. We had to make private arrangements so that I could have a cylinder near my hospital bed,” he recalls. Margaret Katusabe, a retired teacher from Ntoroko District, was admitted in late July 2021. She vividly remembers the terrifying moment her breathing worsened yet no oxygen was available. “I remember lying there, chest burning, struggling to breathe. The nurse informed me that they were waiting for a cylinder to be delivered from another ward.
I waited for more than an hour, not knowing if I would make it. Every minute felt like death was inching closer,” she says. Katushabe adds that she watched fellow patients around her lose consciousness due to oxygen deprivation. She was eventually stabilsed after a cylinder was sourced from a nearby facility, but the fear never left her. For John Byamukama, a bodaboda rider in Kyenjojo District, taking him off oxygen while he still needed it brought the crisis to his home. He had been rushed to Kyenjojo General Hospital after his oxygen levels dropped dangerously low. “The health workers put me on oxygen but in less than 30 minutes the cylinder was disconnected. I was taken off the machine to give another patient a chance.
I could hear the doctors and nurses whispering among themselves, asking if any more oxygen cylinders were coming from FRRH. I resorted to prayers,” he says. He describes a ward full of wheezing, coughing patients, many with desperate eyes locked on the oxygen tanks as if their lives depended on each one, which they did. At the height of the Covid-19 pandemic, FRRH faced a dire shortage of oxygen with its aging plant barely producing five cylinders every three hours, far below the critical demand. Patients in need of oxygen therapy across the Tooro sub-region were left vulnerable, as the hospital struggled to support both its wards and neighbouring health facilities.
Light at the end of the tunnel
However, in December 2024, in a move to strengthen pandemic preparedness and improve emergency response, the Ministry of Health (MoH) commissioned a new high-capacity oxygen plant at the hospital. With the ability to generate 10 oxygen cylinders per hour and up to 100 cylinders daily, the new facility is poised to serve the entire sub-region, including the 10 districts of Kasese, Kabarole, Kamwenge, Kitagwenda, Kyenjojo, Kyegegwa, Fort Portal City, Bunyangabu, Ntoroko and Bundibugyo, ensuring that hospitals and health centres are better equipped to handle future surges in demand. Eng. Dan Niwaha, the hospital’s biomedical engineer, says the new plant features two compartments; one for medical air and another for oxygen. “Each compartment is equipped with 10 slots for oxygen cylinders. The old plant could refill one cylinder every 46 minutes and it had only five filling stations.
The oxygen plant at Lira Regional Referral Hospital is able to produce 100 cylinders per day. PHOTOS/ BILL OKETCH
It would take three hours and 50 minutes to refill five cylinders,” he says. Patients in the hospital’s private wing, who could not afford the exorbitant hospital fees, would be discharged and allowed to take the oxygen cylinders back home, only returning for refills. “The oxygen was free of charge at the facility. However, manufacturers had to pay Shs800,000 per cylinder. Today, the hospital’s demand for oxygen is 27 to 28 cylinders per day, although 180 cylinders are readily available. We can now meet our demand,” Eng Niwaha explains. The oxygen plant also supplies several health facilities in the region. The demand, though, varies. Some facilities may go a month without a single patient in need of oxygen. On average, the plant refills between 100 and 150 cylinders per month. “Facilities are training their health workers on administering oxygen and proper handling of the cylinders.
With proper care, an oxygen cylinder can last up to 10 years. The primary challenge for health centres is transporting the cylinders from the referral hospital due to lack of fuel,” Eng Niwaha notes. FRRH also struggles with transporting oxygen cylinders from the storage area to the wards. The facility is working with MoH to explore alternatives, including a plan to install a piped oxygen system from the plant directly into the wards. Currently, the oxygen plant is operated by a biomedical engineer, although MoH guidelines indicate that it should have dedicated operators and staff responsible for loading and off-loading cylinders during refills.
National plan Before the Covid-19 pandemic, there were significant gaps in the country’s oxygen production capacity. Oxygen therapy is vital for addressing hypoxaemia, a medical condition characterised by low oxygen levels in the blood. Hypoxaemia is prevalent in various health issues such as pneumonia, sepsis, malaria, obstructed labour, caesarean sections, birth asphyxia, and Covid-19. To reduce the gaps that lead to inadequate access to medical oxygen, the MoH launched the National Implementation Plan for Medical Oxygen Scale Up 2023/2024 - 2027/2028 with the aim of reducing mortality and morbidity from all causes of hypoxaemia. The Covid-19 pandemic accelerated global oxygen demand and made the delivery of oxygen supplies more urgent than ever. The World Health Organisation (WHO) says the need for oxygen has increased to 1.1 million cylinders in low to middle-income countries alone.
Pneumonia alone accounts for 800,000 deaths per year, according to WHO. However, it is estimated that 20–40 percent of these deaths could be prevented with the availability of oxygen therapy. Dr Morris Chris Ongom, an economist and leadership development expert, recommends that to strengthen preparedness for future health crises, policymakers must take deliberate steps to decentralise and expand oxygen supply systems.
“This includes setting up oxygen production hubs at district hospitals, deploying solar-powered concentrators in off-grid communities, training biomedical personnel, and ensuring oxygen is prioritised in district health budgets,” he says. Dr Ongom further adds that collaborations with private sector partners and active community involvement will be key to making oxygen a readily accessible, life-saving resource in every health facility, district, and region.
Medical oxygen is an essential clinical need for patients with a range of acute and chronic conditions, as well as for those undergoing surgery
MoH with support from the Global Fund to Fight Aids, Tuberculosis, and Malaria, has been establishing oxygen plants at regional referral hospitals and the National Medical Stores (NMS) in a bid to build local capacity for oxygen supply. One such hospital is Lira Regional Referral Hospital (LRRH) where the oxygen plant, commissioned in November 2024, can simultaneously fill medical oxygen cylinders as well as supply oxygen directly to the hospital via a medical gas piping system (MGPS).
According to internet reports, a MGPS is a critical infrastructure in healthcare facilities, designed to safely and efficiently transport medical gases like oxygen, nitrous oxide, and medical air directly to points of use, such as patient rooms and operating theaters. This system eliminates the need for individual gas cylinders at the bedside, improving safety and convenience for medical staff. The major challenge, though, has been ensuring proper maintenance and stable power supply through dedicated power lines to ensure unhindered production of oxygen by the newly commissioned oxygen plants.
“I call on policymakers to advocate for special rates for electricity tariffs for oxygen producers. They have to develop resource mobilisation tools for management of medical oxygen, such as increasing the tax on alcohol and tobacco and using that money to provide medical oxygen,” says Hamza Okello, the principal private secretary to the Paramount Chief of Lango. Dr Andrew Odur, Lira Hospital’s acting director, says the oxygen plant has significantly impacted the healthcare they provide to the service seekers. “The oxygen plant is able to produce 100 cylinders per day, and this is supporting many of health facilities in the entire region. We have a dedicated power line, straight from Jinja Camp substation in Lira City West Division,” he says. Dr Odur adds that there are fewer cases of power outages in the hospital.
The global need
A report, Reducing global inequities in medical oxygen access: the Lancet Global Health Commission on medical oxygen security, published by the Lancet Global Health Commission in March 2025, found that each year, 374 million people need medical oxygen: 364 million in acute medical and surgical contexts, and nine million with long-term oxygen needs due to chronic obstructive pulmonary disease. The report further found that 306 million (82 percent) of the 374 million people who need oxygen live in low-income and middle-income countries (LMICs), 253 million (68 percent) in South Asia, East Asia and the Pacific, and sub-Saharan Africa.
“Our work emphasises that provision of oxygen is an essential public service, not just a commodity or commercial product, and that achieving equitable oxygen access will require a systems approach addressing multiple domains (production, storage, distribution, supply, clinical use, coordination, regulation, and financing) across the health, education, energy, industry, and transport sectors,” the report further states. It argues that previous efforts, including major investments in response to the Covid-19 pandemic, largely focused on the delivery of equipment to produce more oxygen, but did not invest in the systems and people required to ensure equipment is distributed, maintained, and used safely and effectively.
Safe use of oxygen cylinders
In Uganda, ensuring the safe use of oxygen cylinders is critical for patient care, particularly in settings lacking direct access to medical gas pipeline systems (MGPS). The Ministry of Health’s National Scale-Up of Medical Oxygen Implementation Plan emphasises the importance of safe handling, storage, and transportation of medical gases, including oxygen cylinders, to prevent accidents and ensure effective treatment.
Key safety measures
Proper storage and handling require that oxygen cylinders be kept in well-ventilated areas, away from flammable materials and heat sources. Cylinders must be secured to prevent tipping and damage. Healthcare workers should use appropriate equipment and personal protective gear when handling cylinders. Regular inspection and maintenance involve conducting routine checks to detect leaks, corrosion, or damage. Cylinders must be within their serviceable period and bear valid inspection stamps to ensure safety. Training and awareness programmes should be provided for healthcare workers on the safe use of oxygen cylinders, including correct attachment of regulators and monitoring of oxygen flow. Staff must also be educated on emergency procedures in case of leaks or fires.
Fire safety precautions include implementing firebreak connectors in oxygen concentrators to stop oxygen flow if a fire occurs. Areas where oxygen is used should be equipped with fire extinguishers, and staff should be trained in their proper use. Transportation and ambulance use guidelines stress that when transferring patients with oxygen therapy, cylinders must be securely fastened and the vehicle adequately ventilated. Oxygen saturation levels should be continuously monitored during transport to adjust flow rates as needed.
By adhering to these safety protocols, healthcare facilities in Uganda can mitigate risks associated with oxygen cylinder use and ensure the safety of both patients and staff. Additional info:www.england.nhs.uk
