Nigeria's Perspective: An Adaptive, Collaborative Approach to Improving Oxygen Access
February 18, 2021 | Perspectives | 100&Change

Chizoba Fashanu, Deputy Program Director, Malaria & Essential Medicines–Nigeria shares how listening to hospital workers helps identify interventions to better deliver treatment to patients who need it.


Five-year-old Usman had been sick with pneumonia for days. His mother, Binta, took him to several health centers. None could help. He began to struggle to breathe and was brought to a general hospital.

But the facility lacked pulse oximeters—simple instruments that indicate if a patient needs oxygen. Even if Usman could have been diagnosed, oxygen at the hospital was limited. His condition worsened. He was referred to another hospital miles away.

It was too late. Usman died before he arrived.

Stories like Usman’s are the reason we at the Clinton Health Access Initiative started working on oxygen accessibility in Nigeria five years ago. We heard these stories repeatedly from clinicians treating patients in public health facilities. So, we began working with our Ministry of Health colleagues to understand what prevents pneumonia patients from receiving the care they need. We interviewed 70-plus health workers and biomedical technicians in more than 24 facilities to better understand challenges they faced every day.

At the same time, we helped the government develop and scale-up its first national medical oxygen plan in 2017. We spent a year talking to policymakers, academic experts, professional associations, and civil society organizations. We learned an enormous amount, which we used to create our strategy.

Even where oxygen supply systems remained unreliable, clinicians with the right tools were better able to prioritize scarce resources and improve patient outcomes.

We wanted to learn more. To test our strategy, we launched a pilot program with ministries of health in three states that assessed the best ways for hospitals to increase patient access to oxygen. Working closely with hospital managers and clinicians, we established quality improvement teams to identify and solve problems facing the health facilities.

Over three years, these facilities increased the proportion of children receiving oxygen from 19 percent to 71 percent. We also saw firsthand the power of simple diagnostic tools, like pulse oximeters, in the hands of trained clinicians. Even where oxygen supply systems remained unreliable, clinicians with the right tools were better able to prioritize scarce resources and improve patient outcomes. Those diagnostic tools have become a central component of our approach.

We also learned that biomedical engineers often felt isolated and had limited opportunities to update their skills, which put significant equipment investments at risk. We worked with Engineering World Health to co-design and carry out training for engineers and established a community of practice of more than 70 engineers who provide mutual support and can help each other troubleshoot technical issues. The support for biomedical engineers has also become a central component of our approach.



We see the results of these strategies, gleaned from community engagement, everywhere.

Like in the smile of Hajia, when she describes how her two-year-old son, Ahmed, received life-saving oxygen during a hospital stay for severe pneumonia. He returned home healthy and happy because his hospital, one of 30 in the pilot program to increase patient oxygen access, was able to treat his condition. Hajia knows how lucky Ahmed and she are.

We smile, too. Ahmed’s hospital, the administrators who keep it running, biomedical engineers who maintain its equipment, health workers who treated him—and countless patients like Ahmed—have taught us how to make sure that, one day, children like him will not be lucky to get oxygen. His treatment will be routine.


View Clinton Health Access Initiative & Murdoch Children’s Research Institute profile ›

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