How UNICEF’s support in increasing oxygen access is saving lives around the world
When UNICEF asked families around the world to share their experience with oxygen therapy treatment, many of them shared the same message — that their critically sick children could not breathe on their own and would not survive without oxygen.
Access to medical oxygen, which is critical for all age groups, is essential in increasing child survival rates. Every year, in low- and middle-income countries, among children under the age of five hospitalized with severe pneumonia, over 7 million require oxygen to survive.
Weak oxygen infrastructure amid a global pandemic
Millions of people worldwide found themselves in this situation during the COVID-19 pandemic, unable to breathe independently and desperately needing oxygen support to survive.
The speed and scale at which COVID-19 spread exposed glaring gaps in healthcare systems, infrastructure, and response mechanisms, exacerbating inequities in global health.
As the virus overwhelmed healthcare facilities, it revealed the extent of oxygen shortages, which meant some health practitioners had to make heart-wrenching decisions about who lives and dies.
Yet, even before this devastating virus, countless children and individuals of all ages faced the dire reality of oxygen inaccessibility. Medical oxygen is a luxury in many parts of the world, especially in small towns, rural communities, and densely populated cities in low- and middle-income countries where oxygen is in short supply.
In fact, countries that have robust oxygen systems can reduce hospital-based pneumonia deaths by half, which is the world’s leading infectious cause of deaths among children under five.
As part of its response to COVID-19 and commitment to ensuring the survival, protection, and development of children, UNICEF is working with governments and partners around the world to strengthen oxygen systems, which is essential in curbing preventable deaths.
Limited oxygen production, data, and capacity creating unsustainable oxygen therapy systems
While working closely with governments worldwide, UNICEF identified several key challenges common in fragile health systems, which were preventing oxygen from reaching the most vulnerable. These challenges, which would need to be overcome to create sustainable health systems with reliable oxygen therapy and quality care included:
- Limited oxygen availability across all levels of healthcare to cover basic and surge needs.
- Lack of adequate data and monitoring systems that would help identify gaps and needs in oxygen production capacity and equipment.
- Limited capacity of health workers, biomedical engineers and technicians to properly operate and maintain oxygen and other biomedical equipment.
- Shortage of available tools such as pulse oximeters to identify patients in immediate need of oxygen therapy.
- Limited knowledge of health workers and a lack of guidelines on oxygen treatment to reduce harm and maximize the successful treatment of patients in critical condition.
- Lack of national plans for oxygen therapy treatment, sustainable management and financing of the oxygen system.
In partnership with governments around the world and in the wake of COVID-19's devastating impacts, UNICEF began to tackle these challenges in order to build robust, sustainable oxygen systems in countries worldwide.
From rapid responses to building sustainable oxygen systems
Given the COVID-19 crisis and a dire need for oxygen globally, UNICEF rapidly expanded its capacity and supply portfolio to provide immediate support to countries for the pandemic response while strengthening oxygen systems and critical capacity for long-term impact, including for children.
UNICEF was able to build on experiences gained through the Scaling Pneumonia Response Innovations (SPRINT) programme, which aimed to increase access to oxygen and antibiotics for pneumonia treatment in Primary Health Care in Ghana and Senegal.
Since 2020, UNICEF has supported oxygen scale-up in more than 100 countries with a focus on:
- Needs assessment and planning: For example, UNICEF’s Oxygen System Planning Tool enables countries to quantify and cost oxygen equipment needs and has been used in 22 countries.
- Product delivery and improving access to medical oxygen in healthcare: UNICEF supplies a wide range of oxygen equipment to countries, from pulse oximeters to identify patients lacking oxygen to complex oxygen-generating plants through the innovative ‘Plant-in-a-box' solution.
- Capacity building: UNICEF supports critical capacity building of health workers to safely administer oxygen therapy and of engineers to operate and maintain oxygen equipment.
- Innovations: UNICEF is constantly developing and deploying oxygen innovations which are informed by challenges faced in countries, such as more resilient oxygen concentrators.
- Market transparency: UNICEF works to provide market transparency on oxygen sources and supplies, including products’ specifications and uses, product deliveries through UNICEF, supplier information, as well as price ranges through the Oxygen Market Dashboard.
Worldwide UNICEF oxygen assistance in numbers
1. Needs assessment and planning
UNICEF is supporting countries to systematically scale oxygen access, which includes using tools such as the Oxygen System Planning Tool (OSPT). OSTP helps countries assess, quantify, and cost oxygen supply needs at all levels: national, subnational, and health facility. This information helps countries prioritize urgent procurement and design long-term strategies to improve the overall oxygen system in health facilities.
Check out Nigeria’s story on how OSTP is helping improve access to oxygen in hospitals and saving lives.
Some say that when couples expect twins, their joy is multiplied by two. But Eyo Etim Okon faced the most devastating loss of his life when postpartum complications led to the death of his wife eight days after giving birth.
The grieving 39-year-old had yet another concern: one of his twins, baby Asher, was in respiratory distress and desperately needed oxygen.
"Breathing became challenging for him," Eyo shared. "I was worried, thinking of what would happen to him if there was no oxygen."
Lack of oxygen can cause irreparable damage to a baby's brain cells, leading to lifelong developmental delays and disabilities. Thankfully, a newly installed oxygen plant at the University Teaching Hospital in Calabar in South Nigeria supplied Baby Asher with oxygen.
Previously, oxygen availability was a significant issue, with some patients having to purchase their oxygen from private vendors. As COVID-19 revealed weaknesses in Nigeria's oxygen systems like many other countries around the world, UNICEF, in support of the government of Nigeria, has worked to strengthen oxygen systems across the country.
Esther Ese Onah, the pediatric nurse in charge of the neonatal unit who cared for baby Asher, ensured he had access to oxygen and checked his vitals every hour when he was in distress. Nurse Esther was one of 454 health workers to participate in a UNICEF-supported training on managing pneumonia and hypoxemia to enhance health professionals' skills in providing oxygen therapy to newborns and young children.
According to Esther, the training has enabled her to detect when babies need oxygen, manage their respiratory distress, and utilize oxygen concentrators to help them breathe, all of which were essential to keeping baby Asher alive.
"At this stage, we are happy with Asher's respiratory rate," she said. "Hopefully, he will be discharged next week as his breathing improves."
Eyo, who said he was relieved knowing there was adequate oxygen support for his newborn, can now focus on supporting baby Asher's development — and navigating life as a single father.
Challenges in accessing oxygen are not unique to Calabar or South Nigeria. In Kaduna state in Northern Nigeria, between 1,000 and 1,500 newborns are admitted to the hospital every year, with over 70% requiring oxygen. Thanks to newly installed oxygen plants in the state and the efforts of dedicated healthcare workers, these babies have a chance at life, as the survival rate of newborns at the hospital is over 80%.
The Nigerian Federal Ministry of Health used the UNICEF Oxygen System Planning Tool to conduct a comprehensive audit of medical oxygen, involving 6,854 health facilities across 36 states plus the Federal Capital Territory — making it the most extensive assessment on oxygen ever conducted in Nigeria. In response to the findings, UNICEF is in the process of installing nine oxygen plants with accompanying solar power solutions, including oxygen equipment and supplies such as oxygen concentrators for primary health care facilities, pulse oximeters, resuscitators, oxygen gas piping, nasal prongs, and face masks in health facilities across nine states.
The Federal Ministry of Health used the audit's findings to develop a national strategy for expanding medical oxygen in healthcare facilities from 2023 to 2027. With assistance from UNICEF, partners, and donors, Nigeria will be better able to create a dependable and sustainable medical oxygen system.
“We are happy to have a newly constructed oxygen plant in Cross Rivers. It will serve all the primary and secondary facilities in the state.”
Dr. Janet Ekpenyong in Nigeria
2. Product delivery and improving access to medical oxygen in healthcare
To overcome some of the challenges in implementing complex oxygen equipment such as Pressure Swing Adsorption (PSA) Plants to increase oxygen production capacity, UNICEF developed an innovative ‘Plant-in-a-box’ solution. The package includes everything needed to produce large volumes of medical grade oxygen, including a menu of PSA plant models of different sizes, accessories supplied in the right quantities, installation of equipment, pre-planned maintenance services and staff training.
While the ‘Plant-in-a-box' solution is helping overcome some of the major hurdles, implementation of oxygen plants is often delayed due to challenges of properly preparing sites for installation, which includes construction work, ensuring adequate power supply, as well as oxygen piping from the plant site to patients’ beds.
Since installing a ‘Plant-in-a-box', Cambodia is better equipped to save lives.
As an alternative to Pressure Swing Adsorption Plants, UNICEF has supported countries including Madagascar, Bangladesh, and Nepal to locally procure and distribute Liquid Medical Oxygen during the pandemic response.
UNICEF Bangladesh is one of several countries which has made significant strides towards comprehensively improving nationwide access to oxygen from hospitals to Primary Health Care centers.
In Sudan, amid conflict, it is increasingly becoming a challenge to deliver oxygen treatment to patients as UNICEF-supported fully functioning oxygen plant has been destroyed.
Learn more about Bangladesh, Cambodia, and Sudan's stories below.
Sharmin Siddiki is the 27-year-old mother of three-year-old Fatima, who became extremely sick and had severe convulsions one night, along with a high fever.
“I lost all my rationale and panicked when my child fell sick and had trouble breathing. I took her in my arms and rushed to the nearest hospital,” she said.
Sharmin took her child to the nearby Mugda Hospital, one of the busiest public health care service providers in Bangladesh. After the necessary medical tests, Fatima was diagnosed with an infection and pneumonia. She was admitted and placed on a bed, which already had an oxygen outlet installed from the central oxygen supply.
Besides being able to administer oxygen therapy immediately to the gravely ill child, the central oxygen system – initially established for COVID-19 patients during the height of the pandemic – made the task much easier for the nurses and other health workers.
They did not need to rush and move an oxygen cylinder from one bed to another, and patients admitted to the critical care ward are now able to easily access oxygen treatment through a central line.
“My daughter was immediately given oxygen. I can never thank the doctors and nurses enough for taking great care of my daughter. I feel the moment my child was able to inhale this lifesaving gas, she was able to start breathing much better.” Sharmin expressed.
Oxygen treatment remains an inaccessible luxury for a large proportion of severely ill
children admitted to hospitals throughout Bangladesh.
To ensure oxygen is always available for critically ill children and other patients, including those fighting COVID-19, with thanks to funding from donors, UNICEF supported the construction and installation of oxygen manifold rooms and central medical gas pipelines in 60 Upazila Health Complexes and Liquid Medical Oxygen plants in 30 hospitals.
Mugda Medical College Hospital is one of the facilities which received this assistance.
“During winter, patients with respiratory problems, particularly children and senior citizens often come to this hospital. The central oxygen system has made the treatment easier and accessible for all.” says Ifte Ara, a Nursing Supervisor of Mugda Medical College and Hospital.
UNICEF in Bangladesh has been a significant stride in strengthening oxygen system across the country - from procuring equipment and delivering those, to setting up oxygen production plants, establishing national oxygen plan and guidelines on oxygen treatment; training doctors, nurses, biomedical engineers and technicians, as well as utilizing UNICEF’s tools in monitoring oxygen management in the country.
Fatima’s mother Sharmin is grateful for the assistance her child has received on time, “This oxygen treatment saved my child. It is a blessing that this service is available here. I did not need to rush my sick child from one location to another, searching for oxygen treatment.”
Two-year-old Rothana is restless. He keeps running away from his bed at Preah Vihear's 16 Makara Provincial Referral Hospital to the small children's library on his ward, grabbing picture books.
His parents – Sreyhahk and Sounoun – are delighted at his energy. Just 24 hours ago, Rothana's temperature had soared over 40 degrees at home, and the young boy began shaking, struggling to breathe. His parents rushed him to the hospital in distress.
Nurses rushed to their aid, fearing the worst. They supplied Rothana with oxygen, piped directly from a newly installed oxygen plant installed in the hospital with support from UNICEF. Nurses also administered intravenous antibiotics to treat the severe throat infection triggering baby Rothana's symptoms.
Within an hour, Rothana breathed easily again, and his temperature had dropped.
"Seeing him not being able to breathe was so frightening," Sreyhahk recalls. "I'm relieved they could help him straight away, especially with the oxygen. Now we will be taking him home well again. I'm just so happy in my heart."
Dr. Suy Keara, who oversees the children's ward at the hospital, says Rothana's case was a matter of life and death — and immediate access to oxygen made all the difference.
"In the past, nationwide shortages of medicine and oxygen meant children died unnecessarily," Dr. Keara says. "Since the plant was installed [providing oxygen] is easy. It will definitely save lives."
According to Keara, if Rothana hadn't received oxygen, he would have been at grave risk of developing pneumonia, which he estimates is the cause of death of 1 in 20 children who die in the province. Preah Vihear's mortality rate among children under the age of five ( 36 per 1,000 live births) is twice as high as Cambodia's national figures (16 per 1,000 live births).
Until UNICEF installed the new oxygen plant, the province of Preah Vihear had no local oxygen plant. The nearest facility with on-site lifesaving oxygen therapy was four hours away in Siem Reap, and the long and bumpy roads meant oxygen couldn't always reach children in time.
Now, the hospital can reduce costs and provide oxygen support to save future patients' lives, including mothers giving birth, newborn children, people suffering from pneumonia or other respiratory conditions, including COVID-19 patients.
Dr. Veasna Sok, Director of 16 Makara Provincial Hospital of Preah Vihearsaid the new oxygen plant is improving the quality of treatment the hospital can provide and increasing patients' confidence in medical services.
"I really want to thank UNICEF and USAID for helping our patients with this oxygen plant. It is good to not have to rely on private suppliers to buy oxygen [as] the hospital has its own oxygen plant on-site which can produce high-quality medical oxygen," said Dr. Sok.
In Cambodia, the new “‘Plant-in –a-Box" reaches nearly 300,000 people — approximately 18% of the country's population. The oxygen plant is piped directly to the intensive care unit and emergency room, maternity, and operating theatre wards, to enhance preparedness for COVID-19 surges and other emerging respiratory illness outbreaks. It also produces oxygen to refill cylinders and transport them to serve patients at health facilities up to 200 km away.
With UNICEF support, Cambodia has received oxygen therapy equipment, including 640 patient monitors, 1,817 oxygen concentrators, and 7,560 pulse oximeters and other oxygen consumables. This equipment will reach 25 provincial referral hospitals and 95 district referral hospitals and health centers in all 25 municipalities and provinces in Cambodia. UNICEF-supported training has reached 312 healthcare workers in five remote provinces and four biomedical engineers who maintain the oxygen plant.
Some key challenges include a need for biomedical technicians with the capacity to sustain and maintain oxygen equipment and the high costs by private service providers to maintain the oxygen plant and concentrators.
UNICEF Cambodia will continue to support the Ministry of Health in maintaining the oxygen plant and collaborate with other development partners to build the capacity of hospital staff and technicians to perform basic maintenance and upkeep of the oxygen equipment to improve its lifespan and ensure all patients in need, especially children, receive life-saving oxygen.
At El-Geneina Teaching Hospital in West Darfur, a recently-installed oxygen plant was destroyed amid an attack and violent intrusion, which also involved looting. Intense clashes began on April 15 in Sudan, with devastating impacts, including civilian deaths and widespread displacement. Medical care has been difficult to access due to facilities being attacked and staff and supply shortages.
Just a few weeks ago, the new oxygen plant at the major referral hospital eliminated the need to rely on oxygen supply from the capital city of Khartoum, 1,500 kilometers away. The dependence on distant oxygen suppliers posed a risk to patients during supply shortages, which were particularly frequent during the peak of the COVID-19 pandemic. In these instances, the hospital purchased oxygen from private sources or other hospitals but with the new plant installation, this was no longer necessary.
In February 2023, with support from UNICEF, Sudan’s Federal Ministry of Health launched a new oxygen plant — the first ever installed by UNICEF in Sudan — to provide a reliable source of oxygen to El-Geneina Teaching Hospital and nearby health facilities. The plant had the capacity to fill approximately 120 cylinders containing 20 liters of oxygen every 24 hours.
And the new plant had an immediate impact on saving lives: When 10-month-old Retag Omer began struggling to eat and was noticeably less energetic, her mother, Magbola Ahamed, couldn’t shake the feeling that something was seriously wrong.
Magbola rushed baby Retag to the nearest hospital. Soon after, medical examinations revealed that Retag had a heart complication. She was admitted for treatment, relied on 24-hour oxygen support from the new plant, and remained in hospital for 23 days
Magbola knows that the oxygen her daughter Retag was able to access helped save her life.
“Without oxygen, we might have [faced] a lot of complications and [ it could have] even lead to death,” Magbola said.
This is now the reality faced by children and other vulnerable individuals relying on oxygen in the city of El-Geneina, as security issues have limited the ability of humanitarian actors, including UNICEF to continue their life-saving work.
Dr. Adam Zakaina, a surgeon at the hospital, conducts up to 10 operations at the hospital daily. He knows having reliable access to an oxygen source is a matter of life and death for his patients.
“Without oxygen, we cannot perform any operation. During anesthesia, we make sure oxygen is available throughout. With this new oxygen plant, we can avoid stock-outs,” Dr. Zakaina said in an interview prior to the attack on the hospital.
To ensure the safe handling of oxygen, Adam and his colleagues participated in UNICEF-supported training for medical engineers and healthcare professionals. Additionally, UNICEF distributed more than 1,000 concentrators at the primary healthcare level which will improve immediately access to life-saving oxygen for critically ill people, including children, closer to where they live.
UNICEF is supporting Sudan’s Federal Ministry of Health to install two additional oxygen plants in North Darfur and North Kordofan states to provide reliable and life-saving oxygen to the most vulnerable populations in Sudan. However, due to the ongoing conflict, delivery of these oxygen plants is on hold until the situation stabilizes. Once installed and fully functional, these three oxygen plants will produce more than 2 million liters of oxygen daily, which is sufficient to support more than 35,000 newborns and children with pneumonia.
“UNICEF is extremely concerned with the impact of the ongoing conflict on the delivery of health services and supplies in Sudan, including oxygen,” said Aigul Nurgabilova, Health and Nutrition specialist with UNICEF Sudan. “UNICEF just recently managed to provide some life-saving supplies to the Darfur states, and we are committed to doing all we can to during this time of heightened vulnerabilities.”
In addition to the conflict, which has backtracked progress on scaling oxygen support in Sudan, other significant challenges persist, such as the need for a national oxygen strategy and maintenance of oxygen plants in a resource-constrained, conflict-affected setting with critical shortages of skilled personnel, notably biomedical engineers who are needed to operate the plants. Amid these challenges, UNICEF continues to advocate for sustained solutions, strengthen broader maintenance systems, and document learnings.
“UNICEF is extremely concerned with the impact of the ongoing conflict on the delivery of health services and supplies in Sudan, including oxygen,”
Aigul Nurgabilova, Health and Nutrition specialist in Sudan
Besides innovative solutions, UNICEF continues to assist countries on improving access to oxygen treatment amid complex challenges. In Venezuela, optimizing existing resources and procuring oxygen products significantly improved availability of oxygen for more patients. Read Venezuela’s story on how oxygen system is being strengthened there.
3. Capacity building
With this context, UNICEF works with governments to establish standard guidelines for oxygen therapy and trained healthcare workers such as doctors, nurses, biomedical engineers, and technicians. As a result, trained doctors and nurses can give patients more accurate oxygen treatment. Likewise, biomedical engineers and technicians can troubleshoot, fix broken parts, and maintain oxygen plants and equipment to ensure the consistent availability of oxygen services.
In Pakistan and Yemen, oxygen therapy training programmes are building the confidence of health workers to appropriately respond to oxygen needs and use all the tools at their disposal to provide patients with the best possible care.
Learn more about Pakistan and Yemen’s stories below.
Aqeel stood silently in the Neonatal Intensive Care Unit of a Punjab hospital, unable to say much as he worried about his newborn baby. His newborn baby was having difficulty breathing, leaving Aqeel and other family members worried he might not survive. They rushed the baby to the hospital and hoped for a miracle.
“When we came to this hospital seeking help, [the baby] was admitted immediately and put on medicine and oxygen treatment,” said Aziz Mai, the baby’s grandmother.
“We did not even name my grandson yet. He is just two days old. Thanks to everyone’s care, the baby’s health has improved, and we are taking him home soon.”
In a nearby room at the hospital, one-day old baby Fouzia was going through a similar life-threatening situation. Lying in a cot, she was put on oxygen therapy by Dr. Muhammed Rizwan, pediatrician in-charge in the Neonatal Intensive Care Unit (NICU) at District Headquarter Hospital in Punjab, Pakistan while her grandmother prayed that she would survive.
“Fouzia was born weak and underweight with breathing difficulty,” said Kauser, the baby’s grandmother
Now, after a few hours in the hospital, I can see that her condition is improving.”
On a near daily basis, babies in critical condition are saved due to the quick thinking of medical professionals such as Dr. Rizwan and his colleague nurse Mariam Bibi, who were both trained in Oxygen Therapy Guidelines through UNICEF-supported training. With enhanced skill and knowledge, these professionals are making rapid and effective decisions to save the lives of newborns.
Pakistan’s health system came under tremendous pressure during COVID-19 in early 2020. A shortage of trained oxygen therapists and oxygen supplies was a massive problem, and it remains a challenge even now.
“The training on these guidelines helped us reinforce our learning and acquire new skills on oxygen therapy. Previously, we only used a Constant Positive Airway
Pressure (CPAP machine) for critically ill patients. Now, we learned how to use bubble CPAP as well. We are applying that learning and seeing better results, and an improvement in newborn’s respiratory distress,” Dr. Rizwan said.
In January 2023, the NICU in District Headquarter Hospital in Punjab admitted 152 newborns and had a recovery rate of 99 per cent.
Staff nurse Mariam said: “This training has given me a boost in my confidence level. I can now give better oxygen therapy to critically sick newborns immediately to help save their precious lives.”
UNICEF, with support from various donors, escalated its support to Pakistan’s government to help strengthen access to oxygen and its management systems. A collaboration with Ministry of National Health Services, the Pakistan Pediatric Association, and the Health Services Academy, achieved the development of the first-ever National Oxygen Therapy Guidelines for Children. UNICEF is also supporting health service providers to master these guidelines. Now, trained medics are using their newly acquired skills in oxygen therapy to efficiently use and maintain oxygen equipment, which is critical to saving lives.
At least 3,797 health care providers, including doctors, nurses, female health workers, health managers, technicians and biomedical engineers were trained on the Oxygen Therapy Guidelines and oxygen equipment management in 18 districts of Khyber Pakhtunkhwa, Punjab, Pakistan Administered Kashmir and Gilgit Baltistan regions, with similar training programmes ongoing in Sindh and Balochistan provinces.
UNICEF is also strengthening oxygen systems in Pakistan with upcoming oxygen "plant-in-a-box" installations in five districts which are home to more than 10 million people.
At the National Health Emergency Centre in Aden, Yemen, a group of health professionals huddles at the front of a classroom as a trainer shows them how to provide life support step by step.
"Time is of the essence," said Hisham Alauthali, a respiratory therapist demonstrating CPR, life support, and trauma life support techniques.
For Ahmed Saleh Al-Wa'er, one of the trainees, an assistant doctor at Abdulqawi Health Centre in Aden, learning about oxygen therapy, rapid intervention, and patient transfers to health facilities showed him how just a few seconds can make the difference between life and death for a patient.
"We were always late to save a patient. It would take us too long to take a patient to the hospital," he said. "Also, one of the most important pieces of information [received during the training] was the method of giving oxygen to the patient. The one we used to use before was wrong."
According to Ahmed, most hospitals and health centres in Yemen employ either recent graduates and volunteers who lack practical experience or senior health workers who have valuable experience but need more training to keep their skills up to date. Health workers sometimes provide patients with "poor quality of services," which is why training are key, Ahmed said.
"This training is very important to me since it… rectified wrong concepts about dealing with emergency cases and saving patients that I used to have," Ahmed said, committing to share his learnings with his colleagues and volunteers to strengthen their emergency response.
Hisham Alauthali, one of the trainers who conducted the four-day training, noted that similar misconceptions amongst health workers were impacting their ability to save lives.
"We rectified the mistakes that used to take place while giving CPR in some hospitals and health centres. The oxygen [was given] to the patients in a wrong way, so we taught the trainees the right ways," Hisham said.
With support from UNICEF, life support training, consisting of theoretical and practical aspects, began in December 2022. The trainings are geared toward doctors, nurses, and emergency and resuscitation workers in emergency departments and operating rooms at government health centres in Aden.
Resilient oxygen concentrator: UNICEF has worked with manufacturers to co-create an improved, state-of-the-art oxygen concentrator that is designed to be durable and resilient to work in challenging settings. It consumes 30-60% less power, is solar friendly and easier to use and repair. UNICEF is launching an Advanced Purchase Commitment of $8+ million to catalyze innovation, with several products expected by 2024.
Power solutions for PSA oxygen plants:
Solar-powered oxygen plants: To address the unreliable power in health facilities and reduce the need for diesel generators, UNICEF is working with Nigeria Country Office to design and install solar power plants to run the PSA ‘Plant in a Box’.
PSA Oxygen Plants Heat Recovery: The initiative of integrating heat exchangers in PSA oxygen plants makes life-saving oxygen affordable and accessible through enabling renewable energy use in health facilities. It reduces energy costs by redirecting heat from air compressor of PSA plant to hospitals. The heat is used to warm water for purposes such as sterilizing medical equipment, laundry, catering services or for creating a comfortable indoor environment for children and patients, transforming energy waste into eco-friendly power supplies. UNICEF is currently testing ways to capture waste heat from PSA plants in Pakistan.
Oxygen-as-a-Service (O2aaS): O2aaS operates on a public-private partnership model, where suppliers provide a guaranteed availability of oxygen at a given facility, through a complete package of products and services. This turn-key solution for providing oxygen is a more reliable, easier to implement, and more cost-effective alternative to traditional methods of purchasing and delivering oxygen.
Newborn CPAP: UNICEF is introducing and scaling innovative newborn CPAP products that are easier to use, require less complex infrastructure, and can even run without power. This allows children in remote settings to receive CPAP treatment.
When six-month-old Constance was coughing and had a rising fever and difficulty breathing, her parents immediately rushed her to the nearest hospital. There, doctors diagnosed her with pneumonia — the biggest infectious killer of children under the age of five, killing over 700 children globally every year.
For baby Constance, receiving immediate access to a sustained oxygen supply made all the difference in her treatment. Like Constance, over 7 million children every year under the age of five in low- and middle-income countries require oxygen as part of their treatment to survive.
Only a few months earlier, oxygen was in short supply at the Kayunga Regional Referral Hospital in Uganda’s Buganda Region due to crumbling infrastructure as the hospital struggled to cope with children’s pneumonia and COVID-19 cases.
“COVID-19 has put enormous pressure on health care facilities across Uganda, particularly in terms of oxygen production capacity. Without available oxygen, we know COVID-19 patients are not surviving who otherwise could be saved,” said Laura Siegrist Fouché, Deputy Representative, Operations, UNICEF Uganda during a wave of COVID-19 cases in 2021.
The COVID-19 pandemic exposed massive gaps in oxygen availability across the world. Similarly too many countries around the world, Uganda desperately needed an increased supply of oxygen. Typically, oxygen plants can take six months or longer to design and order — but with the COVID-19 pandemic and high pneumonia cases placing a strain on healthcare systems, there was an urgent need to develop a quicker solution to prevent avoidable deaths.
UNICEF recognized the gaps and worked to drive solutions that would quickly deliver large-scale systems to address the pandemic and underlying health systems gaps. Scaling the production of oxygen at hospitals and health facilities in low-resource and poor-infrastructure environments is complex, and UNICEF addressed the challenge through the Oxygen “Plant-in-a-Box" solution.
“Plant-in-a-Box” is an all-in-one solution to produce large volumes of medical oxygen. It involves the delivery and installation of a fully functional Pressure Swing Absorption Plant and is part of a package comprising more than 500 different pieces of equipment and accessories such as an air compressor, oxygen generator, tank, and cylinders, as well as initial training on operation and a maintenance contract.
The equipment is robust, capable of operating in high heat and altitudes, and able to withstand electrical voltage fluctuations that are common in the challenging environments where UNICEF works.
UNICEF’s first Plant-in-a-Box was installed and made functional in Soroti Regional Referral Hospital in November 2021, followed by two other plants at Masaka Regional Referral Hospital and Kayunga Regional Referral Hospital in early 2022. The oxygen produced by the Kayunga plant was a lifesaver for Constance and will continue to support children like her. In total, UNICEF, together with the Ugandan government, will install six such plants, which will cover the needs of 15 million people, over 30 percent of the country’s population.
In Uganda, Dr. Olaro Charles, Director of Clinical Services and Senior Consultant Surgeon at the Ministry of Health, shared that the existing “Plant-in-a-box" and those set to be installed in the coming months are helping save lives during a pivotal time of the COVID-19 pandemic. He said the UNICEF-supported plants continue to support patients experiencing diseases and conditions such as pneumonia, sepsis, malaria, obstructed labor, birth asphyxia.
“The Ministry of Health Uganda is grateful for the timely support of UNICEF country office,” said Dr. Olaro Charles. “The UNICEF investment in oxygen production and diagnostic equipment has… saved many lives which would have been lost if access to live saving oxygen had not been provided and supported the continuity of essential services amidst the COVID-19 pandemic and Ebola virus epidemic.”
UNICEF’s oxygen therapy interventions helped save the lives of over 5,200 patients who had COVID-19, severe pneumonia, and other critical illnesses, including over 2,100 children under five in Neonatal Intensive Care Units and pediatric wards at Kayunga, Masaka and Soroti Regional Referral Hospital between January and June 2022.
UNICEF also trained 325 clinicians and 59 biomedical engineers and technicians on hypoxemia and maintaining and repairing oxygen equipment, who will train an additional 4,000 health workers nationwide.
While these successes have saved lives, including baby Constance’s, many challenges remain, including the need for ongoing training of health workers and biomedical engineers, maintaining and repairing existing oxygen equipment, and procuring additional oxygen cylinders to replace the estimated 20 percent of oxygen cylinders in Uganda which are aged beyond repair.
As UNICEF installs additional Plant-in-a-Box across, the agency is prioritizing mentoring and training health workers and biomedical engineers, facilitating repairs and maintenance to oxygen equipment, and strengthening the quality of care of maternal, newborn, and child health services including oxygen access at Primary Health Care level.
This is largely due to challenges these vulnerable children have in accessing oxygen therapy, which is not only needed to save the lives of children, but of pregnant mothers, elderly, and other vulnerable populations.
Oxygen is a critical treatment for many of the 30 million small and sick newborns born every year, and children with pneumonia as well as other conditions.
In fact, oxygen is so essential to the survival of children that strengthening oxygen systems worldwide can cut under-five child hospital deaths by a quarter.
In Iraq, UNICEF is supporting governments to strengthen oxygen systems and increase access to oxygen therapy, which is improving newborn care and ensuring that more babies can live healthier lives.
Learn more about Iraq’s story below.
In Baghdad, 15-day-old Jana Husam received critical oxygen treatment alongside other medicines at an intensive special care newborn unit for babies. She was suffering from severe diarrhea.
Her family rushed her urgently to Al-Iskan Teaching Hospital, which hosts one of the two oxygen production plants UNICEF has helped set up. This oxygen plant is critical to ensure the constant flow of oxygen for sick babies like Jana.
For child survival, immediate availability of oxygen treatment in healthcare is imperative. UNICEF worked closely with the hospital authorities and the government to centralize the oxygen network in emergency units in this hospital in Baghdad.
Born premature, Mohammed Fanar, a four-week-old baby boy, has been in this hospital for 18 days in an incubator. Trained medical staff were closely monitoring his health. Oxygen was helping him breathe, gain strength and fight off potential diseases.
In 2020, UNICEF in Iraq, through the Ministry of Health, distributed around 100 oxygen concentrators for emergency COVID-19 patients' treatment. Since then, UNICEF is consistently assisting the government in strengthening the oxygen system in Iraq through oxygen products and equipment delivery as well as training health workers.
In 2021, UNICEF Iraq initiated a dialogue with the government on oxygen management to establish a clear vision on the situation, needs, gaps and available resources. In 2022, UNICEF Iraq received funds to start the oxygen programme.
Since then, UNICEF has established two oxygen production plants in two hospitals in Ninawa and Muthana and trained 175 biomedical engineers and technicians on medical gas usage and maintenance guidelines.
UNICEF also trained around 200 doctors and nurses, such as Jana and Mohammed's nurses, on intensive neonatal care and hypoxia management. At least 24 staff were also trained in data collection and management of oxygen in health facilities. UNICEF aims to continue expanding the oxygen programme in Iraq and save many more lives.
Ensuring sustainability and scalability of oxygen investments
COVID-19 has triggered unprecedented investments in oxygen systems which have ensured that the most vulnerable can access oxygen treatment when needed, saving countless lives.
To ensure these investments are sustained and further scaled, UNICEF will continue to provide support to governments to identify remaining gaps and needs to ensure universal access to oxygen, including for pandemic surges.
UNICEF thanks all partners and donors that supported our COVID-19 response and oxygen systems strengthening efforts over the past three years.
This includes investments made through the ACT-A Supplies Financing Facility and the ACT-A Humanitarian Action for Children Appeals for the COVID-19 oxygen response of over 94 million USD to 62 countries in 2021 and 2022, with generous support from many partners, including the Governments of Canada, Norway, and the United States, and the private sector.