Challenges in the medical oxygen ecosystem of Peru: A political economy analysis.

Medical oxygen is essential in the management of several human disease conditions including acute respiratory conditions across the life course, and yet access remains unequal in many low- and middle-income countries, including Peru. This study explores Peru's challenges in ensuring reliable oxygen supplies, with a focus on those laid bare or exacerbated by the COVID-19 pandemic, to inform strategies for improving medical oxygen access. Using a political economy analysis, we conducted 13 key informant interviews with stakeholders involved in oxygen policy, supply, and health care, supported by reviews of 117 academic and grey literature sources, including policy documents. Before the COVID-19 pandemic, Peru's requirement for medical oxygen to be > 99% pure restricted competition, consolidating control of a few large liquid oxygen suppliers on the oxygen market and blocking smaller, affordable providers due to high compliance costs. Although pre-pandemic oxygen supplies were reportedly adequate, the pandemic exposed severe limitations including market constraints, slow government response, and lack of data management, resulting in an acute oxygen crisis. Civil society and private organizations stepped in, donating medical oxygen generator plants, but many of these are now unused due to insufficient planning for maintenance and operation. This study underscores the urgent need for a National Oxygen System in Peru to oversee supply, distribution, and maintenance, and strengthen resilience for future health emergencies. Solutions include reducing reliance on a small number of external suppliers, infrastructure investments, dedicated funding for maintenance, and training for personnel to ensure continuous oxygen access nationwide. This research highlights systemic vulnerabilities in Peru's health system and calls for coordinated policies to ensure equitable oxygen access and preparedness for future crises.