For years, many health facilities in Ethiopia struggled with chronic shortages of medical oxygen. A 2016 assessment of over 100 hospitals showed that only 62 percent had oxygen access in their In-patient Pediatric Department (IPD), and fewer than half (45%) had pulse oximeters to monitor patients’ oxygen levels. With suppliers often hundreds of miles away, transportation costs soared, stockouts were frequent, and healthcare workers struggled to treat patients for conditions that would be manageable with the right resources.
Today, the landscape has changed dramatically. From just three oxygen plants in 2016, Ethiopia now boasts 55 production facilities—a staggering 1,733 percent increase. This remarkable evolution didn’t happen by chance. It’s the story of strategic partnerships, targeted interventions, and a government-led commitment to improve healthcare for millions of Ethiopians.
A national roadmap for oxygen access
In 2016, CHAI began working with the Ethiopian government to develop its first national oxygen roadmap, laying the groundwork to address the critical oxygen shortage in the country. The plan focused on more than just buying the right equipment—it aimed to build a sustainable system. New policies and guidelines were established, healthcare workers received specialized training in diagnosing and treating hypoxemia, and critical equipment was distributed to facilities nationwide.
By 2019, the results were clear. Oxygen was available in all in-patient pediatric departments within the program’s scope, and pulse oximeter availability skyrocketed from 45 percent to 96 percent. Clinical practices improved dramatically, with pulse oximeter use at diagnosis jumping from 10 percent to 75 percent.
COVID-19: A head start during a global emergency
PSA plant commissioning at Tikur Anbessa Specialized Hospital
When the COVID-19 pandemic hit, the need for oxygen surged beyond capacity. But prior investments gave Ethiopia a head start.
The Ministry of Health quickly converted Addis Ababa’s Millennium Hall, the country’s largest multi-purpose event venue, into a 1,000-bed COVID treatment center. CHAI and the Gates Foundation supported the installation of an oxygen pipeline and manifold system for 130 beds and trained over 2,000 health workers.
Still, this met only 10 percent of demand. The government procured two more oxygen plants with CHAI’s help, increasing supply by 40-60 percent when pandemic-related oxygen demand peaked. These efforts paid off.
The hub-and-spoke model: oxygen within reach
As Ethiopia emerged from the acute phase of the pandemic, CHAI continued to work closely with the government on building more resilient and accessible oxygen systems, which could treat a variety of conditions—from pneumonia to severe tuberculosis to pregnant women with obstetric complications, and newborns with respiratory distress. The solution came in the form of a “hub-and-spoke model” for oxygen distribution—a concept as simple as it is effective.
Bedside oxygen tanks at Bonga Hospital ICU
Imagine a bicycle wheel: at the center is the hub (a hospital with an oxygen production plant), and extending outward are the spokes (smaller healthcare facilities that need oxygen). Instead of each facility trying to source oxygen independently from distant suppliers, the hub-and-spoke model designates oxygen production centers as central hubs that supply surrounding facilities.
This approach dramatically reduces logistical challenges and ensures more consistent oxygen access. For example, before the hub-and-spoke model, Dilfana Primary Hospital had to source oxygen from Addis Ababa, more than 400 kilometers away. Transportation alone costs a fortune, and delays were common. Now, the hospital gets its oxygen from Arbaminch General Hospital, just 5 kilometers away—reducing costs, minimizing delays, and ultimately saving lives. The hub-and-spoke model is being expanded across the country.
Over the last five years, with funding from the Global Fund and Unitaid, CHAI has facilitated the procurement and installation of 14 additional PSA plants, strategically placed to serve as regional hubs. Each plant is sized not just to meet its host hospital’s needs but to supply neighboring facilities. This strategic placement has extended reliable oxygen access to approximately 58 million people—almost half of Ethiopia’s population. Additional funding from Helmsley Charitable Trust has been critical in transforming more spoke facilities to hubs.
Equipping facilities and training health workers
Reliable oxygen supply is only one part of the solution. For the hub-and-spoke model to work effectively, the “spoke” facilities needed proper equipment to store, transport, and administer oxygen. In January 2025, with US$1.8 million in funding from the Helmsley Charitable Trust and ELMA, 911 health facilities across Ethiopia received essential equipment—oxygen cylinders, concentrators, pulse oximeters, and analyzers.
In hospitals within Hadiya Zone in South Ethiopia Region, healthcare workers installed flow splitters that allowed multiple patients to benefit from a single oxygen concentrator—a simple innovation with profound impact.
Oxygen plant pipeline outlets in NICU at Bonga Hospital
Meanwhile, more than 5,000 healthcare workers across 14 regions have been trained on oxygen therapy management. CHAI partnered with the Ministry of Health to develop continuing professional development materials to facilitate the trainings.
At Gorey Health Center, newly trained staff treated patients including neonates using newly available oxygen therapy. These cases demonstrate the real-world impact of comprehensive oxygen system improvements.
The sustainability factor
To maintain these gains, CHAI has supported the development of an Oxygen Sustainable Financing Directive, now approved in nine regions. Spoke facilities pay hubs for medical oxygen, and hub facilities pay as part of revenue generation and sustainability efforts. This innovative approach allocates revenue from oxygen plants to fund maintenance, spare parts, and repairs.
A blueprint for other countries
Bonga Hospital pressure swing adsorption (PSA) oxygen plant
Ethiopia’s oxygen transformation shows what’s possible when government, technical partners, donors, and communities work together. The progress—from three to 55 oxygen plants, equipment distribution to 911 facilities, and oxygen access for millions—goes beyond numbers. It’s a blueprint for countries facing similar challenges.
The hub-and-spoke model, in particular, offers valuable lessons. By strategically placing production facilities and optimizing distribution networks, countries can maximize the impact of their investments in medical oxygen.
Ethiopia’s approach shows the importance of building systems that can withstand crises, investing in both infrastructure and human capacity, and keeping sustainability at the forefront. This comprehensive strategy has created lasting change through thoughtful, systematic approaches to critical healthcare challenges.
