Context

• Medical oxygen is an essential, life-saving treatment with no alternative.
• Despite its critical role in healthcare, access to medical oxygen remains alarmingly limited, especially in low- and middle-income countries (LMICs).
• Around five billion people globally lack access to safe, quality, and affordable medical oxygen, a glaring public health inequity that demands urgent attention.
• The COVID-19 pandemic exposed and worsened this gap, revealing vulnerabilities in oxygen infrastructure and highlighting the pressing need for long-term, sustainable solutions.

The Scope of the Crisis

• The Lancet Global Health Commission on medical oxygen security reveals that South Asia and East Asia and the Pacific bear the brunt of this crisis, with an oxygen service coverage gap of 78% and 74% respectively.
• These figures underline the massive shortfall in oxygen availability, despite its fundamental role in treating conditions ranging from pneumonia and sepsis to COVID-19 and obstetric emergencies.
• While emergency interventions during the pandemic brought short-term relief, progress has since stalled.
• The World Health Organization (WHO) has emphasised the need for sustained investment and policy commitment to maintain momentum.
• Their 2022 report from the South-East Asia Region stresses that equitable access to oxygen is both a healthcare imperative and a matter of social justice.

Systemic Barriers to Oxygen Access

• Structural Issues
  • A host of structural issues obstruct the integration of medical oxygen into healthcare systems.
  • Equipment shortages are among the most visible problems. Only 54% of hospitals in LMICs are equipped with pulse oximeters, and just 58% have access to medical oxygen.
  • These deficits limit healthcare providers’ ability to diagnose and treat patients effectively, especially during respiratory crises.
• Financial Constraints
  • Financial constraints are another major hurdle. The estimated global cost to bridge the oxygen gap is $6.8 billion, with South Asia alone requiring $2.6 billion.
  • LMICs often struggle to prioritize oxygen infrastructure amid competing healthcare needs, risking the sustainability of improvements made during the COVID-19 emergency response.
• Lack of Skilled Workers
  • The lack of skilled biomedical engineers and technicians further compounds these issues.
  • Even when oxygen plants and concentrators are available, frequent breakdowns due to insufficient maintenance and technical know-how hinder reliable access, particularly in rural and underserved regions.

Strategic Solutions for Long-Term Impact

• National Oxygen Scale-Up Plans
  • National governments must take the lead in developing and implementing comprehensive oxygen scale-up plans.
  • These plans should be aligned with broader health system goals and tailored to the specific needs of each country.
  • Working in partnership with the World Health Organisation (WHO), ministries of health can assess current capacity, map oxygen demand across regions and facilities, and identify infrastructure gaps.
• Robust Monitoring and Accountability Tools
  • To ensure that commitments translate into tangible outcomes, there must be mechanisms to monitor progress and hold stakeholders accountable.
  • The WHO Access to Medical Oxygen Scorecard is one such tool that enables countries to track implementation of their oxygen strategies against key indicators, such as availability, quality assurance, infrastructure functionality, and workforce capacity.
  • Regular reporting, as mandated by the WHO Oxygen Resolution, also ensures transparency and provides opportunities to recalibrate strategies based on evidence.
  • Progress should be reported to the World Health Assembly in 2026, 2028, and 2030, reinforcing global accountability.
• Sustainable Financing Mechanisms
  • One of the major obstacles to long-term impact is the lack of sustainable financing.
  • To address this, countries must:
    • Integrate oxygen infrastructure costs into national health budgets and universal health coverage frameworks.
    • Leverage international development financing, such as Global Fund and World Bank health investments.
    • Develop public-private partnerships to attract industry investment in local manufacturing and maintenance services.
  • Donors and global health institutions must ensure that funding does not decline post-pandemic but is redirected toward building permanent systems.
  • Multi-year financing commitments, tied to performance milestones, can help ensure continuity and long-term impact.
• Workforce Development and Technical Capacity
  • Infrastructure alone is insufficient without trained personnel to operate and maintain oxygen systems.
  • Therefore, building human resource capacity is critical. Countries should:
    • Establish national and regional training programs for biomedical engineers, technicians, and healthcare workers.
    • Develop curricula on oxygen technologies, diagnostics (e.g., pulse oximetry), and maintenance protocols.
    • Facilitate south-south cooperation, where nations with strong capacity (e.g., Nepal, India) support training in neighbouring countries (e.g., Bhutan, Bangladesh).
  • WHO’s example of training collaboration between Nepal and Bhutan illustrates how cross-border partnerships can rapidly enhance technical skills and ensure sustainability. 

The Way Forward: Strengthening the Oxygen Ecosystem

• A coordinated, multi-stakeholder effort is essential to building a resilient global oxygen ecosystem.
• Governments must integrate oxygen access into universal health coverage and emergency preparedness plans.
• Establishing clear regulatory frameworks for quality control, storage, and transportation will safeguard the efficacy and safety of medical oxygen.
• The private sector has a vital role to play in local manufacturing, supply chain optimization, and the development of cost-effective technologies.
• Meanwhile, global health agencies must continue to prioritise oxygen access, providing financial and technical support to scale up delivery systems.
• Academic institutions and researchers should focus on developing affordable, adaptable oxygen solutions suited to the unique challenges of LMICs.
• Digital technologies can also play a transformative role; real-time monitoring, predictive analytics, and smart logistics can streamline oxygen delivery and minimize waste.

Conclusion

• The COVID-19 pandemic spurred the installation of PSA oxygen plants across many countries, but these must now be fully operationalised and maintained.
• Donors who supported these initial efforts should continue to invest, ensuring surplus capacity is distributed to peripheral health facilities through technologies like booster pumps.
• As The Lancet Global Health Commission reminds us, ensuring access to medical oxygen is not only a public health priority, it is a moral obligation.
• Instead of returning to crisis-driven strategies, the global community must seize this opportunity to create a lasting and equitable system where oxygen is treated not as a privilege, but as a basic human right.