Photo essay

A SPRINT during the pandemic to stop pneumonia

With over one year in action in Senegal, UNICEF’s SPRINT programme (Scaling Pneumonia Response Innovations) demonstrates key achievements in building stronger health systems to stop children dying from pneumonia.

UNICEF

A health worker at Kolda District Hospital in Senegal cares for an infant who is hooked up to oxygen. — UNICEF/MFall

15 April 2021

When we think of hospitals, what may first come to mind is bright florescent lit hallways, the beeping sounds of heart monitors, cabinets filled with antibiotics and medicines, and plastic tubing of free-flowing oxygen hooked up to patients. In most regional or city hospitals across the world, this essential equipment and medicines are readily available and used to treat patients and save lives.

But for local health clinics in lower and middle income countries, which is the main access point for many peoples’ health needs, unfortunately, this is often not the case. Medical equipment can be expensive, complex, and difficult to transport. When looking at pneumonia – the biggest killer of children under five – access to basic support is often not available. In fact, approximately 4.2 million children with pneumonia who need oxygen currently do not have access to it.

“SPRINT” (Scaling Pneumonia Response Innovations) is UNICEF’s strategic initiative to expanding access to oxygen therapy and antibiotics, both of which are required to treat pneumonia. The programme was first launched in Senegal in January last year in partnership with the Government, and since then has helped increase access to treatment for thousands of children in the country.

This photo story will take you on the ground in Senegal, “sprinting” during the pandemic to bring pneumonia treatment closer to home for thousands of families.

1 - The tools of oxygen

Ensuring access to oxygen therapy is not the simplest of feats. Medical oxygen first needs to be concentrated, either chemically extracted from the ambient air (i.e. via an oxygen plant or concentrator) or vaporized from a liquid form and then either stored for transportation (i.e. via oxygen cylinders) or directly provided to patients (i.e. via a concentrator or a central piping system in a hospital). Administering oxygen to a patient requires many tools to understand the needs per patient and ensure the right amount of oxygen is given to that patient. Below we highlight just a few of the many tools required to build an oxygen system and how UNICEF Senegal and The Government have invested in ensuring they are available, not only at larger hospitals, but also at local health posts in the country.

The range of equipment necessary

New equipment that has been installed in health clinics via SPRINT across Senegal: concentrators, cylinders, pulse oximeters and tubing. — UNICEF/MFall Some of the new equipment that has been installed in health clinics via SPRINT across Senegal: concentrators, cylinders, pulse oximeters and tubing.

The flow meter

A health worker adjusts a new flow meter installed via SPRINT in the Newborn Intensive Care Unit of Kolda Health Center in southern Senegal. — UNICEF/MFall A new flow meter installed via SPRINT in the Newborn Intensive Care Unit of Kolda Regional Hospital in southern Senegal. This device distributes oxygen from one source to multiple independent outlets. It allows healthcare workers to use the hospital’s centralized oxygen system to treat more premature patients at the same time.

The oxygen concentrator

A health worker adjusts an oxygen concentrator. — UNICEF/MFall An oxygen concentrator is a machine that takes in ambient air, removes the nitrogen, and produces a continuous source of oxygen. In Senegal, UNICEF implements a mix of different oxygen delivery options, and via the SPRINT programme, a model incorporating oxygen concentrators and cylinders has been implemented. Over the course of the pandemic, 95 concentrators were delivered to Senegal, 41 of which were installed at health facilities in targeted districts via the SPRINT project.

The oxygen cylinder

A cylinder of oxygen at the Kolda District Hospital, in Senegal. — UNICEF/MFall Cylinders are a common form of oxygen delivery in low-resource settings. Oxygen is produced in a central plant, then transported to health clinics via these storage devices. In many Senegalese hospitals, like at the Kolda District Hospital, oxygen is provided to patients through a central oxygen piping system. However, they also ensure back-up cylinders are available, like those seen in the picture, to ensure oxygen is available at all times.

The pulse oximeter

Health workers at Ndorna Health Post who are learning how to use a pulse oximeter. — UNICEF/MFall Health workers at Ndorna Health Post learn how to use a pulse oximeter. Without understanding the oxygen saturation levels, it’s extremely difficult to know if a child requires oxygen as part of his or her treatment. A pulse oximeter detects the oxygen saturation levels, and through SPRINT, many health facilities in Senegal now have access to these devices. During the pandemic 69 pulse oximeters were provided to health facilities via SPRINT, with 72 more planned for delivery to ensure that each health facility in a SPRINT-targeted district has two.

2 - The right way to provide oxygen

Purchasing equipment is only one part of the puzzle. There’s immense planning required to ensure the equipment is of the correct type, size and amount, and that there are maintenance plans in place, sufficient power available, and that people are trained to use the equipment properly. The photos below display three key programming pieces that SPRINT focuses on in country – the right sizing of equipment, the right planning for referrals and treatment, and the right training required to run the equipment.

The right size

A neonatal pulse oximeter on the foot of a an infant. — UNICEF/MFall A neonatal pulse oximeter that allows medical staff to accurately detect oxygen levels in infants. In many health facilities across Senegal, basic oxygen equipment has been available, however, it is often not of appropriate sizing for children. A medical trainee at the Kolda Health Post in Senegal explains: “Before SPRINT, we already had oxygen in our emergency care unit - two concentrators and all the accessories as well as oxygen cylinders in the ambulances. However, we did not have the right-sized consumables for children. The SPRINT equipment allows us to take care of children who need oxygen therapy.”

The right plan

A pulse oximeter and hands of health workers discussing oxygen therapy. — UNICEF/MFall An oxygen system is complex, which is why the necessary equipment is often only available at hospitals, while at local health clinics, medical staff must refer patients who need oxygen to a larger facility. And in urgent cases, an ambulance is necessary, which is sometimes difficult since hospitals can be far from home. UNICEF Health Specialist Alpha Seydi Ndiaye explained how the practice of referrals is now changing their response plans thanks to SPRINT. “With the new equipment, instead of referring patients with respiratory difficulties directly to the hospital, the health staff at a local clinic can measure the oxygen saturation of the patient with the pulse oximeter and if needed, stabilize them with oxygen therapy. If referral is still needed, they have the means to provide oxygen through the cylinders during the ambulance ride.”

The right skills

Healthcare workers being trained in how to use the oxygen therapy. — UNICEF/MFall Through SPRINT, UNICEF initiated various training sessions at health clinics across Senegal, where health workers learned how to plan, install, use and maintain the new equipment they received. Madame Kanoute, the head midwife Sikilo Ouest Health Post explained: “I had been trained to use oxygen therapy during my studies, but that was a long time ago.” She described how the SPRINT training helped her measure the oxygen saturation of the newborn baby and when it was 93 per cent, she was able to ensure that there was no danger.

3 - Amoxicillin dispersible tablets - the treatment

When a patient becomes severely ill or suffers respiratory distress, oxygen is crucial to keeping the person stable and well enough to receive a medical treatment. However, this usually does not resolve the underlying condition. For pneumonia, antibiotics are needed to stop the infection of the lungs and fend off the disease. For children, the recommended treatment in low-resource settings is the dispersible tablet form of amoxicillin, an innovative solution to the syrup form that requires refrigeration (which many homes don’t have access to) and measuring at home via caregivers (which has a high risk for error). With the dispersible tablet form, the medicine can be stored for long periods of time in ambient temperatures and can easily be administered by a parent to a child by simply dropping the tablet into a glass of water so it can be diluted before being consumed.

A health worker wearing a mask shows amoxicillin dispersible tablets (DT) used in the treatment of respiratory diseases. — UNICEF/MFall Through SPRINT, 831,400 amoxicillin dispersible tablets (DT) have been provided to 157 health facilities in Senegal. The medicine is programmed to be delivered along with oxygen, so thousands of children can access both treatments to survive pneumonia. This is a catalytic impact of SPRINT, which has led to the Government taking over the procurement and distribution of amoxicillin DT and extending the access from five SPRINT pilot districts to all 79 districts of Senegal.

So, what is “SPRINT?”

SPRINT doesn’t focus on creating any new products or devices, but instead works to ensure access to already proven treatment to pneumonia. It’s a structured approach to implementing oxygen therapy and amoxicillin DT, consisting of first identifying the key bottlenecks and secondly utilizing existing knowledge to overcome these bottlenecks.

The ‘SPRINT model’ helps countries identify the most pressing challenges relative to their goals and guides them with relevant knowledge to help them meet their goals. It looks at key sectors of a country’s health and financial systems (i.e. national & local markets, supply chains, advocacy & demand, etc.) when delivering oxygen therapy and amoxicillin DT to ensure sustainability, as indicated in the image below.

Senegal has applied the SPRINT model to scale-up access to oxygen therapy and Amoxicillin DT. Each country’s model is adapted for their specific contexts and needs. For Senegal, this photo story highlights activities under 'Financing and Procurement' and 'Training and Installation' as indicated in this SPRINT model gr

Expanding the “SPRINT” to more countries

With over one year of the SPRINT programme in Senegal, the results are clear – 64 health clinics now have access to new oxygen equipment and 157 have the antibiotics necessary to treat children suffering from pneumonia. The new equipment has also supported the country to establish an oxygen response for COVID-19 by treating patients who have been severely affected by the disease.

The programme has also been introduced in Ghana, where 13 health facilities in the Eastern Region have gained access to equipment and/or antibiotics, including 75 oxygen concentrators, with plans to introduce SPRINT to more countries.

With supporting governments, partners, and donors, it is possible to limit the preventable deaths of children suffering from pneumonia.

UNICEF is seeking support to expand access to pneumonia treatment to more countries via SPRINT. For more information, read our investment case for SPRINT which provides key information on how you can support UNICEF’s fight to end childhood pneumonia.