April 24, 2025
Executive Summary
Access to a timely supply of medical oxygen plays a critical role in managing respiratory distress associated with various conditions, including birth asphyxia, chronic obstructive pulmonary disease, pneumonia, myocardial infarction, trauma, carbon monoxide toxicity, and hemorrhage. Although an inexpensive and essential tool in patient care, medical oxygen has been largely neglected in health systems. The recent experience with oxygen shortages during the Coronavirus Disease 2019 (COVID-19) pandemic sharply highlighted its need beyond tertiary hospitals in large cities in many countries.
The oxygen ecosystem is riddled with issues of access, quality, pricing, safety, and regulatory compliance on the supply side and challenges with knowledge and recognition of when and how to use medical oxygen on the demand side (WHO 2023). Supply side challenges have been addressed in previous reports including by the 2024 Lancet Commission on Medical Oxygen. In brief, liquid medical oxygen has a natural monopoly, and the prices are kept artificially high by a small number of players who have little incentive to serve patient populations outside profitable urban centers. In contrast, the demand side has received much less attention. Insufficient knowledge of or ability to use pulse oximetry and oxygen for routine medical care outside of tertiary settings means that oxygen is not prioritized or is used unsafely, wastefully, or ineffectively.
Supply follows demand. If there is no demand for medical oxygen during normal times in non-urban settings, it follows that there is no reliable supply either. This is a problem both during non-pandemic times and also when there are pandemic-associated emergencies. In essence, oxygen shortages during the second wave of Covid-19 was due in part to a lack of supply outside of tertiary care settings, but a major underlying cause was that frontline healthcare providers outside these settings were neither trained in the use of medical oxygen nor were they authorized to do so.
In 2022, the One Health Trust, in partnership with PricewaterhouseCoopers (PwC) and with the support of USAID-RISE, Gates Foundation, and Swasth Alliance, developed a blueprint for India’s national medical oxygen grid to highlight the importance of information technology for tracking oxygen assets and safeguarding against oxygen crises and kickstart an effort to solve the supply side of the equation (Aggarwal et al. 2022). Guidance documents are available from international bodies and organizations on how to maintain a functioning oxygen ecosystem (Department of Public Health Government of Maharashtra 2021; WHO and UNICEF 2019; O’Driscoll et al. 2017; IMA 2020).
This guidance document aims to address the demand side. To the best of our knowledge, there are no guidelines that address how medical oxygen should be used in community health facilities outside urban settings. Without clear guidelines on how, when, and why oxygen should be used in medical care, demand will remain underrecognized and oxygen underused. This document is intended to encourage the judicious use of medical oxygen and its recognition as an essential component of any modern health care system. The guidance was developed in consultation with Indian pulmonologists and experts and is meant for use by policymakers, health care administrators, procurement officers, biomedical engineers, and technicians.
Download the guide here.
Image from Canva.
