A fundamental and sustainable response to COVID-19: improving local oxygen systems

UNICEF has been supporting countries to provide oxygen therapy and monitoring equipment, while at the same time building a sustainable approach for treating respiratory illnesses.

An oxygen tank for tuberculosis patients stands in the men's tuberculosis ward in Hospital Torax in Tegucigalpa, Honduras, in 2004.
30 April 2020

Amid the constraints to global supply chains due to the COVID-19 pandemic, governments are facing considerable challenges to support their populations. With a high demand and low availability of essential medical supplies, export restrictions and limited transportation capacity due to the decrease in air travel, how can countries effectively respond to COVID-19 and ensure systems have the capacity to treat future respiratory illnesses?

At UNICEF, a sustainable approach has been incorporated into the overall response. By building on the work of the Oxygen Therapy Innovation Project, focus has been given to improving local oxygen therapy systems.


"Nowhere is the technology gap more apparent than in the provision of oxygen … Oxygen is seldom available in the poorest countries beyond urban hospitals and private providers. Pulse oximeters, effective and inexpensive diagnostic devices for measuring blood oxygen levels, are similarly unavailable to those who need them most." 1

Henrietta H. Fore, Executive Director, UNICEF & Kevin Watkins, Chief Executive, Save the Children UK

Oxygen is a major component for treating severe pneumonia, as well as other conditions. COVID-19 causes pneumonia, and approximately 15 per cent of COVID-19 patients are classified as ‘severe’ and require oxygen therapy. Much fewer, approximately five per cent, are classified as ‘critical’ and require a ventilator2.  

A ventilator is a complex device that requires well trained staff to operate and maintain. It provides mechanical ventilation and is only used for those critical COVID-19 patients in intensive care who are unable to breathe. Oxygen therapy, on the other hand, involves a free-flow of oxygen through the nostrils to support hospitalized patients recover from COVID-19. It is normally provided via an oxygen cylinder or an oxygen concentrator in combination with nasal prongs and can be used at the primary care or first referral level of the health system.   

UNICEF COVID-19 response focus has been on increasing the capacity of health facilities to treat severe patients with non-invasive oxygen therapy and monitor them with pulse oximetry with an approach that strengthens the health system.


UNICEF is shipping oxygen concentrators to countries impacted by the COVID-19 outbreak to help patients recover from the disease. Find out more about these life-saving devices.

Improving local oxygen systems during COVID-19  

With the increase in demand for oxygen therapy equipment due to COVID-19, countries are facing challenges in understanding what type of, how much and where to find the needed equipment.

Under the Oxygen Therapy Project, first launched in 2017 with support from the Bill and Melinda Gates Foundation, a number of tools have been developed for health care planners and practitioners, which include:

  1. A computer-based planning tool helps decision makers ensure the appropriate oxygen equipment is available throughout a country. It takes country inputs at a local health facility level, then calculates oxygen needs and recommends the best response to meet those needs (i.e. an oxygen plant, concentrators, or cylinders). It provides a list of products for procurement and estimates cost, both in capital and operating expenditures. Improving the availability of oxygen equipment will help countries better manage the surge of COVID-19 cases and supply needs as forecasted by the WHO Surge Calculators. The UNICEF Oxygen System Planning Tool v1.0 is now available for download here.  
  2. The Technical Specifications and Guidance for Oxygen Therapy Devices manual, recently published by WHO and UNICEF, includes detailed specifications on a wide range of products for delivering oxygen therapy and monitoring. The information within helps decision-makers select, procure, use and maintain appropriate equipment, especially in low- and middle-income countries. An increasing amount of countries have been using this resource during the COVID-19 pandemic to ensure the availability of oxygen equipment at health facilities.  
  3. UNICEF has been updating our Supply Catalogue to include the full range of products required to provide oxygen therapy and monitoring. With COVID-19, UNICEF has expanded the supplier base for oxygen therapy supplies. 

With the groundwork built through these three project tools, UNICEF is now helping countries to mobilize all sources of equipment available in-country while collaborating with the Case Management Consortium, formed under the United Nations Supply Chain Task Force, to expand access to oxygen therapy.  A COVID-19 Oxygen Guidance with sample product lists and cost estimates was developed for planning, budgeting, selecting and procuring affordable technologies that ensure oxygen supply is available for COVID-19 response. Over twenty countries have benefited from this direct technical assistance so far.

Screenshot of the oxygen system planning tool 1.0
Screenshot of the oxygen system planning tool 1.0

Ensuring a sustainable approach  

The Oxygen Therapy Project was originally developed to build a sustainable response to treat children suffering from pneumonia, hypoxemia or other respiratory illness. Since COVID-19 is a respiratory illness, this emergency has demonstrated the importance of investing in health system strengthening projects.   

By capitalizing now on improving oxygen systems, countries will be better prepared to treat children with respiratory illnesses and respond to future outbreaks.  


Key resources




1 Original quote is from this article.

2 WHO data as of 4 April 2020.