Counting every breath: Leveraging the COVID-19 response to increase access to medical oxygen in Somalia

In mid-2020, when the first wave of the COVID-19 pandemic hit Somalia, the fragility of the health system to manage patients with severe symptoms was brutally exposed. Lives were needlessly lost due to a lack of medical oxygen and supplies. Based on the WHO Biomedical equipment for COVID-19 case management inventory tool, the WHO Country Office in Somalia assessed the availability of oxygen sources and planned for a surge in demand for oxygen as COVID-19 cases spiked. The inventory survey revealed that 26% of respondent health facilities had at least one oxygen source while 4% of health facilities had oxygen concentrators and only 22% of health facilities had access to oxygen cylinders. The gaps in the available supply of medical oxygen were alarming. To bridge the gaps, WHO developed a data-driven strategy to scale up access and availability to medical oxygen in Somalia.

How did Somalia do it, and how did the WHO Secretariat support Somalia?

The first phase of WHO’s strategy was to equip all 1200 primary care centers with oxygen concentrators and distribute pulse oximeters to over 3000 community health workers. Since only one in four health facilities in Somalia has access to uninterrupted electricity, WHO also set up solar-powered oxygen concentrators in remote health centers across the country. Delivery and installation of solar-powered medical oxygen equipment in a paediatric hospital was one of the most innovative and cost-effective solutions to providing secure access to oxygen in settings where access to electricity is neither consistent nor guaranteed.

In the 11 months following installation of the solar-powered medical oxygen system, 476 care seekers presenting with very low oxygen saturation levels received medical oxygen. Ninety-five percent (452 care seekers) were discharged without complications following normalization of oxygen levels. Children under 5 years of age comprised 62% of those who received oxygen from the solar-powered system. In most cases, mean oxygen saturation levels improved from 40% to over 98% within 1 to 2 days. Though the solar-powered medical oxygen system was initially set up to support case management for COVID-19 patients, children with neonatal asphyxia, pneumonia and other acute respiratory diseases soon represented the majority of patients.

The introduction of innovative, solar-powered medical oxygen systems in Somalia has demonstrated the power of innovation to accelerate impact in fragile settings. The solar-powered oxygen system in Somalia was financially supported by Grand Challenges Canada and the University of Alberta. WHO worked across the three levels of the Organization—headquarters, regional office, and country office—to set up the system in Somalia. Other United Nations agencies and implementing partners provided support to turn the idea into reality on the ground. WHO is working with the multi-partner collaboration, the Global Action Plan for Healthy Lives and Well-being for All (SDG3 GAP), to match the demand and supply of life-saving oxygen in Somalia. Implementation of this innovative solution is coupled with research supported by the United Nations Children's Fund (UNICEF), the United Nations Development Programme (UNDP), the World Bank, and the WHO Special Programme for Research and Training in Tropical Diseases (TDR) to gather evidence of the system’s feasibility, utilization, cost effectiveness and survival in complex contexts like Somalia.

As a smart investment for Somalia, the WHO Country Office aims to facilitate scale up the solar-powered oxygen system as well as pressure swing adsorption (PSA) plants to bridge gaps in access to medical oxygen in the country. Replicating the system can save many more lives and help Somalia inch closer to attaining WHO’s triple billion targets and health-related Sustainable Development Goals. In 2018, it was estimated that pneumonia killed 15 165 children under 5 in Somalia (about 21% of child deaths) approximately 2 children every hour. Global evidence indicates that up to 35% of childhood deaths from pneumonia are preventable with the use of simple medical oxygen. Therefore, the WHO Country Office in Somalia is hopeful that strategic partnerships forged with innovators, funders, SDG3 GAP agencies and the private sector will increase demand for medical oxygen and innovation and accelerate the public health impact of the initiative. As of December 2021, WHO delivered and installed two containerized PSA oxygen plants in two central locations as part of the drive to scale up the availability of oxygen. Each plant can deliver bedside oxygen to 25 intensive care unit patients through a pipeline and can refill 100 40-litre oxygen cylinders per day. By leveraging the COVID-19 response, WHO aims to increase access to medical oxygen in Somalia to reverse the gross health inequities observed in one of the most disadvantaged countries in the world. Further, such innovative solutions could be exemplary in other settings.