Oxygen Access and Affordability in Health Facilities in Kenya

Abstract

Insufficient oxygen levels in the blood, referred to as hypoxaemia, is a potentially fatal complication of many causes of mortality. A topical example is the current COVID-19 pandemic, a result of the Coronavirus disease (COVID-19), a respiratory tract infection that started in Wuhan province, China, in December 2019, and has rapidly spread around the world. By February 2021, there were 112 million confirmed cases worldwide and 2.47 million deaths. During the same period, Kenya recorded 104 thousand cases and 1,827 deaths (Worldometers, 2021). Although most people develop only mild symptoms, approximately 19% develop severe to critical disease requiring hospitalisation. Of these, approximately 14% need oxygen support and 5% require admission to intensive care, often requiring ventilator support (WHO, 2020). Medical Oxygen can represent a significant cost to hospitals in low- and middle- income countries (LMICs). Contributors to the high cost include logistical challenges in transporting oxygen that also leads to intermittent availability. The high oxygen cost to the patient can limit use or lead to early discharge. Even where oxygen is subsidised or provided at no cost at government health facilities and hospitals, its high cost often leads to periods of unavailability. Oxygen concentrators are portable devices that remove nitrogen from the air and are able to produce oxygen at concentrations of 85%-95%. Although the use of concentrators could solve the supply chain problems of oxygen cylinders, concentrators come with their own host of challenges. These include the need for a continuous, reliable supply of electricity (often not available in LMICs), a robust system for monitoring, maintenance and repair, and a clinical staff trained in their use (Gray et al, 2017