Amid the Coronavirus surge, when the Government of Nigeria announced its approval of $17 million to set up oxygen plants across the country, there was some cheer that a long-neglected element of health systems planning was finally a policy priority.
The pandemic has laid bare the stark reality of weak health systems in low- and middle-income countries, including the fact that sustainable and affordable access to medical oxygen is a challenge. Beyond turning the “spotlight on deep national and global inequalities in health”, Covid-19 has brought to the fore the role of oxygen as an important life-saving therapy for patients who are hospitalised with severe respiratory conditions.
Oxygen treatment is the basis of acute medical care for many pathological conditions. The rationale for administering oxygen therapy in emergencies is to prevent a health condition known as hypoxemia – low levels of oxygen in the blood. In Covid-19, pneumonia causes respiratory distress in the lungs, leading to falling blood oxygen. Oxygen therapy is the administration of oxygen at a higher level than in the air we inhale.
While the Covid-19 pandemic has brought global attention to the need for strong oxygen systems, the same cannot be said of the far more devastating effects caused by pneumonia in children.
The numbers paint a grim picture. Using data on the proportion of children with pneumonia and diagnosed with low levels of oxygen, analysis by Save the Children, UNICEF and the Clinton Health Access Initiative report that in more than 100 countries, including Nigeria, an estimated 4.2 million children under the age of five are hospitalised with pneumonia-related hypoxemia, desperate for oxygen.
Oxygen therapy is vital for the treatment and survival of these children. It is also important to note that sustainable approaches are incorporated in the broad response of improved oxygen systems. These sustainable approaches include driving investments in service delivery, influencing and policy endeavours – just as Save the Children is doing in Nigeria.
Mighty oaks from little acorns
In the states of Lagos and Jigawa, we are, with relatively little effort, successfully drawing attention to the fact that investments in childhood pneumonia and oxygen systems are vital to ensure children have a healthy start in life. This demonstrates that a cohesive approach, even if small scale, can over time contribute to – and even scale up to – a grander initiative to reduce morbidity and mortality of children. Save the Children is bringing together interventions and services through two related interventions:
- the Integrated Sustainable Childhood Pneumonia and Infectious disease Reduction in Nigeria (INSPIRING) partnership with GSK
- the Pneumonia Centenary Commitment (PCC), a global strategy of Save the Children to tackle systemic failures that contribute to slower declines in child deaths due to pneumonia.
Through these projects, Save the Children is playing its part in the public-private partnership known as United for Oxygen, to increase access to oxygen and pulse oximetry in health facilities.
To tackle the burden of childhood pneumonia, both the INSPIRING and PCC interventions take on an integrated and cohesive approach. In Jigawa, a rural and conservative state in northern Nigeria, there are community-level interventions to:
- increase health-seeking behaviour
- support essential health services and oxygen supply
- train health workers.
The training we have given health workers in Jigawa covers diagnosing, treating and referring patients with pneumonia, including treating patients with oxygen therapy, and monitoring blood oxygen levels with pulse oximeters. We have complemented the training with the supply of oxygen to secondary and tertiary health facilities. Save the Children has donated oxygen cylinders, concentrators, analysers and pulse oximeters. We have delivered piped systems with multiple outlets, allowing oxygen to be delivered to many patients at the same time.
The interventions have demonstrated the need to strengthen health systems through sustainable responses and approaches. In Jigawa State, we are building public awareness of childhood pneumonia and policy interest in oxygen therapy.
In Jigawa, replicating efforts at the national level, and borrowing from Stephen Devereux’s idea of policy pollination in social protection, Save the Children has assumed the role of a pollinator. We are seeking to influence the Jigawa State government to adopt and implement well-designed rational health policies to promote child health and elevate childhood pneumonia.
We have supported Jigawa State’s ministry of health to develop and cost a pneumonia control strategy, adopted from the national Pneumonia Control Strategy. This is a major step in bringing childhood pneumonia to the fore as a key health issue.
Ditto for the national policy on Medical Oxygen in Health Facilities, a framework that provides the basis for planning for the scale-up of oxygen. The policy on oxygen designed for Jigawa State prioritises oxygen access and pulse oximetry. Save the Children is supportive of existing national healthcare financing mechanisms to push for universal health coverage, especially for mothers and children under five.
Referring to Devereux’s concept of policy pollination, the expectation is that fertilisation is achieved when Jigawa State approves, finances and fully implements these policies as advised by the pollinator, Save the Children.
Looking ahead
The Covid-19 pandemic has provided an opportunity to build back better. In rural states like Jigawa, as in the rest of Nigeria, bridging the oxygen gap and making sustainable investments in the health sector will not only address the treatment of patients with Covid-19 and health inequality in oxygen systems. Ultimately it will strengthen the health system and improve health outcomes, including for many children who need oxygen treatment to survive.
The policy announcement by the Government of Nigeria to establish oxygen production plants must gain traction and move beyond the contracting stage. The multiplier effect of fully functional plants will go a long way in closing the oxygen gap and contribute to treating severe respiratory conditions, including childhood pneumonia.
Governments and donors need to invest significantly in oxygen systems and sustainable supplies to deal with the challenge of access and health inequality. This includes the need to establish and explore sustainable financing options for oxygen systems and delivery, including business cases, budgetary allocations and private sector funding opportunities.
Within the framework of health strategies for mothers, newborns and children, it is important to make oxygen access a priority in plans and guidelines. These plans should outline the full implementation of integrated responses.
The case for sustained investments to shore up oxygen systems and strengthen the health system in Nigeria is stronger now. This should remain a priority for impending health emergencies. More support for investments from the government, international donors and private sector in this remains critical.
Finally, pneumonia is underestimated and suffers a lack of visibility in comparison with other childhood diseases. Ecosystem partners, local communities and civil society should maintain momentum in awareness raising to increase visibility of this public health challenge.
