Oxygen therapy for newborn, child, and maternal health

Oxygen is essential: a policy and advocacy primer

This primer helps advocates and decision-makers understand the need for strengthening oxygen delivery systems and how it can be done—even with limited resources. It provides materials intended to help advocates and decision-makers understand the planning, policies, and technologies involved in oxygen delivery scale-up. It showcases a successful example of oxygen policy planning from Ethiopia, and provides guiding questions for decision-makers considering a national or subnational scale-up effort of their own. A messaging map, including a compilation of key messages, provides the most effective talking points about the need for oxygen and how to increase access to this essential treatment.

Who is this primer for?

Advocates: Anyone aiming to increase access to oxygen delivery systems by influencing decision-makers to act in support of this goal. Advocates can include civil society representatives, technical experts, academia, community members, religious and community leaders, and members of the media, among others. Decision-makers are also important advocates.

Decision-makers: People with the authority to make improved access to oxygen delivery systems a reality through supportive policymaking and implementation—including funding, regulations, and laws. This might include officials from the ministry of health or finance, parliamentarians, regional health leaders, or district health committee members, among others.

Primer materials

Oxygen Is Essential: A Policy and Advocacy Primer – Entire document

Table of contents:

  • Oxygen Is Essential: An Issue Brief
    • What is oxygen therapy, and why access to oxygen delivery systems is important. Go to the resource.
  • Oxygen Is Essential: A Policy Brief
    • Strategies, benefits, and challenges for integration of oxygen delivery into existing policies and programs. Go to the resource.
  • Global Guidelines for Shaping National Oxygen Policy
    • Synthesis of the latest global normative guidelines for safe oxygen therapy requirements and use. Go to the resource.
  • Oxygen Technologies and Supplies
    • Review of the various oxygen technologies and supplies needed to delivery and monitor oxygen therapy in health facilities. Go to the resource.
  • Guiding Questions for Oxygen Scale-up
    • Eight essential questions to help decision-makers lay the foundation for national and subnational oxygen scale-up strategy. Go to the resource.
  • Mapping a Future for Oxygen Access for All: Ethiopia’s Experience
    • A case study of Ethiopia’s experience developing and implementing an oxygen scale-up road map. Go to the resource.
  • Oxygen Messaging Map
    • Key messages to help advocates clearly communicate the problem and locally-relevant solutions to civic and government leaders, policymakers, and other stakeholders. Go to the resource.


Below, is a list of key references and resources used to support the data included in the primer:

  • Catto AG, Zgaga L, Theodoratou E, Huda T, Nair H, El Arifeen S, et al. An evaluation of oxygen systems for treatment of childhood pneumonia. BMC Public Health. 2011;11(Suppl 3):S28.
  • Decormier Plosky W, Stover J, Winfrey B. The Lives Saved Tool: a computer program for making child survival projections. Spectrum system of policy models. Baltimore, MD: Institute for International Programs at Johns Hopkins Bloomberg School of Public Health; 2011.
  • Djelantik IG, Gessner BD, Sutanto A, Steinhoff M, Linehan M, Moulton LH, et al. Case fatality proportions and predictive factors for mortality among children hospitalized with severe pneumonia in a rural developing country setting. J Trop Pediatr. 2003;49(6):327–32.
  • Duke T, Wandi F, Jonathan M, et al. Improved oxygen systems for childhood pneumonia: a multihospital effectiveness study in Papua New Guinea. The Lancet. 2008;372(9646):1328–1333. doi:10.1016/S0140-6736(08)61164-2.
  • Duke T, Graham SM, Cherian MN, Ginsberg AS, English M, Howie S, Peel D, Enarson PM, Wilson IH, Were WM; Union Oxygen Systems Working Group. Oxygen is an essential medicine: a call for international action. Int J Tuberc Lung Dis. 2010;14(11):1362–8.
  • Enarson PM, Gie R, Enarson DA, Mwansambo C. Development and implementation of a national programme for the management of severe and very severe pneumonia in children in Malawi. PLoS Med. 2009 Nov 10;6(11):e1000137.
  • Federal Ministry of Health, Ethiopia. (2016). National Medical Oxygen and Pulse Oximetry Scale Up Road Map (2016-2020/21). Available at: https://www.medbox.org/et-policies-others/national-medical-oxygen-and-pulse-oximetry-scale-up-road-map-2016-202121/preview? Accessed November 21, 2017.
  • Floyd J, Wu L, Hay Burgess D, Izadnegahdar R, Mukanga D, Ghani AC. Evaluating the impact of pulse oximetry on childhood pneumonia mortality in resource-poor settings. Nature. 2015;528(7580):S53–9. doi: 10.1038/nature16043.
  • Graham H, Tosif S, Gray A, Qazi S, Campbell H, Peel D, McPake B, Duke T. Providing oxygen to children in hospitals: a realist review. Context. 2017 Apr 1;95(4). Available at: http://www.who.int/bulletin/volumes/95/4/16-186676.pdf.
  • Holmer H, Oyerinde K, Meara JG, Gillies R, Liljestrand J, Hagander L. The global met need for emergency obstetric care: a systematic review. BJOG 2015;122:183–189.
  • Liu L, Oza S, Hogan D, Chu Y, Perin J, Zhu J, Lawn JE, Cousens S, Mathers C, Black RE. Global, regional, and national causes of child mortality in 2000–15, an updated systematic analysis with implications for the Sustainable Development Goals. Lancet. 2016;388(10063):3027-35. doi: 10.1016/S0140-6736(16)31593-8.
  • Marchant T, Bryce J, Victora C, Moran AC, Claeson M, Requejo J, et al. Improved measurement for mothers, newborns and children in the era of the Sustainable Development Goals. J Glob Health.2016;6(1):010506.
  • PATH. Essential medicines selection: Oxygen (New indication – hypoxaemia) – EML and EMLc page. World Health Organization website. Available at: www.who.int/selection_medicines/committees/expert/21/applications/oxygen/en/. Accessed June 22, 2017.
  • Subhi R, Adamson M, Campbell H, Weber M, Smith K, Duke T; Hypoxaemia in Developing Countries Study Group. The prevalence of hypoxaemia among ill children in developing countries: a systematic review. Lancet Infect Dis. 2009;9(4):219–27
  • United Nations Children’s Fund (UNICEF), World Health Organization, World Bank, United Nations Population Division. Levels & trends in child mortality: report 2015. New York: UNICEF; 2015.
  • Vo D, Cherian MN, Bianchi S, Noël L, Lunde G, Lundeg G, et al. Anesthesia capacity in 22 low and middle income countries. J Anesth Clin Res. 2012;3(4):1000207.
  • World Health Organization. (2017). Child mortality fact sheet. Available at: http://www.who.int/mediacentre/factsheets/fs178/en/ Accessed June 22, 2017.
  • World Health Organization. (2016). Maternal mortality fact sheet. Available at: http://www.who.int/mediacentre/factsheets/fs348/en/ Accessed November 21, 2017.

Please direct any questions, comments, and feedback on the primer to advocacyandpolicy@path.org.