The oxygen concentrator hypothesis — what and how we are learning to strengthen the position of the oxygen concentrator in the global ecosystem
The COVID-19 pandemic has highlighted and exacerbated a critical vulnerability in the health infrastructure of many low- and middle-income countries (LMICs): a critical shortage of medical oxygen. This has driven an acceleration of work in the last few years in the oxygen equity space globally, with significant investment in established delivery systems like liquid oxygen and large scale oxygen generating plants (pressure swing adsorption — PSA plants). Whilst critical in cities and well connected areas, these systems can’t effectively reach people in more remote settings.
We believe the oxygen concentrator has an important role to play in strengthening the oxygen ecosystem across low-resource settings in LMICs, alongside PSA plants and liquid oxygen. Since its inception as an immediate response effort to the pandemic, the FCDO-funded Oxygen CoLab has been working with partners to create and accelerate the conditions necessary to fully understand the role and importance of the oxygen concentrator. Read more here about our journey, track record, and learnings to date.
We are now entering a phase of deeper exploration and learning, working with a range of brilliant grantees to build evidence on the use cases for oxygen concentrators, deepening our collective understanding across what works, how, and where.
What might it look like if fit-for-purpose oxygen concentrators are being used in the right places, at the right time, for the right people?
How might this need differ between countries to account for the contextual differences in the set up of their health systems?
What evidence is needed to prove that the oxygen concentrator has a role to play in the global oxygen space?
An oxygen concentrator hypothesis to give oxygen concentrators their place in the global oxygen ecosystem
Across the portfolio we are testing a range of approaches to each of the key points in the equation. Our overarching hypothesis for the portfolio looks like this:
The Oxygen CoLab’s investment hypothesis is that if we know the right mix of concentrator products and service modalities across different contextual constraints, and we accelerate innovation to the products themselves, and we use that evidence along with collective action to advocate for changes to policy and investment (nationally and globally), then reliable oxygen will be accessible and affordable to patients at the place and time of need.
With a group of talented organisations working deeply with communities globally, we are hoping to build the evidence that will allow us to collectively learn and iterate against this hypothesis.
Sidenote: on learning across many dimensions concurrently
The CoLab methodology brings a range of partners and issues together to be tackled at one time. We understand that whilst product research and development is important, even if we had the perfect product, business and service delivery models would be the next set category of uncertainty for us to gain clarity around. Instead of waiting, we’re tackling both at the same time to increase our velocity
For this, we are funding two interconnected portfolios of work acting on different parts of the system, helping us learn what works, how, and where.
Research & Development Product Innovation Portfolio
We’re contributing to an accelerated path-to-market for oxygen concentrator innovations, funding two streams:
1. Research and development (R&D) grants
We’re offering catalytic R&D grants to manufacturers to innovate their current products in-line with UNICEF’s Target Product Profile (TPP), which is at a minimum, the ‘requirements necessary for suitability of oxygen concentrators within LRS. If these criteria are not met, the oxygen concentrator is likely to be considered unsuitable for use in a global health context.’
Through this small portfolio we are exploring:
Can the combination of small catalytic R&D grants from the Oxygen CoLab (signalling donor interest) and UNICEF’s progress towards the creation of advanced purchase commitments for TPP-ready oxygen concentrators, enable manufacturers to secure internal sign-off for progressive innovation plans?
We are delighted to announce that Drive DeVilbiss and Kroeber have committed to innovate their products in line with the TPP to manufacture products that are fit for purpose in low-resource settings. We are excited to share more about their journey as we continue to work together.
2. Lab testing current oxygen concentrators against UNICEF’s TPP
We’re bringing together a range of current products, from different manufacturers, countries and backgrounds, to rigorously test how they perform against UNICEF’s TPP to understand:
Will data from lab testing evidence the size of the gap between the capabilities of current products and TPP requirements for low-resource settings?
Can we highlight the areas of development that need the most focus and enable current procurers to make the best purchasing decisions?
Our hope is that should we be able to answer these questions, the combination of R&D grants and lab testing results will equip manufacturers with the knowledge and market incentives they need to adapt their products and ensure they are fit-for-purpose in LMIC contexts.
Oxygen-as-a-Service portfolio
Evidence has shown that many donated oxygen concentrators in low-resource settings end up in equipment graveyards as they were not designed for use in these situations and environments. To create the ideal conditions for innovators and manufacturers to commit to the development of more robust oxygen concentrators, we are funding pilots that prove the existence of a market for more resilient products, and testing business models that provide wrap-around implementation, maintenance, training and support.
In addition to proving there is a market for oxygen, our oxygen-as-a-service portfolio is testing elements across the whole service package- beyond concentrators alone - to understand what a viable business model might look like through different combinations of product and service.
We are funding a mix of oxygen products (concentrators, O2 Cube, cylinders) each with a package of support that includes clinical training and maintenance. While each of the models differ greatly by contexts across LMICs, we are already seeing three main grantee models forming across the portfolio, against which we are testing different assumptions around oxygen service delivery:
- ‘Concentrator & high-touch support — Oxygen concentrators sit within healthcare facilities and clinical training is provided with wrap around maintenance support to the healthcare facility.
- ‘Facility-located O2 Cube’ — An on-site O2 cube generates the oxygen supply for the whole healthcare facility, maintenance and clinical training is provided with additional maintenance support.
- ‘Hub & Spoke O2 Cube’ — An off-site O2 cube generates oxygen to fill portable cylinders for more than one healthcare facility in the surrounding area.
These pilots are testing different answers to our oxygen hypothesis, which in practice looks like exploring questions like:
What is a viable price point and payment model for delivering medical oxygen using oxygen concentrators, in my particular context, taking into account the way that health services are procured and delivered?
What are the best mechanisms to deliver clinical and equipment training for healthcare workers in the diagnosis of hypoxia and correct administration of oxygen therapy?
What are the right mechanisms for the effective delivery of technical training for locally-based biomedical engineers and healthcare workers in preventive and responsive maintenance of oxygen equipment?
Our Oxygen-as-a-Service grantees
We’re funding 5 oxygen-as-a-service (O2aaS) grantees testing their models across 7 contexts.
- Access Oxygen in Kenya, a consortium made up of CPHD, Mediquip and Air Liquide, are testing the use of concentrators in 12 urban healthcare settings in Nairobi, a mix of private, public and faith-based facilities. They are using a service contract model to deliver maintenance and clinical training service and the Access O2 app to provide continuous digital training.
- Sanrai in India, are testing the use of concentrators in public health care facilities in two districts of India, Uttar Pradesh and West Bengal. They are using a subscription fee model to deliver comprehensive clinical training and a routine maintenance service package.
- FRE02 in Tanzania, are testing the use of concentrators in 17 public and faith-based healthcare facilities in rural Tanzania and 1 public facility on Mafia Island. They are using a subscription-fee based O2aaS model which provides clinical training, remote and ‘swap and go’ maintenance support.
- HealthPort in Nigeria, are testing the use of LeanMed’s 10 LPM O2 cube in a fixed off-site location in Ogun county, supplying 6 healthcare facilities, a mix of public and private, with cylinders using a hub and spoke model. They are combining the sales of cylinders with clinical training and in-house maintenance. In addition, they are testing the use of LeanMed’s 10 LPM O2 cube and cylinders on-site at a healthcare facility in Lagos.
- ICC Change in Uganda and the DRC are testing the use of LeanMed’s 10 LPM O2 cube in two fixed off-site locations in Rukungiri, Uganda and Butembo, Democratic Republic of Congo. They will supply a mix of nearby health care facilities, public, private and faith-based, with cylinders using the hub and spoke model. They are combining the sales of cylinders with clinical training and in-house maintenance.
Using evidence from our portfolio to build a movement around oxygen concentrators
As the work progresses, we’ll collectively continue to make sense of the evidence emerging from our pilots within an open source evidence framework. Our aim is for this to help us learn out loud against our oxygen hypothesis and in turn point us towards the key policy changes and recommendations needed to help get concentrators on the map.
In time, we hope that through the contributions of this work, we’ll be able to tell, share and hear stories in 2030 about:
- New markets and businesses emerging that support the full oxygen service delivery chain
- Communities that know there is local oxygen access within a decent mile radius and seek healthcare accordingly
- Doctors, nurses and clinicians feeling empowered and safe to diagnose and administer oxygen therapy
- Ministries and health providers that are able to sustain oxygen access for their populations through purchasing fit-for-purpose concentrators
Follow our journey as we continue to work and learn together:
If you are on Twitter, follow @FuturesCoLab for updates
On LinkedIn you can find us on: https://www.linkedin.com/company/better-futures-colab/ Or email us at oxygen@makingbetterfutures.org
