Consider a hospital and consider the patients. A child at the facility is suffering with pneumonia, while an elderly man has an exacerbation of chronic obstructed lung disease after his hernia operation. A woman struggles with acute bronchitis on top of a baseline lung disease, and a teenager arrives at the emergency department with abdominal wounds. What do all of these patients have in common? They are all going to need oxygen, because oxygen is an essential and lifesaving medicine.
But what happens when it’s not available?
PATH, an international health organisation driving transformative innovation to save lives, is working with global partners to increase access to oxygen therapy for newborns, children and pregnant women through normative policy change. As part of this effort, PATH submitted an application to the 21st World Health Organization (WHO) Expert Committee on the Selection and Use of Essential Medicines to include an additional listing for oxygen for the management of hypoxemia on the WHO Model List of Essential Medicines (EML) for adults and children, which serves as a guide for essential medicines lists developed by countries and institutions.
“Oxygen is one of the most basic treatments a health facility can offer, yet it is often not available to everyone fighting for breath. Health facilities in low-resource settings, particularly primary care facilities, may lack the appropriate technology, utilities, or health care workers to provide oxygen therapy. Oxygen gives life, and can save lives, especially for those most vulnerable: newborns, children, and pregnant women,” explained Bonnie Keith, Senior Policy and Program Officer at PATH.
“Despite oxygen being an indispensable medicine, health systems often fail to ensure it is available, affordable and accessible. Roughly half of health facilities in low and middle income countries, including many hospitals, lack access to reliable supplies of oxygen gas, as well as functional pulse oximeters—critical technology for diagnosing hypoxemia and monitoring oxygen treatment.”
“From an anaesthesiologist’s perspective the problem is even more challenging,” explained Professor Adrian Gelb, WFSA Secretary.
“Patients who have sustained trauma or have painful diseases or injuries of the chest or abdomen frequently need more oxygen than is in the air, if not in the emergency department, then in the operating room, but also post-operatively in Post Anaesthetic Care Unit (PACU) and on the ward. It’s really about continuity of care, and for anyone with acute lung disease, even if they’re not going to the operating room, there needs to be access to oxygen around the hospital. We need to remember that anaesthesiologists are also involved in intensive care, and looking after patients in the PACU, and we need to give them the tools to work as safely and effectively as possible,” he added.
Resource-poor hospitals vary a little on whether they have an ICU or whether they use their PACU as their high dependency unit. However all facilities need to have somewhere they can provide oxygen and it cannot be in the emergency department alone, it needs to be in other locations around the hospital.
It is for this reason that the WFSA offered it’s support to PATH’s initiative and submitted a supporting letter along with the PATH application, with the clear implication that oxygen needs to be made more widely available in hospitals, but also in different hospital departments.
Systematic issues, such as inadequate maintenance, insufficient provider training, and a lack of infrastructure, contribute to access limitations for oxygen. While these issues require investment into country health systems, policies and guidelines that support oxygen access make it easier for Ministries of Health and governments to address these challenges.
“In theory, and I think in practice, governments in many low and middle income countries do actually look at the Essential Medicines List and determine what they should have. The concept of the EML is that it’s an inventory for Ministries of Health to use, and for hospitals to use, to guide the minimum standards that they need,” Professor Gelb explained. “So the inclusion of oxygen in the EML will have a real practical impact”.
"It is important because currently decision-makers are in a position where they can say that 'oxygen is only for the operating room and we’ve put a couple of cylinders of oxygen in there.' However, the intent of this change is to make oxygen more ubiquitous. It should be in the emergency department, ICUs, PACU, anywhere where sick people are likely to be,” Professor Gelb concluded.
PATH hopes that highlighting oxygen’s vital role in managing hypoxemia in policy guidance will support efforts by ministries of health and institutions around the world to increase access to this lifesaving commodity.
The application is now available for public comment on the WHO website, and additional letters of support and/or comments on the application may be submitted via email to until 24 February 2017. Please demonstrate your support for increasing access to oxygen, particularly for the most vulnerable populations.
Cover image credit: https://www.flickr.com/photos/glaxosmithkline/8723803622/in/set-72157633456645708