Low blood oxygen—known as hypoxemia—is a life-threatening complication of many illnesses, including pneumonia, sepsis, and malaria. No matter the underlying cause, hypoxemia increases the risk of dying seven-fold. It contributes to over a million deaths in low- and middle-income countries every year—many of which could be prevented with medical oxygen.
But many hospitals in these regions are not properly equipped to diagnose hypoxemia or deliver oxygen to patients. Over 90 percent of facilities do not have pulse oximeters, the simple handheld devices used to measure blood oxygen levels. Fewer than half of these facilities have a reliable oxygen supply. Because of this, only 20 percent of hypoxemic patients are diagnosed and less than half of these receive the oxygen therapy they need.
The worst pandemic respiratory illness in a century has brought unparalleled attention to the value of medical oxygen—and highlighted the life-threatening inequities in access facing millions of patients.
The Clinton Health Access Initiative (CHAI) and the Murdoch Children's Research Institute (MCRI) work directly with governments and health administrators to make pulse oximeters and high-quality medical oxygen available in hospitals. They also work to put in place policies and practices that ensure all patients are screened for hypoxemia, oxygen is available in all hospital wards, oxygen systems are maintained, and health facilities without oxygen can rapidly transport patients to a hospital to receive proper care.
The project will focus on five countries—Ethiopia, India, Kenya, Nigeria, and Uganda—facing some of the greatest needs for access to oxygen therapy. These countries account for nearly one-third of estimated hypoxemia cases globally.
CHAI and MCRI have achieved dramatic results in their pilot projects. After working with 74 Nigerian and Ethiopian hospitals, the proportion of hypoxemic children receiving oxygen doubled. In Southwest Nigeria, access to pulse oximetry and oxygen therapy cut the risk of death in half for children admitted to hospital with pneumonia.
As COVID-19 wakes the world up to a crisis our partner governments know all too well, we have a once-in-a-generation opportunity to demonstrate that equitable access to oxygen is as attainable as it is necessary.
The team made the following changes to its proposal since it was first submitted in August of 2019, informed by additional research, project development, and authentic engagement with communities of interest—defined as beneficiaries, those who might suffer harm, other funders, and competitors.
Medical oxygen is arguably the most important treatment available for COVID-19—which has increased the global hypoxemia burden and more than doubled the volume of oxygen needed to meet clinical demand. In early 2020, CHAI and MCRI quickly pivoted to support global actors and country governments to address the additional strain on oxygen systems created by the pandemic—and have pushed to leverage emergency response efforts to create a stronger foundation for sustainable, long-term improvements. Changes in our approach in response to this new landscape include:
- Expanding the scope of public-private partnerships for oxygen supply to include maintenance and operational services to ensure equipment provided to meet short-term surges in oxygen need can be absorbed into national supply systems after pandemic response funding subsides.
- Increasing engagements with Development Finance Institutions for oxygen systems infrastructure investments to include concessional debt, regional market and volume guarantees, and capital lease financing.
- Supporting country governments to consolidate recurrent financing for oxygen systems by, in part, transitioning respiratory care components of free COVID-19 treatment programs into national health insurance and other sustainable financing programs.
About Our Team
The CHAI and MCRI teams are driven by a commitment to healthcare equity, striving to improve outcomes for the most vulnerable patients — especially children — by tackling seemingly-intractable neglected global health problems. CHAI brings established country teams and strong relationships with governments, distributors, and regulators, while MCRI brings expertise in field research, child health policy, clinical training, and global health advocacy.
Dr. Mphu Ramatlapeng, Executive Vice President for Implementation, Clinton Health Access Initiative
Dr. Hamish Graham, Senior Research Fellow, Murdoch Children’s Research Institute
Zachary Katz, Vice President–Essential Medicines, Clinton Health Access Initiative
Audrey Battu, Director–Essential Medicines, Clinton Health Access Initiative
Felix Lam, Associate Director–Essential Medicines, Clinton Health Access Initiative
Martha Gartley, Senior Technical Adviser–Essential Medicines, Clinton Health Access Initiative
Jason Houdek, Senior Technical Adviser–Essential Medicines, Clinton Health Access Initiative
Rosemary Kihoto, Program Director–Maternal, Neonatal, and Child Health, Clinton Health Access Initiative (Kenya)
Habtamu Seyoum, Senior Program Manager–Child Survival, Clinton Health Access Initiative (Ethiopia)
Chizoba Fashanu, Deputy Program Director–Malaria and Essential Medicines, Clinton Health Access Initiative (Nigeria)
Deepak Dabas, Associate Director–Essential Medicines, Clinton Health Access Initiative (India)
Yewande Kamuntu, Program Manager–Hypoxemia Diagnosis and Treatment, Clinton Health Access Initiative (Uganda)
Jason Houdek, Senior Technical Adviser, Clinton Health Access Initiative, (312) 513-9283
"Oxygen is an Essential Medicine: A Call for International Action"
International Union Against Tuberculosis and Lung Disease
"Improved oxygen systems at hospitals in three Nigerian states: An implementation research study"
Chizoba Fashanu, et al, Pediatric Pulmonology
"Oxygen therapy for children: A key tool in reducing deaths from pneumonia"
Hamish Graham, et al, Pediatric Pulmonology
"Covid-19 has turned the spotlight on the uneven provision of oxygen—a stark health inequity"
Kevin Watkins and Adamu Isah, et al, Save the Children via the British Medical Journal
"Health systems neglected by COVID-19 donors"
Ann Danaiya Usher, The Lancet