A government-led approach to increasing access to oxygen in Nigeria

At Barau Dikko Teaching Hospital in Kaduna state of Nigeria, a nurse checks on a four-year-old child who was admitted for severe pneumonia. Luckily, lifesaving oxygen is available at this hospital, allowing him to make a full recovery. In Kano state, a three-year-old arrives at a hospital with signs of severe pneumonia and struggling to breath. With oxygen, he could have survived, but the hospital did not have any available. This is the case for far too many children in Nigeria.

A nurse administers oxygen to a young boy in Barau Dikko.

Pneumonia is the leading killer of children globally, responsible for over 900,000 deaths each year. This infection causes a patient’s lungs to fill with fluid, making it difficult for them to breathe. In some cases, this can result in a complication called hypoxemia—extremely low levels of oxygen in the blood—putting the patient at an even greater risk of death. While correct diagnosis of both pneumonia and hypoxemia, followed by prompt treatment including oxygen therapy, are essential for preventing these deaths, this often does not happen.

In 2016, CHAI worked with the Government of Nigeria to better understand the availability of oxygen and pulse oximeters (a device used to diagnose hypoxemia and measure oxygen levels in the blood) in health facilities. Of 169 hospitals assessed in eight states, only 55 percent provided oxygen therapy – this figure was even lower (17 percent) in pediatric wards. Pulse oximeters were only found in 11 percent of hospitals.

CHAI is working with the Government of Nigeria to expand access to life-saving oxygen therapy – especially for children. Since 2016, the Government of Nigeria has demonstrated their commitment to increase access to oxygen and, with CHAI’s support, has achieved important milestones that will help drive progress throughout the country. As a first step, the government updated national policies and guidelines to emphasize the importance of oxygen and pulse oximetry for managing patients with hypoxemia.

This week, the government launched its first-ever National Strategy for the Scale-up of Medical Oxygen in Health Facilities , outlining a vision to ensure that all patients who need oxygen receive it. “We are committed to reducing deaths due to hypoxemia and improving patient outcomes. Coordination of efforts across all levels of care is needed to address barriers limiting access to medical oxygen in health facilities in Nigeria”, said Professor Isaac Adewole, Honorable Minister of Health, Nigeria at the 60th National Council on Health meeting held in Ogun state. This strategy provides a framework that can be followed by government departments, hospital staff, and other key decision makers to achieve this goal.

Furthermore, CHAI has partnered with the government in three states with high rates of childhood deaths from pneumonia—Kano, Kaduna, and Niger—to provide dedicated support to hospitals, including providing technical support to states in the evaluation, selection, and purchase of new, quality oxygen equipment. The focus now is on making sure this new equipment is successfully installed and maintained and that staff know how to use it.

Oxygen is unlike other simple therapies since it is administered to patients through special equipment, each consisting of different parts and components (like tubing, filters, and catheters), requiring close and careful monitoring from hospital staff. To address this, the program provided a five-day, hands-on training for biomedical engineers and technicians who are responsible for ongoing maintenance and general repairs of oxygen equipment in hospitals. The training covered a range of topics—from electrical basics, to oxygen hazards and safety, to the mechanics of oxygen delivery devices and generators for continuous power supply.

Engineers troubleshoot broken oxygen equipment during a training in Lagos.

Engineer Dauda Jatau traveled from Kaduna to Lagos—a seven hour journey—to attend a training at a major teaching hospital. He walked away, eager to apply his new skills: “I have some broken concentrators in my workshop which I didn’t know how to fix. With the new manual we received in training, I will go back to my facility, troubleshoot, and fix those concentrators.”

In the emergency pediatric unit of Barau Dikko Teaching Hospital, 80 percent of the concentrators were found to deliver oxygen at very low, less than recommended, concentrations. Following routine maintenance and repair from a trained engineer, all concentrators have since been working optimally.

Health care workers also play a critical role. Dr. Lawal Haliru, a consultant pediatrician at Barau Dikko Teaching Hospital, also participated in a separate three-day training designed for doctors and nurses. He was excited about the potential to improve the quality of care for patients in his hospital: “We’re very confident that, after the training, we will be more enlightened and skilled to administer oxygen and manage patients with pneumonia.”
The enthusiasm from the government and hospital staff in Nigeria for improving oxygen delivery is inspiring.

Moving forward, it will take a closely coordinated, multi-disciplinary effort, as well as additional interactions between newly trained healthcare workers and their supervisors to entrench correct behaviors and best practices into the existing system. This will allow patients visiting these health facilities to benefit from the new oxygen equipment for many years to come in Kano, Kaduna, and Niger states. Ongoing leadership from the government and additional support from development partners, the private sector, and other stakeholders, will be equally important for extending these benefits to other facilities and states in the country.

At a special event held in honor of this year’s World Pneumonia Day, the Government of Nigeria joined the Every Breath Counts Coalition, a new public-private partnership to end child pneumonia deaths by 2030—providing the platform for Nigeria to connect with a range of organizations and innovative solutions. Specifically, the government pledged a commitment to launch United4Oyxgen to accelerate national efforts to scale up oxygen: “We’re honored to have the opportunity to contribute to the coalition through our partnership with the United4Oxygen Alliance…We look forward to working with the coalition to achieve the vision of the new National Strategy and ultimately end preventable child pneumonia deaths in Nigeria” said Dr. Ngozi Onwudiwe, Director, Federal Medical Centres, Federal Ministry of Health Nigeria.

Strengthening the system and building the capacity of governments and local staff in these states has potential to save hundreds of thousands of lives each year. For the next young child admitted with hypoxemia to Barau Dikko Teaching Hospital—or the neighboring hospitals—it won’t just be luck that determines whether or not he or she receives oxygen. It will be the new standard of care.

A pulse oximeter is used to measure oxygen levels in the blood.