OVERVIEW OF OXYGEN SYSTEM

LEARNING OBJECTIVE
 At the end of this session, the participant will be able to:

Q Describe the importance of oxygen

Q Discuss Oxygen system and its components
Q Describe sources of oxygen with pros and cones

Q Describe the situation of medical oxygen therapy in Ethiopia,

efforts and challenges;
Q Identify the key strategic areas of the new national medical
oxygen roadmap to ensure access/utilization of oxygen

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KEY QUESTIONS FOR SELF-REVIEW

INSTRUCTION: BRAIN STORM AND REFLECT ON THE

FOLLOWING QUESTION FROM YOUR EXPERIENCES

 What do you think oxygen is important in health care setting?

Time allocated: 5 minutes

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 Medical oxygen is a lifesaving
medicine used to treat various
health conditions that, if left
untreated, result in severe
complications and death

It is an essential medicine
used to treat hypoxemia with
no substitution

SAMPLE FOOTER TEXT 4

  Supplemental Medical Oxygen therapy is the
administration of oxygen as medical treatment to
deal with Hypoxemia (low oxygen saturation in the
blood).
 Cost-effective intervention, and saves lives,
 Pneumonia: Leading cause of death in children (700,000 under
HYPOXEMIA five, 15% of all deaths)
AND OXYGEN  Children with pneumonia often experience hypoxemia (low SpO2)
THERAPY - a major fatal complication
 Hypoxemia prevalence in children with pneumonia:
 Non-WHO classified clinical pneumonia: 36%

 Radiological pneumonia: 19%

 Organism-specific pneumonia (e.g., respiratory syncytial virus): 33%

 Strengthening oxygen supplies could prevent up to 122,000

childhood pneumonia deaths annually

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 OXYGEN IS IMPORTANT IN CLINICAL
SETTING FOR
 Respiratory Support: pneumonia, chronic obstructive pulmonary disease (COPD),
asthma, COVID-19 symptoms, and respiratory distress syndrome.
 Emergency Situations: In critical emergencies like cardiac arrest, trauma, or near-
drowning incidents, prompt administration of oxygen can be lifesaving.
 Surgical Procedures: Medical oxygen is provided during surgeries to maintain
adequate oxygen levels and prevent hypoxia (low level of oxygen in the tissue).
 Neonatal Care: Supplemental oxygen is vital in neonatal intensive care units
(NICUs) to enhance their lung function, improve oxygen delivery, and promote
healthy growth and development.
 Chronic Conditions: Patients with chronic respiratory conditions like COPD,
bronchitis, or cystic fibrosis often experience difficulty in breathing due to
compromised lung function. Long-term oxygen therapy assists in managing these
conditions, alleviating symptoms, enhancing quality of life, and improving survival
rates.

SAMPLE FOOTER TEXT 6

OXYGEN IS VITAL
TAKING IN ACCOUNT
THE BURDEN OF
DISEASE RELATED TO
HYPOXEMIA

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 Of the top 10
causes of
Admission for
children
younger than 5
years old
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9
of all causes of Death 80% (n=8) of the top 10
for across all age causes of death across all age
groups. groups involved conditions
requiring supplemental
medical oxygen.

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KEY QUESTIONS FOR SELF-REVIEW

 what challenges did you come across related to oxygen access

while working on the system?

Time allocated: 5 minutes

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THE KEY CAUSES FOR OXYGEN DELIVERY
BARRIERS IN ETHIOPIA
Policy
related
Oxygen device
Financing/ challenges and
Budget infrastructure
related challenges

Partnership Quality
and Related
networking Key bottlenecks Challenges
of Oxygen
delivery
M&E system HR Related
related Challenges

Supply Use
Chain
Related
related
challenges challeng
es

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 NATIONAL SITUATION OF OXYGEN THERAPY

National Medical Oxygen and Pulse Oximetry Scale Up Road

Map (2016-2021) aimed to provide wider access to oxygen
supply and pulse oximetry, ensuring utilization

End-line evaluation findings:

19 private
38 oxygen
(industrial gas 17 public 2 joint venture
plants:
vendors)

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 NATIONAL SITUATION OF OXYGEN THERAPY
(ROADMAP-I END-LINE EVALUATION, 2021)

 Geographical equity not yet addressed

 827 M3/Hr capacity in 17 public oxygen plants
 19% of facilities within 100-200KM from oxygen plants, and 25% >200Km away
 Oxygen manifold system available in referral and university hospitals (6 out of 20
sampled)
 No staff trained on rational use of medical oxygen in 37 HCs providing oxygen
 59% of charts had at least one SpO2 measurement, 41% had none
 Oxygen administered to 94% of patients with SpO2 below 90%, and 49% with
SpO2 above 90% 14
 GROUP ACTIVITY

Instruction: Be in group of five and discuss about the

issue in bullet below to reflect to the larger group

 Discuss about oxygen system

 What are the components of oxygen system?

Time allocated: 10 minutes

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  Medical oxygen is a complex product which is produced under strict
regulations and guidelines.
 It requires additional infrastructures including
 Sources: plants and oxygen concentrator
 Medical oxygen cylinder to transport
 Sustainable power infrastructure for production
 Internal distribution requires either pipeline or cylinders
OXYGEN  Oxygen administration requires sustainable availability of delivery
SYSTEM devices, regulatory devices, conditioning devices
 Requires uninterrupted availability of regulatory devices to control
pressure and flow rate
 Functional maintenance system and BMEs/technicians
 Safety issues attributed the gaseous nature
 Skilled professional for administration and close monitoring
 Devices for quality/purity check up.

SAMPLE FOOTER TEXT 16

.

SAMPLE FOOTER TEXT 17

 OXYGEN SOURCES

INDIVIDUAL REFLECTION
INSTRUCTION: REFLECT INDIVIDUALLY THE FOLLOWING QUESTION UP ON REQUEST BY FACILITATOR

What sources of medical oxygen do we use in Ethiopia?

What are pros and cons of the sources you know?

Time allocated: 5 minutes

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MEDICAL OXYGEN CYLINDER

Medical oxygen gas can be Advantage: Does not

compressed and stored in Cylinders can be used by require electricity. No
cylinders. These cylinders installing them directly power sources and limited
are filled at a gas within patient areas or by maintenance requirement
manufacturing plant, either connecting them to sub- by trained technician.
via cryogenic distillation or central manifold systems.
PSA plant. Disadvantage: requires
It requires moderate check transport supply chain, Risk
It can be used in all oxygen of fittings and connections of gas leakage and risk of
need. It meets medical and regular check of unwanted relocation
grade oxygen 93+-3% filled oxygen level and cleaning
from PSA plant.

SAMPLE FOOTER TEXT 19

 OXYGEN CONCENTRATOR
 Is a self-contained, electrically powered medical device

designed to concentrate oxygen from ambient air. It

delivers low-flow, continuous, clean, and concentrated
oxygen (> 82%) from room air (21%).
 Use to deliver oxygen at beside or within proximity to

patient area. Using a flow meter stand for splitting flow, it

can provide a continuous supply of oxygen to multiple
patients at the same time. Provide continues supply with
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minimum cost and output can be split.

 OXYGEN CONCENTRATOR …

 Moderate maintenance required with trained technician.

Moderate cleaning of filter and exterior part required by

users.
 It requires electricity.

 Not use full when high flow is needed (ICU, Anaesthesia

machine)
 Low pressure output usually not suitable for CPAP and
ventilator; Requires back up supply and Require
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maintenance
OXYGEN PLANT
 Oxygen plant is a huge oxygen concentrator that
used to produce oxygen, nitrogen and other gas
with higher production capacity
 There are two major types of oxygen plant;
namely, cryogenic and pressure swing
adsorption (PSA).

SAMPLE FOOTER TEXT 22

 PSA OXYGEN
LANPSA PLANT
 Oxygen plant is an onsite oxygen-

generating system using pressure swing

adsorption (PSA) technology, which
supplies high-pressure oxygen throughout a
facility via a central pipeline system or via
cylinders refilled by the plant.

SAMPLE FOOTER TEXT 23

  Meets medical grade oxygen 93+-3%
 Cost effective for large facility and continuous

PSA PLANT supply.

 Requires electricity,
 Require high capital investment, uninterrupted
power, infrastructure, high maintenance for
pipeline, back up cylinder, and risk of leakage.

SAMPLE FOOTER TEXT 24

 LIQUID OXYGEN
 Produces bulk liquid oxygen through cryogenic
distillation and stores it in a large tank.
 Air separation is based on the cryogenic distillation
process, in which the air is cooled down to the required
very low temperature of negative 183 degrees Celsius
and then liquefied.
 When distillation is carried out, the individual
components of air are separated from each other due to
their varying boiling points.
 To use LOX at a health facility, on-site vacuum insulated
Liquid oxygen tank @ storage tanks is needed. 25
Tirunesh Beijing
  Can be used for all oxygen needs including high pressure supply
and facility’s where power supply is intermittent or unreliable.
 Meets more than 99% oxygen purity and large supply with small
LIQUID OXYGEN space requirement.
 Requires significant maintenance of system and piping by highly
trained technicians and engineers.
 Requires transport supply chain, adequate infrastructure, high
maintenance for pipeline, requires back up cylinder and risk of
leakage.

SAMPLE FOOTER TEXT 26

 OXYGEN SOURCE VS
DISPENSING TO PATIENT

 Production from ASU plant-

directly piped from storage,
filled to cylinder( transport,
manifold, bed side)
 Production from PSA plant-
directly piped to bed side, filled
to cylinder (transport, manifold,
bed side)
 Oxygen concentrator- directly to
patient

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TIM PSA PLANT- DIRECTLY PIPED TO BED SIDE, FILLED TO CYLINDER (TRANSPORT, MANIFOLD, BED SIDE)
 PULSE OXIMETER

 A pulse oximeter is a device that non-invasively measures the oxygen saturation in

the blood.
 A pulse oximeter is used to measure the percentage of oxygenated hemoglobin in
arterial blood (SpO2).
 The normal oxygen saturation at sea level in a resting individual is 95–100%
 Pulse oximetry is the standard method for assessing patients for hypoxemia.
 Oxygen is usually given with a saturation <90% measured at room air and the
response to oxygen therapy can be measured with the pulse oximeter.

SAMPLE FOOTER TEXT 28

NATIONAL OXYGEN ROAD MAP

 Pair Discussion

Instruction: be in a pair with the person next to you

and discuss the following issues.
Does Ethiopia have a national oxygen road map? If
yes, describe the strategic objectives of the road
map and explain your experience in implementing
the strategic objectives.

Time allowed: 10 Minutes

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 ETHIOPIAN NATIONAL MEDICAL OXYGEN ROAD
MAP II (2022-2027)

DEVELOPED TO ADDRESS GAPS AIM: ENSURE WIDER ACCESS TO SEVEN MAJOR STRATEGIC AREAS
FROM THE FIRST NATIONAL OXYGEN SUPPLY AND PULSE FOR IMPLEMENTATION WITH 25
ROADMAP OXIMETRY, AND PROPER MAJOR INTERVENTIONS
UTILIZATION

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KEY INTERVENTIONS

Strengthen leadership and coordination

• By integrating medical oxygen into new and existing standards, guidelines, and policies, as well
as by establishing and/or strengthening the structures of medical oxygen at MOH, RHBs, and
health facilities, this focuses on enhancing coordination and leadership of medical oxygen in the
health system. Moreover, establishing and implementing KPIs improves the monitoring,
assessment, and feedback system.
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• Integrate oxygen to national documents

• Strengthen structures and coordination
• Create an accountability mechanism
KEY INTERVENTIONS

Improve equitable access

• This focuses on ensuring that medical grade oxygen is available around-the-clock in healthcare
facilities. It aims to increase the effectiveness of the logistics operations of the refilling system for
those without oxygen plants and the medical oxygen supply chain system in healthcare
institutions. The other goal of this objective is to put in place a reliable oxygen quantification
system at the national, subnational, and health institution levels.
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• Equitable production across

regions
• Enhance quantification and
procurement
• Improve logistic management
system
KEY INTERVENTIONS

Improve the quality

• This objective aims to strengthen the rational use of medical oxygen and appropriate
management of medical devices related to oxygen through capacity building of health care
professionals and making medical oxygen one of the priorities for quality improvement projects.

• Scale up the efforts to strengthen of rational use of

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medical oxygen
• Develop capacity-building activities to improve the
clinical use of oxygen.
• Integrate medical oxygen system into existing QI
activities
KEY INTERVENTIONS

Strengthen device management

• This objective is about ensuring that medical oxygen products are acquisition, commissioning,
utilization, and decommissioned correctly. This includes but is not limited to an oxygen plant, a
medical gas pipeline system, oxygen therapy, a diagnostic and monitoring device, and spare
parts and supplies (consumables).
• Reform the medical oxygen device acquisition system
• Ensure the timely installation and Commissioning of MODs
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• Develop a system for the safe operation, maintenance, and

calibration of MODs
• Establish a decommissioning and disposal system
KEY INTERVENTIONS

Strengthen the Medical Oxygen Regulation System

• This objective is to strengthen Ethiopia's regulatory framework for the complete oxygen
ecosystem and oxygen services in all healthcare settings, including home care. Additionally, it
aims to strengthen the regulatory body's capacities and integrate oxygen regulation into the
current regulatory framework. Furthermore, it aspires to create an environment where
innovations can progress to local production.
• Develop Regulation Minimum Standards35

• Integrate Oxygen Regulation with a Routine Regulation

System
• Capacity building of regulatory professionals
• Establish a regulatory support system to translate innovations
to local production
KEY INTERVENTIONS

Enhance Research and innovation in the medical oxygen

system
• This objective focus on building research and innovation hubs across the country while also
identifying critical research priority areas of medical oxygen. It also intends to mobilize resources
or combine medical oxygen with current grand challenges initiatives to promote local
manufacture of oxygen-related goods. Additionally, to use the research findings to improve
policies and make decisions supported by evidence.
• Develop research priority areas 36

• Establish a national oxygen research repository and use for

decision making
• Integrate the national medical oxygen grand challenge
• Translate innovations into local production
KEY INTERVENTIONS

Ensure a sustainable financing mechanism for medical

oxygen system
• This objective is to make sure the long-term availability of medical oxygen through sustainable
sources of financing by improving the capacities of both individuals and organizations,
establishing business plans for long-term financing, and devising cost recovery strategies for a
sustainable oxygen supply.

• Building MoH/RHB capacity for medical oxygen with a

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sustainable financing strategy

• Coordinate analytical activities to develop better investment in
the production and distribution of medical gasses for public and
private facilities
SUMMARY
Oxygen therapy is one of the most cost-effective interventions to reduce
mortality

A comprehensive oxygen system is necessary to improve oxygen access

There is limited availability of supplies and training of staff in oxygen therapy in

facilities.

The new roadmap has plans to address the problems

.
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THANK YOU

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