@article {Smith, author = {Victoria Smith and Alana Changoor and Chloe McDonald and David Barash and Bernard Olayo and Steve Adudans and Tyler Nelson and Cheri Reynolds and Monica Cainer and James Stunkel}, title = {A Comprehensive Approach to Medical Oxygen Ecosystem Building: An Implementation Case Study in Kenya, Rwanda, and Ethiopia}, year = {2022}, doi = {10.9745/GHSP-D-21-00781}, publisher = {Global Health: Science and Practice}, abstract = {Key FindingsA social enterprise approach for medical oxygen production and distribution led to median increases in procurement of oxygen ranging from 112\%{\textendash}220\% at customer hospitals, at an estimated cost of US$7.34 per patient treated.A key challenge faced by this model has been inconsistencies in cash flow, resulting from irregular purchasing patterns from hospital customers and infrequent schedules of reimbursement from the government. This was further exacerbated by national insurance schemes that do not sufficiently cover hospital costs.Key ImplicationsThis social enterprise model addresses oxygen scarcity in semirural and rural areas, where 60\% of the population in sub-Saharan Africa resides. Pressure swing adsorption plant models offer a substantial advantage in mitigating transportation barriers that often preclude oxygen access to rural communities.To be successful, this model requires long-term budget commitments and prioritization of plant maintenance by funders, medical facilities, and implementers. Other enablers of success include investment in quality equipment and the early development of a long-term business strategy to achieve financial sustainability.Medical oxygen is an essential treatment for life-threatening hypoxemic conditions and is commonly indicated for the clinical management of most leading causes of mortality in children aged younger than 5 years, obstetric complications at delivery, and surgical procedures. In resource-constrained settings, access to medical oxygen is unreliable due to cost, distance from production centers, undermaintained infrastructure, and a fragmented supply chain. To increase availability of medical oxygen in underserved communities, Assist International, the GE Foundation, Grand Challenges Canada, the Center for Public Health and Development (Kenya), Health Builders (Rwanda), and the National Ministries of Health and Regional Health Bureaus in Kenya, Rwanda, and Ethiopia partnered to implement a social enterprise model for the production and distribution of medical oxygen to hospitals at reduced cost. This model established pressure swing adsorption (PSA) plants at large referral hospitals and equipped them to serve as localized supply hubs to meet regional demand for medical oxygen while using revenues from cylinder distribution to subsidize ongoing costs. Since 2014, 4 PSA plants have successfully been established and sustained using a social enterprise model in Siaya, Kenya; Ruhengeri, Rwanda; and Amhara Region, Ethiopia. These plants have cumulatively delivered more than 209,708 cylinders of oxygen to a network of 183 health care facilities as of October 2022. In Ethiopia, this model costs an estimated US$7.34 per patient receiving medical oxygen over a 20-year time horizon. Altogether, this business model has enabled the sustainable provision of medical oxygen to communities with populations totaling more than 33 million people, including an estimated 5 million children aged younger than 5 years.}, URL = {https://www.ghspjournal.org/content/early/2022/11/21/GHSP-D-21-00781}, eprint = {https://www.ghspjournal.org/content/early/2022/11/21/GHSP-D-21-00781.full.pdf}, journal = {Global Health: Science and Practice} }