More often than not, whenever people complain about a shortage of drugs in the health facilities, not much thought is given to medical oxygen. A shortage of oxygen threatens the lives of millions suffering from life-threatening diseases and injuries.
The oxygen availability gap is colossal: while it is a ubiquitous drug in developed countries, 25 percent of health facilities in sub-Saharan Africa never have oxygen available, while 32 percent have an irregular supply. As a result, the use of the available oxygen is restricted to surgeries and a small number of very ill patients.
So critical is oxygen in emergency care, that without it, pregnant women, newborns and children under the age of five, risk death if the gas is not available in hospitals. And lack is often the norm, rather than the exception, and where it is available, in short and irregular supply, it is often too expensive.
Our medical practitioners should not have to make difficult decisions on which patients receive oxygen and which do not, just because there is not enough oxygen available at the facility.
In Kenya, 42 percent of children prescribed oxygen were unable to get it. According to the Kenya Demographic Health Survey (KDHS) 2014, the Infant Mortality Rate is 39 deaths per thousand while the Under 5 Mortality Rate (U5MR) is 52 deaths per thousand; chest infections are reported as the major contributor to these deaths–an issue that could be solved through a reliable supply of oxygen.
The specific issues that cause the prevalent lack of access are many: first, the distances between hospitals and the source of oxygen can be vast.
Oxygen cylinders must be picked up at an oxygen generation plant in a major city and transported hundreds of kilometres. This adds delays and significant cost.
Second, local alternatives to O2 cylinders require a steady power source and are prone to maintenance issues. One in three concentrators recently sampled at Kenyan hospitals were broken or unusable. Third, oxygen is expensive when sold by the tank. Locally, oxygen at an average Sh1,000 per litre. This is 13 times the average US price. The cost is driven by the lack of competition and by the high cost of transportation.
The other challenge in the sector is that because oxygen is not treated as essential drug by some health facilities, most workers do not undergo continuous training on the benefits of oxygen as well as how, when, and how much oxygen to administer to patients in different scenarios.
Given that access to oxygen is so sparse, health workers are not as familiar with its use as they could be.
The consequences can often be shocking. In August 2017, 64 children died in a hospital in north India due to lack of oxygen while their horrified parents stood watching. The disruption in that case was caused primarily due to lack of financial resources. This problem is severe in developing countries, with nearly half of these deaths concentrated in sub-Saharan Africa.
One of the initiatives worth emulating is the partnership between Siaya County government and Hewa Tele, a locally registered social enterprise set up with a key mandate to ensure oxygen is available. manufacturing plant.
Dr Steve Adudans is the Executive Director, Centre for Public Health and Development.