Providing Oxygen in Low-Resource Settings: Challenges and Solutions
The Importance of Oxygen Support for Treatment of COVID-19
Oxygen support remains essential for the treatment of acute and severe manifestations of COVID-19. However, in low-resource settings like Nepal, medical oxygen availability was inadequate even before the pandemic. The mid-2021 wave of COVID-19 transmission starkly exposed the supply-demand imbalance of medical oxygen across the country, with more complex cases being referred to hospitals with better resources but which were themselves overrun.
Challenges to Providing Oxygen in Resource-Poor Health Facilities
Providing adequate oxygen supply in resource-poor health facilities faces numerous challenges. These challenges include complex geographies, sparse infrastructure, and inadequate electricity supply on a logistical level. On a provider level, the shortage of trained staff and equipment necessary to administer and monitor medical oxygen creates additional pressures.
Unequal Distribution of Oxygen between Urban and Rural Areas
Oxygen is available in limited quantities in Nepal, and the unequal distribution of available oxygen between urban and rural areas has led to increased unmet needs for oxygen by patients in rural areas. Health posts, which account for 78.3% of total public healthcare facilities, are operated by paramedical personnel without doctors, whereas patients with complex conditions are directed to primary healthcare centers, which have doctors but minimal other resources. As a result, patients who require more advanced care are routinely sent to tertiary care facilities, which are mostly concentrated in metropolitan areas, leaving patients in rural regions severely deprived of quality healthcare services in terms of skilled staffing and infrastructure.
Inadequate Health-Care Infrastructure
For its population of 29 million, Nepal has only 1,127 intensive care unit beds and 1,555 high-dependency unit beds. Across the entire country, only 453 ventilators are available. These infrastructures are mostly concentrated in metropolitan areas. Hence, referrals from rural areas for oxygen support and complicated cases are very frequent. In the most deprived rural areas, transporting the required oxygen is another major issue. As a result, people are often bound to carry oxygen cylinders by hand and walk long distances from cities to their local health-care facilities on foot. Road ambulances and helicopters (if available) for transporting oxygen are prohibitively costly and often necessitate families to take out loans to cover costs.
Sustainable Approaches to Provisioning Oxygen to Those in Greatest Need
Recognizing the end of the pandemic is still a long way off in many parts of the world, it is imperative that sustainable approaches to provisioning oxygen to those in greatest need are considered at a policy level. Efforts should focus on looking at the issues from the health systems approach. Looking through the WHO health system building blocks framework, the oxygen demand-supply crisis needs attention in four of the six areas as described next. These areas include:
Medical Products
A sustainable solution to generate oxygen at the point of use is by pressure swing adsorption oxygen plants. These can be transported and installed onsite in hospitals in the form of systems, which are quite compact. Although requiring a large, upfront operational investment, pressure swing adsorption plants are a sustainable local solution that can be achieved by developing partnerships among local governments and the private sector.
Health Information
A health information system needs to be strengthened to monitor oxygen requirements and availability effectively to ensure timely external response when oxygen demands increase.
Health-Care Financing
Government budgeting systems need to focus on effective, sustainable investments in systems that can enable oxygen production at local levels in hospitals, and at manufacturing plants at provincial levels.
Leadership/Governance
Leadership is essential to ensure adequate political commitment at the national and local levels for policy formulation/implementation, including budgeting and logistics management of oxygen as an essential medical supply. Mobilization of resources at local levels are also required, as is facilitation of the formulation of policies.
Sustainable Solutions
Efforts to provide sustainable solutions for oxygen supply in resource-poor health facilities should focus on standardizing the rates for ambulances and helicopter airlifts. The sourcing and development of transportable and sustainable oxygen equipment such as mobile oxygen concentrators should be prioritized along with an alternate means of providing an uninterruptible supply of electricity, such as solar-powered oxygen delivery systems. Focusing on the mobility and agility of oxygen equipment is another area for investigation—considering battery-powered oxygen concentrators, lightweight oxygen cylinders, and efficient delivery devices such as double-trunk masks.
Conclusion
The COVID-19 pandemic has cruelly exposed the vulnerabilities of Nepal's health system, of which the supply of oxygen is but one very important and concrete example. A thorough evaluation of existing supply management systems using frameworks such as the WHO health system building blocks may help to develop effective and sustainable oxygen delivery chains, encompassing both physical material and provider-side technical capability. We are facing both a challenge and an opportunity to learn important lessons from the COVID-19 pandemic and its impact on hospital oxygen management in Nepal.
Originally Post From https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8991354/
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Providing Oxygen in Low-Resource Settings: Challenges and Solutions for COVID-19 Treatment
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