100&Change: 2020

Breathing New Life: Transforming Access to Oxygen Therapy for Children

Expanding access to life-saving oxygen in high-burden countries by improving hypoxemia screening, oxygen availability, and reforming policy and financing to sustain these improvements at scale.

DOWNLOAD: Project Factsheet
Two-page overview of proposal
Current Work Location
  • Ogun State, Nigeria
  • Ādīs Ābeba Āstedader, Ethiopia
  • Central Region, Uganda
  • Nairobi, Kenya
  • Madhya Pradesh, India
Proposed Work Locations:
  • State of Uttar Pradesh, India
  • Kano State, Nigeria
  • Dire Dawa Region, Ethiopia
  • Eastern Region, Uganda
  • Nairobi, Kenya
Priority Populations:
  • Infants and toddlers
  • Children
  • Low-income people
Sustainable Development Goals (SDGs):
  • 3. Good health and well-being
  • 10. Reduced inequalities
Competition Participation
100&Change: 2020

Executive Summary:

Low blood oxygen, or hypoxemia, is a life-threatening condition contributing to approximately 825,000 deaths annually in developing countries. Oxygen therapy could prevent many of these deaths. Unfortunately, access to oxygen in many developing countries has been neglected for decades and use is limited by poor diagnosis and unreliable oxygen supplies. Increasing hypoxemia treatment rates therefore requires three coordinated interventions: 1) improving hypoxemia diagnosis in referral and primary facilities, 2) extending access to reliable oxygen at referral facilities and high-functioning primary facilities, and 3) strengthening referral systems at primary facilities without oxygen. Over the last three years, we have worked with governments in five high-burden countries to create national oxygen strategies, pilot and refine our solution, and set the stage for scale-up. By pursuing these steps at scale and driving improved hypoxemia management in these five countries, we can halve their annual hypoxemia-related mortality by 2025—averting approximately 40,000 deaths annually.

Organization Details
Lead Organization

Clinton Health Access Initiative, Inc.

website: https://clintonhealthaccess.org/
Organization Headquarters
Massachusetts, United States
Organization ID
Annual Operating Budget
$100 to $199 Million
Number of Full-time Employees
> 1,000

Charity, fund, non-governmental organization, religious institution, school, or other entity

Challenge Statement

Low blood oxygen, or hypoxemia, is a life-threatening complication of preterm birth, surgery, labor and delivery, childhood illnesses, and others. Hypoxemia is so common among hospital admissions that up to 16% of admitted under-five children—and up to 22% of admitted newborns—are hypoxemic. Whatever the primary diagnosis, hypoxemia can increase the odds of death by over seven-fold. In low- and middle-income countries (LMICs), hypoxemia contributes to approximately 825,000 preventable deaths every year. We estimate that there are over 3.8 million cases annually. Oxygen therapy is the only treatment for hypoxemia. In high-income countries, oxygen is routinely administered to all patients who need it. Unfortunately, it’s been neglected for decades in many LMICs: 80% of hypoxemic patients go unidentified while only about half of those identified receive oxygen. Treatment is limited by poor diagnosis and unreliable oxygen supplies. A lack of pulse oximeters (inexpensive, accurate screening devices) drives poor diagnosis. Without them, diagnosis relies on clinical symptoms alone—missing up to 40% of cases—or is overlooked entirely. Increasing pulse oximeter use can improve clinical practice, increase diagnosis, and potentially double current treatment rates. Once diagnosed, inaccessible, nonfunctional equipment—and high, variable prices—limits oxygen access and increases mortality. Studies in LMICs show fewer than half of all facilities have uninterrupted oxygen. Even when available, oxygen equipment is often improperly maintained—causing frequent breakdowns and inconsistent supply. Oxygen is therefore rationed to operating theaters and emergencies as a scarce resource. Improving oxygen availability will ensure diagnosed patients receive prompt treatment.

Solution Overview

The program aims to dramatically increase hypoxemia treatment rates for all admitted patients—with an emphasis on vulnerable groups such as neonates and children. Our approach is informed by our recent experience supporting governments and facilities to improve oxygen systems and employs three coordinated interventions: 1) introduce routine hypoxemia screening to drive improved diagnosis by facilitating increased pulse oximeter procurement, optimized deployment, and training and mentorship of health workers; 2) extend oxygen access by assisting governments to mobilize adequate domestic and external resources, negotiate supply, distribution, and maintenance partnerships which radically reduce costs and maximize reliability; 3) strengthen referral systems at primary facilities without oxygen. Our primary success metric is reduced hospital-based mortality, which we’ll validate through an independent impact evaluation. To track progress, we’ll routinely measure the proportion of children with hypoxemia who receive oxygen. To manage our performance, we’ll review patient records to track the proportion of patients screened with pulse oximeters and who receive oxygen when indicated, conduct facility assessments to measure availability of functional oxygen, and review health financing data to estimate funding allocated to oxygen systems. We’ll work in five high-burden countries (India, Nigeria, Ethiopia, Kenya, Uganda) which account for nearly one-third of global hypoxemia burden and will focus on their highest-burden areas to cover a population of at least 700 million people across all five countries. By scaling our approach and driving improved hypoxemia management in these geographies, we can halve their hypoxemia-related mortality by 2025—averting approximately 40,000 deaths annually in these countries.