A vital tool in treating COVID-19, oxygen, once in short supply, flows again in Madagascar


Fanja Saholiarisoa
Approvisionnement d'oxygène
UNICEF Madagascar/2021/Nabil
03 June 2021

Madagascar’s second wave of COVID-19 has put a huge strain on the country’s already fragile health system while creating an urgent need for oxygen supplies to be used in the treatment of the virus.

One of the poorest countries in the world, Madagascar lacks the infrastructure to supply major hospitals with liquid oxygen. During this second wave of the pandemic, the country has been heavily dependent on gas oxygen which is supplied through old and poorly maintained generators.

One solution was to work to meet the immediate needs of the COVID-19 response through oxygen cylinders. This, however, was limited by an insufficient number of bottles, and the requirement that additional cylinders be imported.  

Additionally, imported cylinders would have to be adapted to local requirements and transported to hospitals across the country.

Despite these challenges, UNICEF Madagascar was still able to become the largest supplier of oxygen to the country’s hospitals. This was made possible through long-term agreements with two companies in Madagascar for oxygen supplies that were implemented in 2020.

“The procedure was not easy, and we had to be very proactive,” said Anne Cabrera-Clerget, UNICEF’s supply manager. “April 2021 was the critical phase, and we were able to bring together the private sector, and the Ministry of Health to discuss potential solutions to the lack of oxygen. The discussions were then extended to UNICEF’s supply division who were able to find both liquid oxygen and gas oxygen suppliers globally.”

Three big companies Air Liquide, EO2LE, and Industrial Gaz of Madagascar joined the task force to contribute to the response. Long-term agreements had been set up with EO2LE and Air Liquide in 2020 for COVID-19 response with Industrial Gaz of Madagascar joining the effort in 2021. This ensured long-term support to the oxygen systems in many hospitals in Madagascar.

“Having a regular supply of oxygen has been a huge relief for our hospital as it would be much harder to save lives without these bottles arriving,” explained General Andriamparary Rafetrason Josoa, Technical Director of the country’s Military Hospital, one of the biggest institutions providing COVID-19 treatment. “The supplies came at just the right time and kept the hospital system from collapsing because of the severe lack of oxygen.”

A.M. Ratsimbazafy spent two weeks going back and forth to the hospital where his wife was being treated for COVID-19. “If she didn’t get a supply from oxygen to reach a blood saturation level of 96%, she would have died,” he recalls. Oxygen is needed not only for the treatment of COVID-19 but is used in the treatment of a wide-range of patients.

Rakotomalala, had a similar observation in the treatment of her 70-year-old mother in law. “She was in hospital being treated for nearly three weeks. Without the availability of the oxygen for her treatment, we don’t know if she would have survived,” she said. 

At the Ravoahangy Andrianavalona hospital, the country’s largest, technical director Dr. Rasoarinoro Lalao recounts how the staff struggled to treat the surge in patients before the arrival of the additional supplies. “It was a hard time as we tried to treat some 120 COVID-19 patients a day. In a severe case, one patient might need five oxygen bottles per day. With this free supply, we were able to treat everyone.”

Dr Lalao concedes that being the oldest hospital in Madagascar, there are infrastructure weaknesses at the center.

To address this, a joint effort between UNICEF, the private sector and the Ministry of Health in May tested a more durable solution to the provision of oxygen cylinders. A test was conducted in one of the biggest hospitals in Antananarivo using liquid oxygen transformed into gas oxygen feeding into the oxygen network within the hospital, a system known as CryoTanks. The test was successful. The hospital system is still fed by this system and the method is now being examined for use in four other hospitals providing COVID-19 treatment.  

Thanks to the engagement of UNICEF and partners with the support of the World Bank, the oxygen needs of COVID-19 patients in the country were covered from the end of April until the present. A plan to further boost the oxygen supply nationwide is under development, supported by the expertise acquired by UNICEF. In May, 200 oxygen concentrations arrived in the country due to funding from UNICEF’s ACT-A Supplies Financing Facility.

In 2020, 12,771 oxygen bottles and 21 oxygen concentrators were used for oxygen therapy over a period of seven months in three of the country’s regions hardest hit by COVID-19. So far, during the second wave of the pandemic, 13,500 oxygen bottles have been supplied to patients in 35 health centers and hospitals in 11 regions. Supporters of these life-saving efforts include the World Bank, the Government of Denmark, the Canadian government and the European Civil Protection and Humanitarian Aid Operations (ECHO)