Highlights on National Oxygen and Pulse Oximetry Scale Up in Ethiopia July 13th 2016

Pneumonia and other newborn issues are the major drivers of child mortality in Ethiopia Causes of Child Mortality The Federal Ministry of Health (FMOH) developed a National Newborn and Child Survival Strategy (2015/16 to 2019/20) Targeted reductions in child mortality: Strategy is expected to prevent deaths of 415,688 under Five and 210,234 neonates by 2020 Oxygen management is a vital component of combatting pneumonia-related issues for newborns and under five Pneumonia (18%) Asphyxia (14%) Prematurity (11%) Newborn infection (9%) Diarrhea (9%) Metric 2015 (current) 2020 (target) >5 Mortality 59 29 IMR 51 20 NMR 28 11

Ability to detect and treat hypoxemia in neonates & children is critical but there are presently significant limitations in Ethiopia Issue/Key indicator Facility %** Proportion of health facilities that have O2 consumption and stock monitoring mechanism Health Centre 3% Hospital 26% Proportion of health facilities have trained biomedical engineers/technicians to perform O2 equipment maintenance 0% 41% Proportion of facilities that think there are enough re-filling sources to meet needs 9% 47% Availability of fully functional O2 device 2% Hospital (IPD) 62% HCWs trained on O2 therapy or have SOPs/job aids on O2 use 14% Functional pulse oximeter available 45% Source: CHAI/FMOH/PFSA baseline survey Dec 2015 3

FMOH recently developed an ambitious roadmap for the national scale-up of oxygen management that builds upon existing initiatives Existing initiatives specific to O2/POx Ambitious targets in the current national oxygen roadmap O2 equipment, pulse oximeters, and related supplies listed in national equipment and emergency medicines list Pulse oximeters and O2 concentrators available at hospital level only Health centers have been supplied with O2 cylinders in the last 3 years but functionality has been significantly low One functional public O2 plant with two more plants currently under construction However, no clear policies and implementation tools in place to prioritize oxygen management and pulse oximetry on a national scale All health centers in the country (~3,800) to be equipped with oxygen concentrators by 2019 All health centers to start using pulse oximetry by the end of 2018 All health posts (~17,000) to be equipped with appropriate pulse oximetry by 2020 Comprehensive implementation of pulse oximetry and oxygen management at all hospitals (~800) by the end of 2018 Construction and operationalization of O2 plants in at least 13 referral hospitals by 2020

Increasing sustainable funding to support oxygen supply systems The road map has targeted six key implementation areas that require coordinated support from all stakeholders 1 2 3 Provide policy basis and decision support to health facilities to scale up oxygen supply Set up and roll out supply and logistics chain systems for oxygen supply Ensure sustainable supplies for hypoxemia diagnostics and related consumables 4 5 6 Establish a mechanism for maintenance of oxygen equipment and supply of spare parts Institute a system of building capacity of HCWs on utilization of oxygen Increasing sustainable funding to support oxygen supply systems

Human resource training, mentoring and SS While detail implementation plan and specific areas of support are refined, FMOH will most likely need support from IPs and donors around below gaps: Human resource training, mentoring and SS Training/sensitization on utilization Training/sensitization on program management Biomedical engineering /maintenance training FMOH encourages integrations into existing systems Establishing systems and capacity for distribution and refilling Sustainable systems and capacity for maintenance Market shaping around O2 devices including O2 plants Financing for technology procurement/establishment