East Africa Program on Oxygen Access (EAPOA)
Summary
In 2024, Unitaid and its partners committed to improve equitable access to medical oxygen, particularly liquid oxygen, in Kenya, Tanzania, Malawi, Mozambique, Uganda, and Zambia. Through a public-private partnership with local manufacturers, the commitment scales local production capacity of medical liquid oxygen, expands in-country distribution capabilities, and increases availability and affordability of medical liquid oxygen to benefit approximately 1.7 million individuals by 2027.
Unitaid is supporting the project through an investment of $22 million, and MedAccess is providing loans and volume guarantees as part of the blended financing approach. Three local manufacturers, Hewatele (Kenya) , Synergy (Kenya) , and TOL Gases Limited (Tanzania) , are expanding production, storage, and liquid oxygen distribution capacity to increase access to oxygen across East Africa, making an additional commitment of funds for these efforts. The Clinton Health Access Initiative is leading implementation with the support of PATH and focusing on meaningful engagement with community and civil society for better oxygen access.
Approach
Unitaid and its partners are making a commitment to address the critical need for improved and equitable access to medical oxygen, particularly liquid oxygen, in low- and middle-income countries, with a focus on sub-Saharan Africa.
The project aims to support the medical liquid oxygen sector, enhance competition, and foster demand, especially by collaborating with the private sector more inclined towards the medical market. Key objectives include: scaling-up production capacity of medical liquid oxygen, with a commitment to supply to public procurers at more affordable prices; expanding distribution capabilities of medical liquid oxygen through foundational investments in innovative storage and delivery solutions, and increasing availability and affordability of medical liquid oxygen in sub-Saharan Africa, benefiting approximately 1.6million individuals over the next three years.
Unitaid will support the project through an investment of $22 million USD. CHAI will lead implementation with the support of PATH, which will focus on meaningful engagement with community and civil society for better oxygen access. Three local manufacturers, Hewatele (Kenya) , Synergy (Kenya) , and TOL Gases Limited (Tanzania) , will expand production, storage, and liquid oxygen distribution capacity, intended to increase access to oxygen across East Africa, making an additional commitment of funds for these efforts. MedAccess is offering loans and volume guarantees as part of the blended financing approach.
The project will focus on three main aspects to ensure its long-term viability —well-placed infrastructure selected in partnership with ministries of health, longer-term budgeting for liquid oxygen supply, and grant/loan/volume guarantees available to companies—which aim to facilitate lower pricing, patient access, and regular payment for services in the long-term.
This Commitment will be initially implemented in Kenya, Tanzania, Malawi, Mozambique, Uganda, and Zambia, with the goal of scaling to additional countries in East and Southern Africa.
Action Plan
Year 1 (2024 to 2025) :
Q2-Q3 2024:
Agreements finalized between MedAccess and Hewatele, Synergy and TOL, inclusive of pricing, quality expectations, and volume guarantee arrangements.
Q4 2024:
Industry Stakeholder Engagement Group established
Procurement plans/reports for ASU purchase, installation, and commissioning developed
Final list of spoke countries
Baseline facility assessment finalized
Year 2 (2025 to 2026) :
Q1 2025:
Price targets, volume guarantee amounts agreed and contracts signed with Hewatele, Synergy, and TOL
Finalized monitoring mechanisms and signed MOUs with price ceiling and production targets
Q2 2025:
Report on estimated needs, price ceiling and production target for the hub countries
Final list of health facilities for LOX supply in hub countries
Market shaping strategy for private and faith-based health facilities
Q3 2025:
Finalized community and civil society engagement strategy for hub countries (timing for spoke country strategy tbc) Community advisory board developed (and bi-annual meetings) Q4 2025:
Market assessment and estimation of needs in spoke countries
Final list of health facilities for LOX supply in spoke countries
Year 3 (2026 to 2027) :
Q1 2026
Executed purchase of the identified equipment or services
Q2 2026
Finalized equipment and infrastructure procurements, along with maintenance and servicing needs
Q3 2026
Finalized strategies for the public health sector in Kenya and Tanzania markets
Finalized strategies for faith-based (FBO) and private sector medical market for each local manufacturer.
Market assessments of spoke countries outside the consortium’s existing knowledge
Developed case studies and advocacy papers to showcase price reductions and overall impact with LOX Capacity building of identified CSOs/CSO Coalitions
Convene trainings and assessments to facilitate the use and expansion of LOX
Q4 2026:
Implementation plan with delivery and distribution network finalized
Year 4 (2027 to 2028) :
Q1 2027
Finalized report on health and economic impact from the project
Document the most impactful innovations and interventions
Q2 2027
Prepare advocacy reports and presentations for further uptake within the LMIC community
Conduct a workshop/meeting to advocate for medical oxygen as a global health priority
Background
Medical oxygen is essential for treating hypoxemia, a dangerous drop in blood oxygen levels caused by various medical conditions. Recognized by the World Health Organization (WHO) as an essential medicine, oxygen is vital for achieving health-related Sustainable Development Goals (SDGs) . It is crucial in obstetric care, neonatal and child survival, chronic disease management, emergency and critical care; and routine surgical practices and pandemic preparedness.
Hypoxemia affects 1 in 6 sick newborns and hospitalized children worldwide, particularly in low- and middle-income countries (LMICs) , according to a 2019 E Clinical Medicine Journal study. This condition, exacerbated by respiratory infections, preterm birth, and surgeries, can increase the risk of death up to seven times, a 2015 review in PLoS One found. Pediatric pneumonia, the leading cause of death in children under 5, contributes to 8.5 million hypoxemia cases annually in low- and middle-income countries, according to a 2022 Lancet study. The COVID-19 pandemic highlighted the need for oxygen, doubling its demand and exposing disparities in access between high- and low- and middle-income countries. Efforts by organizations like the Clinton Health Access Initiative (CHAI) and PATH have shown improving oxygen supply systems can halve in-hospital deaths from childhood pneumonia and reduce overall child mortality by 25 percent.
Yet equitable access to oxygen remains a challenge in LMICs due to a lack of skilled workforce, inadequate infrastructure, and fragmented supply chains. Additional obstacles include insufficient financing, limited policy support, regulatory constraints, and a scarcity of data for effective management.
Liquid oxygen can improve sustainable, affordable access in LMICs. It can be produced locally or regionally, procured cost-effectively, and managed by health facilities. However, liquid oxygen production is not as prevalent in these countries, leading to less access and higher costs than wealthier settings enjoy. Industrial gas companies do not have the same access to capital to expand production and delivery, creating a market trap of low volumes and higher pricing, making it less attractive to ministries of health.
Progress Update
Partnership Opportunities
The project represents a first-of-its-kind intervention in Africa to transform access to medical oxygen through blended financing to accelerate and expand regional manufacturing and distribution of liquid oxygen. Unitaid is seeking additional financing and partnerships to (1) Increase the impact of the project by further expanding liquid oxygen production, storage, and delivery capabilities beyond what is possible with the available grant funding and complementary financial instruments of MedAccess – the project has been designed to fit within the available funding envelope vs. what could be achieved with the ideal funding amount (2) Expand liquid oxygen regional production to West Africa and other underserved regions by replicating the project’s transformational blueprint. Additional support and partnerships will enable future scale-up to countries, including Ethiopia, Rwanda, and Uganda, Burundi, Madagascar, Somalia, South Sudan, and Zimbabwe., Unitaid is a global leader in building sustainable, reliable and affordable access to medical oxygen and oxygen equipment in low- and middle-income countries. Increasing access to oxygen is more than simply increasing supply; Unitaid’s market-shaping approach entails collaborating with partners to introduce innovations such as better quality, more affordable oxygen delivery systems; strengthen health security by building regional oxygen production capabilities; create healthy competitive markets by negotiating lower prices with existing suppliers; facilitate skills transfer and training for emerging suppliers to meet quality standards and further lowering prices and creating more competitive markets; and to support governments and health facilities to determine the most appropriate oxygen system for their needs.