Access to Oxygen

The Need

Medical oxygen is a life-saving medicine that treats a wide range of critical conditions. Unfortunately, in many low and middle-income countries around the world, there is a severe lack of medical oxygen and training on the proper use of oxygen therapy. As a result, preventable deaths occur every day.

In East Africa, rural health facilities truck oxygen hundreds of miles in cylinders to deliver a fraction of the lifesaving gas needed. Long transportation distances and few production facilities make oxygen costly and scarce. Even when oxygen does arrive, health workers lack adequate oxygen therapy training. These issues directly impact the patients most in need of lifesaving oxygen.

Our Solution

Assist International (AI) has developed a sustainable and scalable model of oxygen production and distribution that provides a consistent, affordable supply of oxygen to hospitals and health clinics. Utilizing oxygen production plants supplied by AI, partnerships create a revenue-generating model of oxygen sales that allows for the repayment of loans, expansion of existing operations, and scale.

Our goal is to save lives in poor and last-mile communities by providing medical oxygen production and delivery through a sustainable social enterprise. Our innovation thrives on public-private partnerships where AI provides the physical production plant, health facilities are the customer, and a local entrepreneur is the private supplier of affordable oxygen. We work with Ministries of Health and other partners to develop a clinical training program to train frontline healthcare workers on best oxygen therapy practices.

Impact

Our oxygen program provides oxygen to more than 40 hospitals in Kenya and Rwanda. We’ve estimated that the hospitals in Kenya and Rwanda serve a population of at least 4.6 million.

Rwanda (Total Oxygen Solutions)

Assist International, the GE Foundation, and Health Builders (Rwanda) partnered together to establish Total Oxygen Solutions at Ruhengeri District Hospital. Total Oxygen Solutions is a financially sustainable model of oxygen production and distribution that provides reliable, affordable oxygen to the host hospital and health facilities in the oxygen plant’s catchment area.

Program Results:

  • After removing transportation and cost barriers in Rwanda, oxygen consumption at our host hospital increased 852%.
  • Five years later, Ruhengeri Hospital currently consumes about 1875% more oxygen than at baseline.
  • The percent of neonatal respiratory infections that ended in death decreased from 9.01% to 0% at hospitals served by the plant. (1) (2)

(1) Oxygen Program: Health Implications Update Yr1-Yr3, Health Builders. Internal Program Report, October 2017.
(2) Program hospitals also received a pediatric CPAP program from the same group, which may have also contributed to the reduction in fatalities.

Kenya (Hewa Tele)

Assist International, the GE Foundation, and the Center for Public Health and Development (Kenya) partnered together to establish Hewa Tele. Hewa Tele delivers affordable oxygen to over 30 hospitals in the western region of Kenya.
Program Results:

  • In Kenya, previous providers took more than 3 days to deliver oxygen. Our program reduced that time to less than three hours.

Ethiopia

Assist International partnered with GCC, the GE Foundation, and the Regional Health Bureau of Amhara to create a PPP and construct two oxygen plants in Amhara, providing an affordable and sustainable oxygen source to hospitals in each plant’s catchment area.
Program Results:

  • According to WHO data, 27% percent of Ethiopian children under 5 visited a health provider for treatment of pneumonia symptoms in 2011. (3)
  • Pneumonia causes more child deaths in Ethiopia than any other disease. (4)
  • Catchment population for the 14 program hospitals is 11.4 million, although we do have concerns that this number is largely inflated because many catchment populations overlap.
  • According to our baseline evaluation, the average monthly oxygen consumption was below the National Medical Oxygen and Pulse Oximetry Scale-Up Roadmap targets by 253% at primary hospitals and 169% at general hospitals. (5)
  • While one referral exceeded oxygen consumption targets in the roadmap, the other referral hospital needs to increase consumption by 135% to meet targets.
  • Both oxygen plants only meet 15% of the current oxygen need documented in the Ethiopian Oxygen Roadmap. (6)

(3) “Ethiopia Statistics Summary,” World Health Organization. http://apps.who.int/gho/data/node.country.country-ETH, accessed August 22, 2019.
(4) 18% percent of deaths in children under 5 in Ethiopia is caused by pneumonia. Ethiopian Federal Ministry of Health, Ethiopia National Medical Oxygen and Pulse Oximetry Scale Up Road Map, 2016, 2.
(5) Targets from Ibid, 9. Baseline data original to the program.
(6 )The Roadmap mentions that Ethiopia will need 234,000 cubic meters of oxygen per month on page 8. Each plant produces approximately 3000 cylinders each (40L size) per month. 2 plants x 3000 40L cylinders x 5.988 cubic meters (see Trevor’s cylinder conversion worksheet) = 35,928 cubic meters. 35928/234,000*100 = 15%

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