RT Journal Article SR Electronic T1 An Oxygen Supply Is Not Enough: A Qualitative Analysis of a Pressure Swing Adsorption Oxygen Plant Program in Ethiopian Hospitals JF Global Health: Science and Practice JO GLOB HEALTH SCI PRACT FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs SP e2300515 DO 10.9745/GHSP-D-23-00515 VO 12 IS 4 A1 Smith, Victoria A1 Changoor, Alana A1 Rummage, Sarah A1 Wolde, Haileab Fekadu A1 Zeleke, Ejigu Gebeye A1 Belay, Getahun Mekonnen A1 Barash, David A1 Stunkel, James A1 Reynolds, Cheri YR 2024 UL http://www.ghspjournal.org/content/12/4/e2300515.abstract AB Key FindingsLocating large-scale pressure swing adsorption (PSA) oxygen plants near high-volume specialized hospitals had a transformational effect, increasing the supply of locally available oxygen.Transportation and distribution are key barriers in large-scale oxygen production systems like PSA plants or liquid oxygen plants and can make up a large percentage of total oxygen costs to hospitals. Reducing transportation distance can dramatically reduce oxygen costs. However, even short-distance distribution can be limited by the capacity and availability of hospital vehicles to pick up oxygen. Planning for short-distance distribution is key to reducing oxygen shortages and stock-outs in hospitals that rely on cylinders.Key ImplicationsPolicymakers should account for the geographic distribution of oxygen supplies and factor transportation methods and costs into long-term national oxygen planning if not all hospitals or health centers will have their own means of oxygen production on site.To achieve maximum efficacy, oxygen supply sources like concentrators, liquid oxygen, and PSA plants must be paired with supplies like oxygen consumables, equipment like pulse oximeters, and clinical training.Background:In response to critical gaps in medical oxygen access, 2 pressure swing adsorption (PSA) oxygen production centers were established using an ecosystem-strengthening strategy in Amhara, Ethiopia, in 2019. A qualitative study was conducted to assess enablers and bottlenecks to oxygen access at the hospital level after installation.Methods:A variety of hospital staff (clinicians, biomedical professionals, hospital administrators, and procurement teams) across 13 hospitals procuring oxygen from the plants participated in comprehensive, semistructured focus group discussions. A thematic framework analysis approach was used to identify key themes.Findings:A total of 101 individuals participated in 26 focus groups in 2021, 2 years after plants were installed. Primary themes were accessibility of supply, affordability, and hospital readiness. Respondents indicated a substantial increase in their hospital’s ability to access lower-cost oxygen, with many attributing this to the locality of plants and reduced transportation barriers. However, other challenges persisted, and the emergence of COVID-19 1 year after plant installation and a civil conflict exacerbated supply shortages. Investments in equipment, supplies, and training optimized clinical utilization of oxygen and were highlighted as a need for ongoing investment.Conclusion:To achieve maximum impact, investments in large-scale oxygen systems must be accompanied by strategic plans to transport oxygen, reduce costs to hospitals, and provide support to clinical teams through equipment, supply procurement, and clinical training. These findings support comprehensive ecosystem approaches to strengthening oxygen access for sustainable impact.