There's something in the air

Oxygen concentrators are remarkable machines.

They suck normal room air in, pass it through special filters, and push medical-grade oxygen out. They literally create life-saving treatment out of thin air.

In rich countries in the global north, where oxygen concentrators are plentiful and work well, they are used to manage chronic respiratory conditions in peoples homes.

In the global south, it’s a different picture. Here oxygen concentrators are being used in acute life threatening situations, often administering oxygen to multiple and very sick children with pneumonia.

Oxygen concentrators rapidly break down and end up in equipment graveyards in the global south. They need a reliable power supply; they can be easily damaged if there’s a power outage. They also don’t cope very well in hot, humid weather conditions or in environments where there’s a lot of dust. The filter mechanisms can get blocked up, and the sieve beds take on moisture rendering the machine useless.

To meet this challenge we established the Oxygen CoLab, a global network to connect, support and empower key players with the aim of designing an oxygen concentrator able to cope with use in LMIC’s.

Designing a better oxygen concentrator

Over the course of several months in 2021 we ran virtual workshops focused on understanding and overcoming key oxygen concentrator design challenges: dust, power quality, and high humidity. To solve these problems the Oxygen CoLab looked at the whole journey of a concentrator: from design and manufacture, to packaging, quality control, transport, storage, user behaviour and maintenance and repair.

Our workshops enabled us to produce a set of recommendations for increasing resilience through good design. This included issues around shelf life where open valves and poor packaging were reducing the integrity of the sieve bed (the filter inside the concentrator that separates out the nitrogen from the oxygen in the air) and causing the oxygen concentration to fall below the standards required for medical grade oxygen, rendering the concentrator useless even before it’s switched on.

Nearly a quarter of primary healthcare centres in sub-Saharan Africa have no access to electricity and, even when it is available, the supply can be very unreliable. However, a truly energy efficient oxygen concentrator could run on solar energy, plus any improvement in efficiency helps hospitals manage their budgets and frees up power to be used in other ways..

The Oxygen CoLab network highlighted two main approaches to improving energy efficiency and compiled specific knowledge and ideas as to show how they might be achieved. The first was improving oxygen recovery (i.e improving the oxygen generating process to require less energy to produce more oxygen) and the second was improving the unit power efficiency of the compressor which is the most power hungry component of the concentrator system.

Commercial oxygen concentrators don’t perform well when it’s very hot or humid. The machines also tend to fail more quickly if they’re in these conditions. If the CoLab wanted to design a concentrator that could withstand the conditions in low resource settings around the world then it would need to find a way of improving their performance and longevity in hot and humid environments.

A number of recommendations for potentially improving the performance of concentrators were contoured in a focused workshop. The recommendations included improvements to the concentrator sieve beds, changes to the concentration process so as to remove moisture from the sieve bed; and pre-treatment of incoming air to make it as dry as possible before it enters the sieve bed.

More recently we have been working with UNICEF to support the development of their published Target Product Profile. We built a powerful network of over 150 innovators and manufacturers who helped to build a 'specification’ for a more resilient, energy efficient and fit-for-purpose Oxygen Concentrator through a Delphi-like process.

And, in Spring of 2022, a usability study began in Nigeria and Kenya to collect feedback from stakeholders and collate usability insights that manufacturers can use in future designs. This is now available on the UNICEF website.

Hacking technology and hacking capitalism

As well as a design evaluation the Oxygen CoLab also tackled innovations in the oxygen concentrator business model. Specifically we wanted to show that we could:

• Develop a replicable, scalable and sustainable business model
• Demonstrate demand and growing market opportunities;
• Understand the human factors and servicing needs in providing medical oxygen as a reliable and accessible service.

To achieve these aims the Oxygen CoLab established the ‘oxygen-as-a-service’ pilot scheme, which offers up to £180,000 to an individual, firm or consortium that’s able to deliver a pilot able to tackle the inevitable entrepreneurial complexities, such as:

• What is the largest market segment with the greatest growth potential and what are the needs and approval processes for those segments?
• How will maintenance be performed on the concentrators, especially as there is an absence of spare parts and skilled maintenance employees in local supply chains?
• How will they create new efficiencies in delivery, installation, and clinical training?

In 2021, after a ‘Dragon’s Den’ selection process, initial oxygen-as-a-service pilot grants were awarded to FREO2 in Tanzania, and Sanrai and Philips, both in India. We’re looking forward to sharing the learnings from each of these programmes as they develop, and you can read more about how FREO2 is piloting their O2aaS programme in Tanzania, in this article.

In the coming months we’ll also be sharing news of the next phase of oxygen-as-a-service pilots, which will be operating across DRC, Philippines, Nigeria, Kenya & Uganda.

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