Making Concentrators Fit for Purpose in Low Resource Settings — How Drive DeVilbiss x Sanrai Tested the Usability of the new PulmO2 Oxygen Concentrator

Mwaniki Nyaga
Better Futures CoLab
8 min readApr 15, 2024

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Amidst the chaos of the Covid-19 pandemic, a crucial issue came to light: oxygen concentrators built for well-resourced healthcare systems were being repurposed in vastly under-resourced environments worldwide. In such conditions, these machines struggled to withstand heat, humidity, and power outages, and were difficult for medical professionals to use, especially when working in high pressure environments where a sudden need to administer medical oxygen to treat patients with conditions like pneumonia and hypoxemia are common.

To address this, as the Foreign, Commonwealth & Development Office (FCDO) funded Oxygen CoLab, we supported the efforts towards the creation of UNICEFs Target Product Profile (TPP), a benchmark for improved concentrators to meet, that ensures these devices are better suited for low-resource settings. We then launched two grants in 2023 to fast-track the development of oxygen concentrators to meet this TPP.

By ensuring more oxygen equipment is fit for purpose, we can take a significant step towards closing the oxygen equity gap.

Two innovators we’ve been backing, the partnership between Drive DeVilbiss x Sanrai and Kröber Medizintechnik, have taken up the challenge, each working on a concentrator tailored to low-resource settings in both its technical design and usability. With the support of UK International Development they have been able to bring their innovative products to market sooner, as well as help others through sharing their valuable lessons learned along the way.

This blog marks the beginning of a two-part series delving into the work of these two product innovators, starting with the partnership between Drive DeVilbiss x Sanrai, who have taken a significant step this year by conducting extensive user testing of their product, the PulmO2 10L Oxygen Concentrator, in low resourced health facilities in Ghana and Malawi. This approach highlights the importance of testing usability in the actual environment where the product will be used, rather than in a controlled laboratory setting.

“Our goal with usability testing was to create a product that fits the environment it’s used in. Most concentrators are made with the US or European homecare context in mind, so we had to reimagine how it works for clinicians and technicians in places with fewer resources. This isn’t just about making a product to sell — it’s about putting people first and making healthcare better for everyone, no matter where they live.”

- Amarpreet Rai, Managing Director Sanrai International

By sharing the journey of Drive DeVilbiss x Sanrai, we hope to offer practical insights and inspire aspiring innovators working on solutions for low-resource settings. Here it is in Amarpreet’s words.

The usability testing journey — partnerships, procedure, and product use.

In order to mirror real-world usage scenarios, we (Drive DeVilbiss x Sanrai) issued an open call seeking partnerships with organisations within low resource settings that would assist in testing their product prototype with healthcare workers. NEST 360 in Malawi and three academic hospitals in Ghana were chosen to be these initial partners. NEST 360’s experience and commitment to engaging with manufacturers early on to ensure products are tailored to local needs made them a natural fit. In Ghana, the three hospitals eagerly embraced the opportunity to provide feedback and input on the usability of the new devices. They were excited about the prospect of bringing something innovative to their country and saw value in being involved in the early stages of its development.

To gather the most relevant information, we created questionnaires and conducted interviews that were open-ended — we led with questions that could not be answered with a simple ‘yes’ or ‘no’, and that instead required healthcare professionals to elaborate on their points. These questionnaires also required users to perform necessary activities, so we could see how the usability improved by action, not just by opinion. Two separate questionnaires were designed, one for clinicians and one for biomedical technicians that allowed us to gather their feedback on the following topics:

⚙️ preparing the device for use,
⏯️ starting and stopping oxygen therapy,
❌ turning the device off,
🔄 repositioning or moving the concentrator,
🧼 cleaning and disinfecting,
🔧 maintenance, troubleshooting and repair (with a focus on biomedical technicians),
♻️ storage and disposal of the device and accessories,
⚠️ dangers and warnings in different environments,
🚥 control panel indicators.

User testing of the PulmO2 concentrators by biomedical engineers in Ghana

Clinicians and technicians across both Ghana and Malawi played a central role in providing feedback and input, particularly on the user interface requirements for the device. The focus of the testing was to observe individuals effectively operating the machine and following maintenance procedures. Each test participant was allocated approximately one hour to go through the various steps, offer open-ended feedback, and explore the device.

This was our first time conducting usability testing in low-resource contexts. We learned a lot about our product and how to successfully run this process, which we hope others doing similar work will take note of.

Key insights — building relationships, staying grounded and harmonising logistics.

  • Build relationships with enthusiastic teams that share your vision.

Seeking partnerships proved invaluable, as enthusiastic teams aligned with our mission to deliver fit-for-purpose products to the world eagerly stepped up to contribute. The enthusiasm and commitment witnessed through NEST 360 in Malawi and the three academic hospitals in Ghana, breathed life into the testing process — highlighting the importance of collaborative efforts in driving innovation.

  • Stay grounded in reality, balancing optimism with pragmatism.

We faced the challenge of obtaining both quality and quantity in bustling, high-paced settings. In hospitals, where clinicians and biomedical technicians are already overworked and juggling multiple responsibilities, coordinating everyone for testing was no easy task. Despite these challenges, we received over 40 responses, highlighting the dedication of our test participants and the importance of perseverance. This experience underscored the need for a balanced approach, blending optimism with a pragmatic understanding of the obstacles we may encounter in the field.

  • Use past experiences and communicate effectively while tackling logistics and coordination challenges.

Understanding the nuances of each country’s import process was crucial to swiftly address issues such as shipments under clearance. Our experience, as Drive DeVilbiss x Sanrai, in shipping worldwide for a cumulative 135 years provided the team with valuable insights into navigating challenges, ensuring that the test products reached their destination and were exported out of the country safely, while meeting regulatory requirements. Furthermore, coordinating logistics and feedback across multiple complex countries demanded clear communication and the application of well-established ways of working.

Unboxed units waiting for initial inspection to evaluate packaging and shipping impact in
Malawi

Real-world discovery — simplicity and surprise.

Our usability testing revealed that users found our oxygen concentrator prototype more user-friendly compared to previous generations. Participants stressed the importance of ease of use and clear instructions, especially in settings with high staff turnover, as it reduces the need for extensive training. They appreciated the simplicity of our device’s control panel, stickers, and labeling, which previous CoLab funded work had shown to be challenging in other designs. Clear interface instructions reduce training needs, allowing healthcare professionals to focus on quality care delivery, ultimately improving patient outcomes and streamlining operations.

Biomedical users in Ghana setting up the device

“I also like the aspect of the control panel. It’s very good, will guide users easily on what to do, know if the device is not working, and when to call for maintenance.”

- Clinical User Feedback, Malawi

Furthermore, a surprising discovery emerged during our usability testing — the unexpected importance of locking caster wheels in use. While it may seem like a minor detail, the role of locking these wheels became a breakthrough, providing essential manoeuvrability and ease of use that were only fully appreciated once the device was deployed in-context. Despite having acknowledged the likelihood of uneven floors in these environments during the product development phase, the significance of this factor became strikingly apparent during testing. Feedback emphasised the necessity of locking the wheels to the casters to prevent the device from rolling away — a detail that had been overlooked in our initial design discussions.

It just goes to show that sometimes, even the most apparent aspects can go unnoticed until they’re tested in their delivery context, underlining the importance in investing in this step of the design process. I hope that in sharing these learnings, we encourage other innovators to deliver on the potential of products designed for low-resource settings by testing them in the context in which they will be used.

The Oxygen CoLab final takeaway: usability testing in low-resource settings is essential, not preferable.

As Amarpreet has demonstrated through the work of the Drive DeVilbiss x Sanrai partnership, in the world of medical innovation, every minor advancement can result in lives saved. As our understanding of usability testing in low resource settings deepens, so does the potential to improve healthcare in resource-limited environments. It’s not just about the product’s robustness; it’s about ensuring that every interface, every interaction, is intuitive and seamless. Because when a clinician hesitates due to complexity, a patient in need may miss out on life-saving oxygen.

“The concept of adding value in low resource settings is not new, but its practicality and market prioritisation have long been debated. However, our foray into usability testing revealed a hidden gem: it not only enhances product development but also serves as a marketing tool. By listening to healthcare professionals working in these difficult environments, we improve our products and also build trust and loyalty with their teams.”

– Oliver Niemann, Managing Director Drive DeVilbiss International

Too often products have been implemented in low-resource-settings without ever having had any tailoring for that context. By embracing user feedback, and prioritising usability, we can truly make a difference. As a result, we are instituting a requirement for all applicants in our next phase of CoLab Innovation Funding to undertake thorough user testing and engagement within these settings.

Imagine a future where all health facilities, no matter their context, are equipped with equipment specifically designed for their environments and the unique challenges they face, enabling healthcare providers to concentrate on their core mission: saving lives.

Be sure to read our second blog in this two part series — a deep dive into what Kröber Medizintechnik learnt about the process of developing their oxygen concentrator for use in low-resource settings.

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This project is funded with UK International Development funding from the UK government.

To stay up to date with our latest news, be sure to follow us on LinkedIn.

You can also get in touch directly by emailing oxygen@makingbetterfutures.org.

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Mwaniki Nyaga
Better Futures CoLab

Amplifying learning, stories and evidence on the Oxygen CoLab as we experiment with increasing access to medical oxygen in low resource settings.