| | Infrastructure |
| (1) | Two additional (beyond those planned through WHO) PSA plants in Tebnin (first priority) and Rachaya (second priority) hospitals, procured via donation and installed with filling stations for cylinders to a network of smaller facilities. The rational for these two plants is related to location (rural/mountainous area) and consumption (risk in case of LOX shortage) |
| (2) | Establishment of sustainable systems for preventative maintenance, spare parts, and quality control for the expected total of 14 PSA plants in government hospitals in the country (14 of 31 public hospitals = 45%) |
| (3) | Reliable electricity 24/7 in all health facilities. Strengthening and expansion of solar or other renewable power in facilities, plus improvements to the national electricity production and grid |
| (4) | Strengthening the resilience of the LOX supply system and reducing costs for hospitals through expansion of provision from the third LOX supplier in Lebanon, initiating a centralised negotiating system (MOPH negotiates on behalf of all hospitals); centralised supply agreements and agreements on across-supplier usage of equipment or purchase of LOX tanks and equipment for hospitals that can be used by all suppliers |
| (5) | Organizing hospitals and PSA plants in the country into networks for bulk purchasing and pooling of spare parts and for filling and transporting oxygen cylinders to smaller facilities |
| (6) | A procurement process that considers unified or compatible systems and suppliers to avoid complicated and incompatible systems across the country |
| (7) | A procurement process that considers comprehensive maintenance/service contracts, full life-cycle costs, and the disposal of equipment, for long-term sustainability of the plants |
| | Supplies |
| (8) | Specification of the supplies (equipment, consumables, and medicines) required for oxygen therapy and other emergency and critical care in all health facilities and ensuring sustainable systems for their provision including integration with the health system supply chain |
| | Training and human resources |
| (9) | Strategies for the retention and motivation of health workers so that hospitals have adequate human resources for quality oxygen, emergency, and critical care provision. This includes defining the minimum skill set required and task-sharing between cadres |
| (10) | In hospitals that already have, or will be procuring, PSA plants (and other oxygen systems), employing and retaining biomedical/other engineers/technicians well trained in maintenance and spare parts and who are stationed locally so that plants are well-maintained, and response times are rapid. This includes defining the minimum skill set required and task sharing between cadres. If the maintenance service is outsourced, implementation of a centralised decision-making and workflow process |
| (11) | Training and advocacy so clinicians are aware that 93% oxygen is as good quality as 99% oxygen for all patient groups and will not lead to worse outcomes |
| | Information |
| (12) | Systems for regular collection, digitisation, and centralised reporting and collation of data about oxygen needs and consumption in the country (including numbers of hypoxic patients, numbers of patients receiving oxygen and the flow rates, and hospital-level and producer-level consumption of oxygen) |
| (13) | An annual national inventory of oxygen plants, bedside concentrators, cylinders, and pulse oximeters, including functionality and needs for maintenance (ideally done digitally using inventory software), needs, analyses conducted at the same time and gaps filled |
| (14) | For a full understanding of the whole country’s oxygen eco-system, an assessment of the private healthcare system and the industrial environment of the LOX producers |
| | System |
| (15) | Integrate the oxygen ecosystem with PHC (including triage, acute care in PHC, adequate referrals, and home-based care) and embed oxygen equipment in existing systems for all other equipment, i.e., oxygen should not be seen as a stand-alone, vertical programme |
| (16) | Integrate oxygen therapy with improved emergency and critical care of mothers, newborns, children, and all other patients (essential emergency and critical care EECC), including the development and use of clinical guidelines |
| (17) | Implement rational prioritisation of essential health services, especially if the ongoing financial crisis results in a reduction of available resources that necessitates reduced services. Ensure that the provision of oxygen and EECC are among the highest priorities that are always maintained |
| (18) | Establish a National Oxygen Committee in MOPH to monitor and review the supply, safety, and demand of oxygen in the country and integration with all other essential health services. |
