Expanding oxygen access: Feasibility, acceptability, and implementation challenges in primary healthcare centers in Guinea and Mali

Access to oxygen in Sub-Saharan Africa faces numerous challenges, especially in rural areas where it is usually only available in hospitals. Even when low oxygen saturation is detected at the primary care level, referring patients to higher-level facilities is often complicated and time-consuming. This study assessed the feasibility and acceptability of introducing mobile filling stations for ambulatory oxygen cylinders in primary healthcare centres in Guinea and Mali. Data collection included quantitative monitoring of equipment use and maintenance; as well as qualitative interviews with health workers, patients, community representatives, and institutional representatives to assess the implementation process and acceptability. Analysis was guided by two conceptual framework. During a median monitoring period of 7 weeks per site, 29 oxygen cylinders were used, with higher usage in Mali compared to Guinea. Nearly all hypoxemic patients received oxygen. Most equipment use occurred on-site rather than during referrals. Interviews revealed that oxygen access improved patient care by enhancing local management of respiratory issues and reducing the need for hospital referrals. However, challenges included difficulties in transporting patients, concerns about long-term equipment maintenance, and the need for continuous training due to high staff turnover. Improving oxygen access at the primary care level through mobile filling stations and solar systems in Guinea and Mali demonstrates potential for better hypoxemia management. The study highlights the importance of local solutions to enhance healthcare quality in resource-limited settings. However, challenges related to equipment sustainability were identified, necessitating further research to evaluate long-term viability and cost-effectiveness.