CSOs ask government to expedite national oxygen plan

Leading civil society organizations have called upon the government to urgently fast track the implementation of the national scale-up plan for medical oxygen to address the current COVID-19 crisis.

They argue that preventable deaths occur every day from hypoxemia—a severe lack of oxygen in the blood. Hypoxemia is caused by a range of medical conditions, including pneumonia, complications from pregnancy and premature birth, and most recently COVID-19.

Deogratias Agaba, PATH/USAID for Better Health senior communications and empowerment officer, says hypoxemia can be reversed by treatment with oxygen therapy, and a lifesaving commodity as classified by the World Health Organization.

However, the COVID-19 pandemic has highlighted the dangerous lack of medical oxygen in many countries around the world, including in Uganda. Agaba was speaking during the virtual meeting organized by PATH in collaboration with other leading CSOs recently, to over 20 journalists from different media houses.

Agaba noted that Uganda has made great strides in increasing access to medical oxygen by increasing the manufacturing capacity through the importation of ventilators and the installation of oxygen plants at all Regional Referral Hospitals.

However, the COVID-19 pandemic—particularly the second wave— has exposed pre-existing health inequities, thereby hampering meaningful enjoyment and realization of the right to health.

“With the rising number of COVID-19 cases, which have already surpassed the 70,000 mark as of June 30, 2021, with many more critically ill cases needing oxygen, the oxygen demand has shot up, hence the current oxygen shortage crisis in Uganda,” he says.

 As a result, hospitals can nolonger admit or adequately take care of patients in need of intensive care. In a country where the availability and access to COVID-19 vaccines is still very low—only about 5% of the target adult population as of June 30, 2021—ensuring access to critical care, including through the use of medical oxygen is paramount.

The surge in demand coupled with a cocktail of neoliberalism, unregulated private sector, and poor government stewardship has seen a sharp rise in costs for health care, particularly in privately owned health facilities.

The Ugandan government has previously committed to solving the challenges related to availability, access, and quality of oxygen therapy in the country through the enactment of the National Scale-up of Medical Oxygen Implementation Plan 2018-2022.

“As civil society, we acknowledge the ongoing efforts by the government to address the oxygen crisis. However, we urge the government to fast track the implementation of the National Scale-up Plan for Medical Oxygen (2018-2022) by taking the following actions,” Agaba says.

1. Increase the production capacity of the existing oxygen plants at the 14 regional referral hospitals: With support coming in to boost oxygen production in the country, such as the sh25bn from the Global Fund, the government should enhance the capacity of the regional referral hospitals to properly operate and manage the oxygen plants.
2. Increase availability and functionality of the medical oxygen supply and distribution: According to MOH, there are three main oxygen supply models in Uganda: the use of cylinders, concentrators, and oxygen generators/plants. Due to the high demand that came with COVID-19, ventilators were added to the list.
3. Provision of an adequate number of empty oxygen cylinders is another aspect of concern, as sometimes oxygen is available at the plants but there are no cylinders to fill them up for distribution.
4. Build the capacity of health workers to detect and manage patients in need of medical oxygen including effective utilization and maintenance of oxygen equipment: MOH should prioritize the training of health workers in the use of oxygen equipment.
5. Improve oxygen equipment management and maintenance: Even when health facilities have oxygen and devices to administer it, they are often mismatched or broken thus preventing oxygen from getting to patients. There is therefore a need for a longer-term and sustainable strategy for oxygen access.
6. Regulate and monitor private actors providing health care. The state should take its leadership back and effectively regulate and monitor private actors to protect the public from extortion and exploitation. Government should fast track expanding access to oxygen therapy from government health facilities as a key protective measure for patients and families.
7. Provide sufficient funding for oxygen and ensure transparency and accountability: The government should reallocate at least sh25b from recently approved votes for MDAs to cover the oxygen gap. It should also ensure transparency and proper accountability for the sh25bn received from the Global Fund and money from other sources being used to bolster oxygen supply during COVID-19.
8. Enhance capacities of Village Health Teams to promote early disease detection and management: Government should consider equipping the VHTs and citizens with basic health information on what it takes for a patient to require critical care, including medical oxygen, to raise their awareness and facilitate timely referrals whenever the need arises.
9. Strengthen citizen participation and increase public awareness about critical care that requires medical oxygen to curb misuse: As a health commodity, oxygen must be managed and prescribed by professional and qualified health workers to avoid the harmful effects, if it is purchased by ordinary people and self-administered. Government should, therefore, invest in creating awareness about medical oxygen toxicity and eventual fatalities, should it be used outside a health care setting and managed by non-medical practitioners.
10. Invest in partnerships for research to provide better data and evidence on medical oxygen: The Government should invest in strategic partnerships with other key stakeholders such as academia and research institutions to conduct studies and research needed to generate timely and context-specific evidence on medical oxygen. This will assist in informed decision making, especially during this pandemic period.

The meeting was organized by Path Uganda in partnership with Uganda National Health Consumers Organization, Action Group for Health, Human Rights and HIV/AIDS, Action for Rural Women’s Empowerment, African Institute for Investigative Journalism, Center for Health, Human Rights and Development(CEHURD), HEPS-Uganda, Reach a Hand Uganda, and  ISER.