Context

Medical oxygen is a life-saving treatment that cannot be replaced, yet approximately five billion people lack access to safe, inexpensive oxygen. The COVID-19 pandemic exposed global deficiencies, necessitating a long-term, fair solution that goes beyond crisis-driven initiatives.

What is Global Oxygen Access?

Global Oxygen Access refers to the equitable and reliable availability of medical oxygen for patients in need, especially in low- and middle-income countries (LMICs). Medical oxygen is a lifesaving treatment used in various medical conditions such as pneumonia, COVID-19, neonatal respiratory distress, trauma, and surgical care. Despite its essential nature, access to medical oxygen remains severely limited in many parts of the world.

Global Oxygen Access Gap

• Severe Coverage Gaps: According to the Lancet Global Health Commission, South Asia and East Asia-Pacific have the largest unmet oxygen demand, with 78% and 74%, respectively.
• Pandemic Lessons: The COVID-19 pandemic highlighted serious oxygen infrastructure flaws, particularly in low- and middle-income countries (LMICs).
• Slow Post-COVID Progress: Despite emergency initiatives and the WHO Oxygen Resolution, long-term progress has slowed.

Why is oxygen demand high in South and East Asia?

• High Population Density: These locations have some of the world's most densely inhabited countries, resulting in a higher disease burden and medical oxygen demand. For example, India and China account for more than one-third of the world's population, putting an additional burden on healthcare facilities during health emergencies like COVID-19.
• High incidence of respiratory infections, such as pneumonia, TB, and chronic obstructive pulmonary disease (COPD), increase oxygen requirements. For example, the World Health Organization reports that over 120,000 children die from pneumonia in India each year, with many requiring oxygen therapy.
• Inadequate Rural Healthcare Infrastructure: Many remote and underserved locations do not have appropriate oxygen production, storage, or delivery infrastructure. 

Challenges Hindering Global Access to Medical Oxygen

• Infrastructure Deficit:
  
  
• Many hospitals in Low- and Middle-Income Countries (LMICs) lack essential medical oxygen equipment.
  
  
• Only 54% of LMIC hospitals have pulse oximeters, and 58% have access to medical oxygen.
  
  
• This deficit results in delayed diagnosis, inadequate treatment, and preventable deaths, particularly during respiratory outbreaks.
  
  
• High Financial Burden:
  
  
• Bridging the global oxygen gap requires an estimated $6.8 billion, with $2.6 billion needed in South Asia alone.
  
  
• LMICs struggle with limited healthcare budgets and competing priorities, making it difficult to invest sustainably in oxygen infrastructure.
  
  
• Shortage of Trained Technicians:
  
  
• Lack of biomedical engineers and technicians affects maintenance and operation of oxygen plants.
  
  
• In rural areas, oxygen concentrators are often unused due to absence of skilled personnel, leading to system breakdowns and frequent failures.
  
  
• Power Supply Issues:
  
  
• Unreliable electricity supply, especially in remote and rural areas, disrupts oxygen production and storage.
  
  
• Countries like Nigeria and Ethiopia have adopted solar-powered oxygen systems to mitigate power disruptions.
  
  
• Weak Policy and Regulatory Frameworks:
  
  
• Absence of national oxygen guidelines and standardised protocols leads to irregular supply chains and compromised quality.
  
  
• A 2021 assessment in Bangladesh by PATH and USAID revealed widespread inefficiencies in oxygen distribution, especially in public rural hospitals.
  
  
• Rural Disparities:
  
  
• Rural healthcare systems face disproportionate challenges due to lack of infrastructure, skilled workforce, and alternative energy sources.
  
  
• Sustainability Challenges:
  
  
• Investments made during COVID-19 are at risk due to lack of long-term funding models and external support.

What has the Indian government done in Southeast Asia? Oxygen Supply to Bangladesh: In July 2021, India sent 200 metric tonnes of liquid medical oxygen (LMO) to Bangladesh via the 'Oxygen Express' rail service. This was the first overseas deployment of the Oxygen Express, demonstrating India's commitment to supporting neighboring countries in disaster.Medical Aid for Vietnam: In August 2021, the Indian Navy's INS Airavat delivered 100 metric tonnes of LMO and 300 oxygen concentrators to Ho Chi Minh City in Vietnam.

Towards Sustainable Medical Oxygen Solutions

• Technological Innovations:
  
  
• Deployment of portable concentrators, solar-powered systems, booster pumps, and community hubs can enhance access in underserved regions.
  
  
• Solarisation is particularly vital in South-East Asia to ensure continuity during power outages.
  
  
• Global Best Practices:
  
  
• Ethiopia and Nigeria have implemented cost-effective, solar-powered systems in remote areas, serving as replicable models.
  
  
• Need for Local Manufacturing:
  
  
• Reducing import dependence is crucial; local production ensures timely and cost-effective last-mile delivery of oxygen systems.
  
  
• Public-Private Partnerships:
  
  
• Collaboration between government and private sector is key to building robust supply chains and scalable oxygen models.
  
  

Strengthening the Oxygen Ecosystem

• Policy Integration:
  
  
• Oxygen should be integrated into universal health coverage and emergency preparedness frameworks to ensure systemic support.
  
  
• Regulatory Measures:
  
  
• Implementation of strict regulations for safety, quality, and standardised distribution is essential.
  
  
• Data-Driven Governance:
  
  
• Use of the WHO Access to Medical Oxygen Scorecard for policy planning, progress tracking, and accountability.
  
  
• Digital Infrastructure:
  
  
• Investment in real-time monitoring, predictive analytics, and supply chain optimisation can significantly improve oxygen logistics.
  
  

Key Stakeholders and Their Roles

• Governments: Responsible for strategy, policy formulation, and resource allocation.
  
  
• Private Sector: Must focus on cost-effective technologies, local production, and context-specific solutions.
  
  
• Global Health Agencies: Ensure technical support, sustained funding, and integrate oxygen in global health financing priorities.
  
  
• Academia & Researchers: Innovate low-cost, adaptable oxygen technologies suitable for Low- and Middle-Income Countries (LMICs).
  
  

Strategic Long-Term Solutions

• National Oxygen Scale-Up Plans:
  
  
• Led by national governments, aligned with health system goals, and informed by WHO collaboration for capacity mapping and gap assessment.
  
  
• Monitoring & Accountability:
  
  
• Use of the WHO Scorecard and reporting to World Health Assembly in 2026, 2028, and 2030 ensures transparency and iterative improvement.
  
  
• Sustainable Financing:
  
  
• Integrate costs into national health budgets, tap into international financing (e.g., Global Fund, World Bank), and foster public-private partnerships.
  
  
• Workforce Development:
  
  
• Set up training programs for biomedical engineers, technicians, and healthcare workers.
  
  
• Promote south-south cooperation, such as Nepal-Bhutan technical training partnerships.
  

Practice Question Q. Suggest a comprehensive policy framework integrating technological innovation, public-private partnerships, and inter-state cooperation to ensure equitable healthcare delivery.