Implementation of a national oxygen distribution network in Lesotho: a longitudinal analysis

ABSTRACT Background Despite its essential and life-saving role in the treatment of many medical conditions, access to medical oxygen remains limited in many countries. In 2021, Partners In Health established an oxygen distribution network in Lesotho to increase medical oxygen access. Methods We conducted a longitudinal analysis of the implementation of an oxygen distribution network in Lesotho from November 2022 to January 2024. Oxygen delivery data were abstracted from tracking logs and analysed in Stata. Continuous and ordinal variables were summarized by medians and ranges. Categorical variables were described using frequencies and proportions. Results Over the 15-month study period, the network expanded from 1 oxygen production hub serving 5 recipients to 4 hubs and 21 recipients located across nine of Lesotho’s ten districts. The network delivered 1,565 filled cylinders containing 9,619.23 m 3 oxygen. For the 13 recipients with inpatient beds, the median monthly volume of oxygen delivered per bed was 1.43 m 3 (IQR: 0.57 to 2.31). Conclusion This study demonstrates the feasibility and impact of an oxygen distribution network in Lesotho, providing proof-of-concept for an intervention to improve oxygen access in LMICs. By employing real-time monitoring and redundant sourcing, the network provided a reliable oxygen supply responsive to variations in demand and periods of oxygen plant downtime. This study also provides insights into facility-level oxygen consumption, which may help policymakers improve quantification and prediction of oxygen demand. Future efforts should focus on enhancing data collection, characterizing oxygen usage, and strengthening infrastructure to promote sustainable oxygen security. KEY QUESTIONS What is already known on this topic Improving access to medical oxygen is a global health priority, as underscored by World Health Assembly Resolution 76.3. Existing research has largely concentrated on facility-level interventions, establishing the impact of multifaceted strategies such as distributing oxygen concentrators, training clinicians, and strengthening supply chains. What this study adds To our knowledge, this is the first study to provide detailed prospective data on the operation of a national oxygen distribution system utilizing a novel “network” model integrating multiple production hubs. It demonstrates the feasibility and effectiveness of this approach, showing improved resilience and reliability in medical oxygen supply across a broad geographic area in a LMIC. How this study might affect research, practice or policy Our results demonstrate that oxygen distribution networks with multiple hubs can help meet regional and national oxygen demands, providing a resilient solution for strengthening oxygen ecosystems by dynamically aligning supply and demand. Additionally, these networks facilitate enhanced data collection for estimating oxygen demand, thereby informing future policy and implementation strategies.