A medical oxygen access gap SE Asia must bridge
Oxygen is a life-saving essential medicine with no substitute. Because of the complexity of the industrial production process, there are many challenges in access to medical oxygen such as availability, quality, affordability, management, supply, human resources capacity and safety. Some five billion people around the world lack access to safe, quality, and affordable medical oxygen.
The Lancet Global Health Commission on medical oxygen security highlights a stark reality — that South Asia and East Asia and the Pacific have the highest unfulfilled demand for medical oxygen (the oxygen service coverage gap in these two regions is 78% and 74% respectively), and there is a clear and urgent need for action to rectify this.
The COVID-19 pandemic exposed vulnerabilities in oxygen infrastructure, particularly in low- and middle-income countries (LMICs). While that crisis did trigger emergency interventions to alleviate the situation, long-term progress has been slow.
A World Health Organization (WHO) report (2022), 'Promising practices and lessons learnt in the South-East Asia Region in accessing medical oxygen during the COVID-19 pandemic', points out that sustained investments and policy commitments are required to ensure that oxygen is available where it is needed most. WHO's Access to Medical Oxygen Resolution and The Lancet Global Health Commission on Medical Oxygen Security provide a road map for scaling up solutions, but its implementation requires urgent action. Governments, global health agencies, industry and civil society must come together to close the oxygen gap. This is an opportunity to create lasting and equitable access to a life-saving medical intervention.
Challenges hindering oxygen access
Several systemic barriers hinder the availability of medical oxygen, preventing its integration into health-care systems. The first is the shortage of equipment — only 54% of hospitals in LMICs have pulse oximeters and 58% have access to medical oxygen. Consequently, this gap in basic monitoring and supply infrastructure leads to delayed diagnoses, inadequate treatment and preventable fatalities, a deficiency that intensifies dramatically during severe respiratory outbreaks, let alone pandemics. Without the necessary diagnostic tools, health-care providers struggle to detect and manage oxygen deficiencies effectively.
However, the issue extends beyond equipment availability. The financial burden associated with increasing oxygen access remains a major obstacle. Bridging the global oxygen gap requires $6.8 billion, with South Asia alone needing $2.6 billion. The reality is that many LMICs face competing health-care priorities, making it difficult to allocate substantial funding toward oxygen infrastructure. Therefore, efforts to improve oxygen access risk being short-lived without sustainable financing mechanisms.
Compounding the challenge is the acute shortage of trained biomedical engineers and technicians. Even when oxygen plants and concentrators are available, a lack of skilled professionals to install, maintain and repair them can lead to frequent breakdowns. These deficiencies exacerbate disparities in access, especially in rural and underserved communities, where alternative solutions are often unavailable.
There needs to be a long-term and multi-pronged approach that integrates innovation, investment and policy action. Transparency, data-driven decision-making, and a strong policy framework will be crucial. The WHO Access to Medical Oxygen Scorecard is a key tool in tracking progress and ensuring accountability, playing a pivotal role in monitoring progress on the WHO Oxygen Resolution. The resolution calls for reporting 'on progress in the implementation of this resolution to the Health Assembly in 2026, 2028 and 2030'.
National governments should develop medical oxygen scale-up plans with support from WHO, to strengthen oxygen ecosystems, allocate resources effectively, and address infrastructure gaps. Tailoring these strategies to health-care needs can create sustainable, resilient oxygen delivery models.
In South-East Asia, WHO has facilitated intra-regional cooperation between countries to build capacity. In partnership with Nepal's National Health Training Center, WHO facilitated training for biomedical engineers and technicians, leading to the installation of state-of-the-art PSA oxygen plants in Bhutan. The training will ensure sustainable operations and maintenance, and this model of cross-border collaboration can be replicated across LMICs.
Infrastructure is insufficient
Ensuring a stable oxygen supply requires strong partnerships between governments, the private sector and international organisations. WHO emphasises local manufacturing to reduce import dependence, cut costs, and improve accessibility. Decentralised production can address supply imbalances and enhance last-mile delivery.
Innovations such as portable oxygen concentrators, solar-powered generators, booster pumps and community-based hubs can bridge accessibility gaps, especially in remote areas. Integrating these solutions into health-care plans can ensure that life-saving oxygen reaches every patient.
Power disruptions hinder oxygen production in South-East Asia, as in many LMICs. In these low-resource settings, solar-powered oxygen systems are a cost-effective and low-maintenance innovation that ensures uninterrupted supply, lower costs and reduced grid dependence. Ethiopia and Nigeria have successfully implemented solar-powered oxygen delivery systems in remote health-care facilities, improving access and saving lives. The South-East Asia region should promote and invest in the solarisation of oxygen plants to ensure a stable supply amid energy insecurity and health crises.
Strengthening oxygen ecosystems
Bridging the oxygen gap requires a unified, multi-stakeholder approach. Governments should lead the way by integrating oxygen access into universal health coverage and emergency preparedness plans. A clear regulatory framework should be established to ensure the quality and the safety of medical oxygen, along with standardised protocols for storage, transportation and distribution. These measures will be needed for sustaining long-term availability of quality medical oxygen.
The private sector must also invest in local production and supply chain optimisation. Industry players have a crucial role in developing cost-effective, scalable solutions that cater to the specific needs of LMICs. Further, global health agencies must ensure that oxygen access remains a funding priority, facilitating financial support for infrastructure development, equipment procurement and workforce training.
Academia and research institutions can contribute by focusing on low-cost, innovative oxygen solutions tailored for LMICs. Prioritising affordability, efficiency and adaptability will be key. Using digital technologies for real-time monitoring, predictive demand analytics and supply chain management can further enhance the efficiency of oxygen delivery systems.
The oxygen crisis is a solvable problem that demands coordinated action, sustainable financing, and strong political will. Our success in installing PSA oxygen plants in countries demonstrates that strategic investments, cross-border collaboration, and workforce training can yield long-term solutions.
To maximise COVID-era investments in PSA oxygen plants, countries must ensure operational readiness. Ideally, donors who have already shown support for these initiatives during the pandemic should continue to support ongoing efforts. Surplus capacity should be distributed to peripheral facilities using booster pumps. WHO stands ready to provide technical support.
As The Lancet Global Health Commission on medical oxygen security reminds us, access to medical oxygen is not just a health issue but also a matter of equity and human rights. Oxygen should never be a privilege but rather a fundamental right for all.
Instead of crisis-driven approaches, sustainable investments in oxygen infrastructure can – and must – be made, ensuring that no one is left behind in their moment of need.
Saima Wazed is Regional Director, World Health Organization (WHO) South East Asia
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