World Oxygen Day: Oxygen saves lives - Communities must demand accessibility

Today, October 2, as the world marks World Oxygen Day, we are reminded of a basic truth: oxygen saves lives.

For most people, breathing is something we do without thinking. But inside a hospital, access to medical oxygen can be the difference between life and death.

Think of a mother experiencing complications during childbirth. Think of a newborn struggling to take its first breath, a child battling severe pneumonia, a patient undergoing surgery or a victim of a road crash being rushed to hospital.

In such moments, oxygen is not a luxury. It is essential medicine.

Kenya continues to face a significant need for medical oxygen. Upper respiratory tract infections remain among the leading causes of illness, while pneumonia and other respiratory diseases account for many outpatient visits.

A Kenyan study involving more than 4,000 adults admitted to medical wards found that 24 per cent were hypoxaemic when they arrived at hospital.

For newborns, birth asphyxia, prematurity and sepsis remain major causes of death, and oxygen is critical in managing all three.

An unreliable oxygen supply can have devastating consequences.

In a study of 57 patients receiving oxygen in rural Western Kenya, nearly a third experienced interruptions. Eleven patients died. Those who died experienced longer interruptions, averaging about 28 minutes, compared with approximately 10 minutes among those who survived.

These figures may appear small, but they demonstrate how little room there is for error when a patient depends on oxygen to stay alive.

A paediatric doctor interviewed in a recent African Population and Health Research Center (APHRC) study described the experience as among the most traumatic for a clinician: knowing a patient's life could be saved but being unable to do so because oxygen is unavailable.

Kenya has made progress, particularly since the COVID-19 pandemic brought medical oxygen into sharper focus.

Access has improved in nearly all counties compared with the pre-pandemic period. More than 20,000 cylinders have been distributed to counties, while new pressure swing adsorption plants and liquid oxygen tanks have been installed with support from development partners.

The Ministry of Health has also launched the Kenya Medical Oxygen Roadmap 2025–2030, which seeks to ensure that all Kenyans have access to quality, sustainable and affordable medical oxygen by 2030.

But a roadmap is not oxygen at a patient's bedside.

The gap between the two is where the real work begins.

Kenya's own estimates show the scale of the challenge. The Medical Oxygen Roadmap estimates that the country requires between 62 billion and 64 billion litres of medical oxygen annually, against a production capacity of about 12 billion litres.

That means current production meets only about 19 per cent of the country's estimated need.

And even the oxygen that is available does not reach Kenyans equally.

Medical oxygen is largely available in county referral hospitals and Level 4 facilities and above, yet health centres and dispensaries are where many Kenyans, particularly those in poorer communities, first seek treatment.

National data cited in the Roadmap show that only about one in five Level 2 facilities offering outpatient services has a cylinder and flowmeter or an oxygen concentrator.

When a patient develops hypoxaemia at such a facility, referral is often the only option. For families living far from higher-level hospitals, that journey can take valuable time and may happen without a reliable ambulance.

For women experiencing complications during childbirth and newborns requiring immediate respiratory support, such delays can be fatal.

But the problem is not simply a lack of equipment.

Even where oxygen plants have been installed, some are not operating at full capacity.

The Ministry of Health's Health Sector Report notes that Kenya has about 70 PSA oxygen plants, yet 89 per cent are not operating at optimal capacity.

In Kakamega, equipment worth about Sh100 million reportedly remained unused in boxes while the hospital purchased oxygen from another county at a cost of Sh2.8 million a month.

In Busia, an oxygen plant remained non-functional for nearly two years.

In other facilities, the problems are less dramatic but equally damaging — a transformer cannot provide enough voltage to operate a plant, a spare part is unavailable or a compressor was never supplied.

In one sub-county hospital, a power upgrade costing about Sh10 million is all that stands between the facility and the ability to produce its own oxygen.

That is particularly worrying in a country where only about 54 per cent of health facilities have reliable electricity. In rural areas, the figure is about 50 per cent.

Equipment also needs people to operate and maintain it.

The Ministry of Health estimates that the public sector requires 1,187 medical engineering technologists, yet only 169 were in post. For technicians, there were only 167 against a requirement of 847.

Without trained biomedical engineers, an oxygen plant can quickly become an expensive monument to an intervention that never reached the patient.

Health workers also need adequate training.

The APHRC study found that some newly deployed staff could not reliably identify low oxygen saturation — a dangerous condition that cannot be determined simply by looking at a patient.

Then there are the seemingly small items that determine whether oxygen can actually be delivered to a patient.

Flowmeters, gauges, humidifiers, nasal prongs, pulse oximeters and compatible valves are all essential.

Some facilities reported having only two gauges for six to 10 patients. Others had cylinders that could not be refilled locally because their valves were incompatible with available systems.

Only 43 per cent of facilities assessed had nasal prongs for oxygen delivery, while just 3 per cent had analysers to confirm oxygen purity.

Behind many of these problems is a question that communities are best placed to ask: where is the money for oxygen?

Medical oxygen itself is VAT-exempt, but the cylinders and consumables required to deliver it are taxed. Respondents in a complementary study estimated that taxes account for about 75 per cent of the cost of a medical gas cylinder.

Families also bear the financial burden.

One study found daily oxygen charges ranging from Sh500 to Sh34,000. In the APHRC study, one family leased out land and raised money from relatives to pay for a child's referral after a sub-county hospital could not provide oxygen.

This is not what equitable healthcare should look like.

There is also a coordination problem.

Some hospitals have more than three development partners providing different pieces of oxygen equipment, while a dominant supplier has locked some facilities into systems involving leased cylinders and specialised valves.

The result is a fragmented system in which significant investments do not always translate into a reliable supply at the bedside.

And if we do not properly count the problem, we cannot fix it.

Reporting on oxygen service delivery reached only 22 per cent in the final quarter of 2024, meaning many stock-outs and service interruptions may never reach the people responsible for addressing them.

The Kenya Medical Oxygen Roadmap estimates that about Sh37 billion will be required over six years to address the country's oxygen needs, including approximately Sh32 billion for capital investment in oxygen systems.

It is a significant investment.

But it must be measured against the cost of preventable deaths.

The money must be budgeted, released on time, spent properly and tracked.

This is where communities have a critical role to play.

Families know what it means to arrive at a health facility and be told that an essential medicine, service or commodity is unavailable. Their experiences should inform how healthcare is planned, financed and delivered.

Our advocacy must therefore go beyond asking whether oxygen is available.

We should ask whether it is affordable. Whether it is available when patients need it — including at night and on weekends. Whether it is available at the dispensary or health centre closest to the community.

We should ask whether health facilities have functioning equipment, reliable electricity, trained personnel, spare parts and maintenance plans.

And we should ask our county governments a simple question: where is oxygen in the health budget?

County governments should establish dedicated budget lines for medical oxygen and its maintenance while planning for the eventual end of donor support.

The national government should release development funds on time and consider removing taxes on cylinders and other essential consumables used to deliver medical oxygen.

The Ministry of Health and development partners should coordinate investments, standardise equipment and strengthen the training and deployment of biomedical engineers.

Communities and civil society, meanwhile, must continue asking questions at health facilities, ward meetings and public budget hearings.

Where is our oxygen?

That question matters because oxygen should not depend on which hospital a patient can reach or whether a family can raise thousands of shillings to pay for it.

As part of the EAPOA CSO Coalition and as a Community Advisory Member for medical oxygen access, convened at PATH, I believe communities must remain at the centre of this conversation.

Medical oxygen is not a privilege. It is essential healthcare.

When communities demand it, ask the hard questions and hold governments and health authorities accountable, access to quality, affordable and reliable medical oxygen can become a reality for every Kenyan who needs it.