By Joyce Ng’ang’a, Senior Policy Advisor at WACI Health
For most people, breathing is invisible—until the health system fails to provide the oxygen that keeps someone alive.
In a maternity ward, oxygen can determine whether a mother survives childbirth. For a newborn struggling to take its first breath, it can mark the difference between life beginning and life slipping away. For a child with severe pneumonia, a surgical patient or someone rushed to hospital after a road accident, oxygen is not an optional resource. It is lifesaving treatment.
Yet access to that treatment is profoundly unequal. Where a patient lives, how much a family can afford and whether a facility has functioning equipment can determine who receives oxygen in time—and who does not. Oxygen is medicine, oxygen is a right, and communities must demand that it be available to everyone who needs it.
Oxygen saves lives.
Yet millions of people live in health systems where access to medical oxygen cannot be taken for granted.
As we mark World Oxygen Day on October 2, we must therefore ask a more uncomfortable question: What happens when a patient needs oxygen but the health system cannot provide it?
That is not simply a medical question.
It is a question of equity, financing, infrastructure, accountability and the right of every person to receive quality healthcare.
It is also a question of whether Africa can achieve the vision of the WACI Health movement: health for all, with no one left behind because of where they live, what they earn or the health facility they can reach.
Oxygen is medicine
Medical oxygen is not merely a piece of equipment in a hospital.
It is an essential medicine and a fundamental component of critical care.
The human body needs oxygen to maintain normal metabolism and the functioning of vital organs. When disease or injury causes blood oxygen levels to fall, supplemental oxygen can become urgently necessary.
Modern medicine has developed different ways of delivering it, from relatively simple systems such as nasal cannulas to more sophisticated respiratory support, including mechanical ventilation.
But the existence of different delivery systems also reminds us of something important: access to oxygen is not simply about having a cylinder in a hospital store.
Oxygen must be available in sufficient quantities. Equipment must work. Health workers must be able to administer it appropriately. Supplies must be reliable. And facilities must have the infrastructure and financing required to maintain the entire system.
Without these elements, oxygen may technically exist within a health system without being accessible to the patient who needs it.
Ensuring that it is accessible is central to the WACI Health vision of health for all in Africa: health systems must be designed to serve every person, especially those most likely to be excluded.
The inequality behind a breath
This is where the global oxygen divide becomes a public-health concern.
Low- and middle-income countries continue to face significant challenges in ensuring reliable oxygen supplies. Weak infrastructure, inadequate equipment, supply interruptions and limited financing can leave health facilities struggling to meet demand.
The consequences are not merely administrative.
They can be measured in human lives.
The COVID-19 pandemic exposed these weaknesses dramatically. As severe respiratory illness surged, hospitals experienced enormous demand for supplemental oxygen, revealing gaps in production, distribution, storage and delivery.
But COVID-19 did not create the oxygen problem.
It exposed and intensified a problem that already existed.
Long after the pandemic, babies will still be born needing respiratory support. Children will still develop severe pneumonia. Women will still experience complications during childbirth. Patients will still undergo surgery. Road crashes and other emergencies will still send critically ill people to hospitals.
Their need for oxygen does not disappear when the emergency making headlines does.
If Africa is to achieve health for all, essential services such as oxygen must be available equitably, consistently and affordably—not only during crises, but every day.
Communities cannot remain spectators
This is why communities must become part of the oxygen conversation.
Families are often the first people to experience the consequences when an essential medicine or service is unavailable.
They know what it means to arrive at a health facility seeking care and discover that something their loved one urgently needs is not available.
Their voices should therefore matter when governments decide what to finance, where to invest and how health services are delivered.
Community advocacy must go beyond asking, “Is there oxygen?”
We should ask:
Is there enough oxygen?
Is it available when and where patients need it?
Is it affordable?
Are health facilities properly equipped?
Are oxygen systems functional and maintained?
Do health workers have the skills and equipment to deliver it safely?
Are governments treating medical oxygen as an essential part of healthcare financing?
These are not unreasonable demands.
They are questions about whether a health system is prepared to save lives and whether it is moving toward health for all.
Accessibility is more than availability
There is an important distinction between oxygen being available somewhere and oxygen being accessible to the patient who needs it.
A facility may have an oxygen cylinder but lack the equipment needed to deliver it.
It may have an oxygen concentrator but face unreliable electricity.
It may have the equipment but lack the resources to maintain it.
It may have oxygen today but no reliable system to ensure supply tomorrow.
And a patient may arrive at a facility that has oxygen but cannot afford the cost associated with receiving care.
Accessibility therefore requires an entire system.
It requires investment in production and supply, equipment, maintenance, electricity, trained health workers and sustainable financing.
It also requires governments and health authorities to listen to the experiences of patients and communities.
This is the foundation of universal health coverage and of WACI Health’s vision: health systems that are accountable, equitable and responsive to the needs of all people across Africa.
The community has a role
This is why civil society and Community Advisory Boards have an important role in medical oxygen advocacy.
For Joyce Nganga, an EAPOA CSO coalition member and Community Advisory Board member for medical oxygen access, convened at PATH, oxygen advocacy is ultimately about ensuring that communities have a voice in decisions that can determine whether patients receive lifesaving care.
“Medical oxygen access improves when communities demand quality, accessible and affordable medical oxygen,” she says.
That demand should not be limited to World Oxygen Day.
It should continue whenever health budgets are discussed, whenever health facilities are planned and whenever governments assess whether their health systems are delivering quality care.
Communities should ask where oxygen is available, how much is available, whether equipment is functional and whether the systems supporting oxygen delivery are sustainable.
They should demand transparency about investment in medical oxygen.
And they should ensure that oxygen does not disappear from the public-health agenda simply because the immediate crisis has passed.
This is how communities help turn the vision of health for all into action: by demanding systems that protect lives, uphold dignity and leave no one behind.
A right to breathe
There is something profoundly unequal about a health system in which whether a critically ill patient receives oxygen depends on where they happen to seek care.
The ability to breathe should not become a privilege determined by geography, poverty or the capacity of a particular hospital.
On World Oxygen Day, therefore, the message should be simple but firm:
Oxygen saves lives. Communities must demand accessibility.
Demand oxygen that is available.
Demand oxygen that is affordable.
Demand functional equipment and reliable supplies.
Demand trained health workers who can deliver it appropriately.
Demand governments that budget for it as essential medicine.
Demand health systems that advance the WACI Health vision of health for all in Africa.
Because when a mother is struggling during childbirth, when a newborn cannot breathe properly, when a child is fighting severe pneumonia or when an accident victim arrives gasping for air, the question should never be whether the health system considers oxygen important enough.
It should already be there.
And if it is not, communities have every reason to ask why—and to demand that it be made available.
Health for all in Africa will remain incomplete until every person can access the lifesaving care they need, including medical oxygen.
EAPOA CAB Member
