Building medical oxygen systems in a resource-limited setting: the case of Cameroon.

Background: Medical oxygen is of critical importance in resource-limited settings where hypoxaemia-causing conditions are prevalent. Its availability/accessibility is, however, often hindered by numerous challenges. Here we present concerted efforts that we undertook to optimise the medical oxygen system in Cameroon in a bid to enhance patient care and reduce hypoxaemia-related mortality. Methods: Technical and financial support was provided to the Cameroonian Ministry of Public Health across three key areas. First, we set up a governance framework via the establishment of two multi-sectoral technical working groups to develop strategies and governing standards for medical oxygen production and use in Cameroon. We then quantified the country's medical oxygen needs by leveraging the results of a two-phase health facility assessment. Lastly, we implemented additional systems ensuring effective and real-time monitoring of medical oxygen investments, and we coordinated the working groups to mobilise funding from different sources. Results: Efforts in developing a governance framework for medical oxygen resulted in the development of a National Strategic Plan for the Provision of Medical Oxygen in Cameroon (2021-2025) centred around four key areas: policy and financing, availability and maintenance of medical oxygen supply systems, clinical management of hypoxaemia, and data collection and use for hypoxaemia management. The second output was a norms and standards document on the production and use of medical oxygen in Cameroon. Quantification revealed a considerable gap in medical oxygen equipment and a monthly medical oxygen demand of about 162.4 million litres, the majority required by district hospitals. To begin bridging the identified gap in equipment, we procured and distributed medical oxygen equipment to 67 health facilities across the country. Furthermore, we successfully supported the government in securing funding from the Global Fund to install five large pressure swing absorption plants in five strategically located hospitals, as well as setting up a liquid oxygen tank and piping system in one high-volume regional hospital. Furthermore, we set up a system to enable effective monitoring and use of medical oxygen facilities, which comprised the definition of 15 indicators and their subsequent integration into the District Health Information System 2 (DHIS-2). Lastly, we trained 601 healthcare personnel on hypoxaemia diagnosis, treatment, and DHIS-2 reporting. Conclusions: Our concerted efforts with the Ministry of Public Health have yielded significant benefits in the establishment of a sustainable medical oxygen system in Cameroon, further strengthening the country's emergency response mechanism. However, considerable gaps remain, highlighting the need for sustained collaboration between the government, private partners, and international organisations for resource mobilisation.