Oxygen-as-a-service is saving young lives
Written by Lynne Ruddick, Harry Sharp, Pritika Kasliwal
Oxygen concentrators are capable of supplying continuous medical grade oxygen in low-resource settings. In May 2022, we visited Tanzania where FREO2 is piloting their O2aaS programme to learn how oxygen can be sustainably supplied in rural health clinics.
Background
In 2021, the Oxygen CoLab awarded 3 UK Aid funded oxygen-as-a-service pilot (O2aaS) grants to test innovative business models that support the sustained provision of medical oxygen in low-resource settings. These were awarded to FREO2 in Tanzania, and Sanrai and Philips, both in India. We look forward to sharing the learnings from each of these programmes.
In May 2022, the Oxygen CoLab team travelled to Tanzania at the invitation of FREO2 to learn about their pilot programme’s impact first-hand (read about the background here). We visited the health centres where FREO2’s oxygen concentrators are installed, attended parliament as guests of the Deputy Minister for Health, and met with members of the British High Commission.
In just 6 months, the FREO2 team scaled to 12 under-resourced health centres across the rural northern part of Tanzania. These remote facilities now have access to sustainable, medical grade oxygen despite the many challenges they face securing a continuous supply of oxygen: the high cost of purchasing, transporting and refilling of oxygen cylinders, and in a context of stretched government funding.
We were astounded by the layers of impact FREO2’s pilot programme has had in such a short period of time. The solution integrates product, installation, education and social enterprise, and has already treated 1473 children, trained 77 health workers and employed 11 local staff.
This blog highlights key learnings and outlines the value of O2aaS after 6 months of work.
The problem
Many children in Tanzania die as a result of premature birth asphyxia, a condition where the baby cannot breathe, or pneumonia due to a lack of oxygen. Oxygen provision is difficult and often not prioritised in rural health centres.
Rural health centres struggle with regular power cuts, which typically last 1–12 hours, and rely on oxygen cylinders as their main source of oxygen. These are very expensive to purchase (approx. USD 450–500), refill, and transport over long distances and difficult dirt road terrains.
If there is no local source of oxygen available, the only option is referral to a larger facility often found in the main cities. In the areas we visited this could typically be anywhere from 3–9 hours away. Many babies do not survive these long journeys, else risk suffering brain damage.
For many mothers the death of their newborn is inevitable; oxygen is not available as standard and as a result it is not expected. This has meant that parents may not recognise the need to demand access to oxygen and better treatment.
In addition, health centre budgets are heavily stretched, requiring difficult decisions about where to allocate funds. Oxygen is frequently not prioritised because its value is poorly understood against other treatments.
The impact on people who require oxygen
There is clearly a strong need and demand for oxygen in these rural areas. In Karatu, a government health centre, 10 premature babies had been treated with oxygen, significantly improving their life chances, since the FREO2 oxygen concentrators had been installed in January. This health centre previously had no oxygen provision for prenatal births. These babies would not have survived before FREO2’s pilot. We heard similar stories elsewhere. In Mong’ola, the most rural health facilities we visited, 50 neonatal and paediatric patients had been treated using FREO2 oxygen.
Through word of mouth, news of these successes has been spreading throughout the community. Expectant mothers are choosing to travel from further away to give birth in facilities which have oxygen, giving them the best chance of survival. The increase in patients visiting some facilities has raised concern about the ability to provide care with limited resources.
Demand is clearly increasing across the region. This is the signalling that we have been looking for. We know there is a need for oxygen in these areas due to high infant mortality but so far the exact demand has been unclear. In order to trigger investment into concentrator product development we need to demonstrate sufficient demand to innovators in this space.
Services wishing to provide oxygen are more capable
There is an increased capability in the region where clinicians are more able to provide high quality assessment and oxygen treatment for babies using the correct equipment and knowledge.
As part of the oxygen service, FREO2 provides pulse oximeters and training to clinicians on how to use the equipment upon installation. This training enables them to correctly identify when oxygen is required and how to manage the flow as their patient’s condition changes.
FREO2 also offers to either fix concentrators on site or replace them if a quick fix is not possible. This means that clinicians can focus on the needs of their patients and no longer worry about maintenance and upkeep of the concentrators.
Dr Samuel at the Karatu health centre explained how a guaranteed supply of oxygen has meant they no longer have to make difficult choices about who can access oxygen. Clinicians who have received FRE02 concentrators and training are also supporting each other through a regional whatsapp group to enable peer-learning.
O2aaS is not just a technical solution. It provides vital value-add services which address the needs of clinicians, improving their confidence and capability in providing oxygen therapy.
Communities are benefiting from oxygen services
FREO2 Tanzania has been set up to build capability in the community. In order to maintain a high quality service and operationalise the ‘swap-and-go’ model, FREO2 Tanzania has employed and trained local Tanzanians as engineers.
This contrasts with other oxygen contractor business models, which often just sell equipment with no support for in-country maintenance. Once they are no longer in use they often end up in equipment graveyards. Such a short shelf life does not justify the cost of a regular concentrator at a health centre.
The ‘swap-and-go’ model is a much more sustainable, cheaper and eco-friendly solution. Moreover it strengthens the local economy by creating jobs and resilience in the health system.
This has brought new incomes to Tanzanian families and has improved their quality of life. They have also become proud ambassadors for the work and spread the word about the value of oxygen.
Governments are supporting oxygen policy and funding at the national level
The Government of Tanzania is in support of the FREO2 pilot programme and O2aaS business model. FREO2 were invited to meet the Minister of Health and visit parliament on the day they presented their National Health Budget.
This government-level engagement was made possible through the prenatal advocacy work of the Doris Mollel Foundation and support from the regional government official where FREO2 is operating.
FREO2 has clearly demonstrated the impact that O2aaS can have which complements the Government’s health care policy on neonates. The Minister of Health recognised the value for money that O2aaS provides. The government has committed to support FREO2 to scale to further health centres in the country.
Securing government support is not easy for innovators. The combination of piloting the service and technology concurrently with wider advocacy has accelerated traction at the national level. This an example of how the Oxygen CoLab aims to bring together different actors in the sector to enable a collective response by leveraging each part of the system for accelerated action.
Key learnings
- Context is key: go where people are in order to understand the problem at all levels of the system (patients, health care workers and policy-makers)
- Build in-country capacity: through education and social enterprise. This is vital to ensure reliable and high standard health care provision.
- Do-to-learn: through piloting in 12 locations FRE02 was able to uncover and quantify the unmet demand revealing the true market need post-covid19
- Always look up and out: by collaborating with actors across the sector you can gain visibility and leverage your collective voice to unlock funds and create impact
What’s next
There were many stories that we’d like to share from our trip, learnings from across the wider Oxygen CoLab and our plans for further work. Stay tuned!
All photography by Bony Kazi @iambonykazi_
