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Review
. 2020 Dec;10(2):020425.
doi: 10.7189/jogh.10.020425.

The development and implementation of an oxygen treatment solution for health facilities in low and middle-income countries

Stephen Rc Howie  1   2 , Bernard E Ebruke  1 , Mireia Gil  3 , Beverly Bradley  4 , Ebrima Nyassi  1 , Timothy Edmonds  5   6 , Sainimere Boladuadua  6 , Senimili Rasili  7 , Eric Rafai  7 , Grant Mackenzie  8   9   10 , Yu Ling Cheng  4 , David Peel  11 , Joan Vives-Tomas  1 , Syed Ma Zaman  1   12
Affiliations
Review

The development and implementation of an oxygen treatment solution for health facilities in low and middle-income countries

Stephen Rc Howie et al. J Glob Health. 2020 Dec.

Abstract

Background: Oxygen reduces mortality from severe pneumonia and is a vital part of case management, but achieving reliable access to oxygen is challenging in low and middle-income country (LMIC) settings. We developed and field tested two oxygen supply solutions suitable for the realities of LMIC health facilities.

Methods: A Health Needs Assessment identified a technology gap preventing reliable oxygen supplies in Gambian hospitals. We used simultaneous engineering to develop two solutions: a Mains-Power Storage (Mains-PS) system consisting of an oxygen concentrator and batteries connected to mains power, and a Solar-Power Storage (Solar-PS) system (with batteries charged by photovoltaic panels) and evaluated them in health facilities in The Gambia and Fiji to assess reliability, usability and costs.

Results: The Mains-PS system delivered the specified ≥85% (±3%) oxygen concentration in 100% of 1-2 weekly measurements over 12 months, which was available to 100% of hypoxaemic patients, and 100% of users rated ease-of-use as at least 'good' (90% very good or excellent). The Solar-PS system delivered ≥85% ± 3%) oxygen concentration in 100% of 1-2 weekly measurements, was available to 100% of patients needing oxygen, and 100% of users rated ease-of-use at least very good.Costs for the systems (in US dollars) were: PS$9519, Solar-PS standard version $20 718. The of oxygen for a standardised 30-bed health facility using 1.7 million litres of oxygen per year was: for cylinders 3.2 cents (c)/L in The Gambia and 6.8 c/L in Fiji, for the PS system 1.2 c/L in both countries, and for the Solar-PS system 1.5 c/L in both countries.

Conclusions: The oxygen systems developed and tested delivered high-quality, reliable, cost-efficient oxygen in LMIC contexts, and were easy to operate. Reliable oxygen supplies are achievable in LMIC health facilities like those in The Gambia and Fiji.

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Conflict of interest statement

Conflicts of interest: Stephen Howie and Eric Rafai have received funding from the Medical Research Council and CureKids New Zealand. The authors completed the ICMJE Unified Competing Interest form (available upon request from the corresponding author), and declare no further conflicts of interest.

Figures

Figure 1
Figure 1
PS system diagram (Panel A) and in situ Basse Health Centre (Panel B and Panel C). Panel A: PS system diagram Basse Health Centre. Panel B: PS system oxygen concentrator connected to 5-outlet SureFlow (Chart Inc) unit. Panel C: PS system electronic control board and battery storage.
Figure 2
Figure 2
Solar-PS systems in the field. Panel A: Standard Solar-PS systems in situ in AFPRC Hospital, Farafenni, The Gambia. Panel B: Trailer Solar-PS system installed at Soma Health Centre, Soma, The Gambia.*Wheels were subsequently removed and fence erected to deter theft. Panel C: Trailer Solar-PS system supplying oxygen to a child in Soma Health Centre, Soma, The Gambia. *Photograph used with permission of caregiver.
Figure 3
Figure 3
Daily hours of usage of Solar PS oxygen system at Farafenni Hospital during formal 12-month monitoring (December 2015 to November 2016).
See this image and copyright information in PMC

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