尽管世界卫生组织（WHO）在2017年将医用氧气称为必不可少的医学，但在所有护理环境中仍未始终使用氧气。医用氧气的短缺对于手术，肺炎，创伤和其他低氧疾病至关重要，存在于弱势群体中prior to the COVID-19 pandemic and persist today. By one estimate, pre-pandemic, only20% of patients在低收入和中等收入国家（LMIC）中，需要医疗氧气就会接受。大流行极大地增加了对氧气的需求，随着氧气成为必不可少的治疗，进一步的复合进入问题。金博宝正规网址在大流行的高峰期，由于患者潮流影响已经脆弱的基础设施，数十个国家面临严重的氧气短缺。
这一挑战的核心驱动力不是缺乏资金和国际关注，而是缺乏购买氧气的基础设施，而不仅仅是设备。尽管组织，Bill＆Melinda Gates Foundation，Clinton Health Access倡议，联合国儿童基金会，他和美国国际发展机构（USAID）优先考虑医疗氧气的资金和规定，许多国家仍然面临重大短缺，但仍面临严重的短缺。甚至更少的LMIC，例如巴西，真正的氧气自给自足。在设计阶段，无意间的全球氧递送基础设施无意间排除了低收入和农村地区代表。此外，当前的交付基础设施由许多个人资助者以及私人和公共利益相关者组成，他们不以协调的方式工作，因为没有全球管理机构来建立全球政策，标准和监督；识别浪费和冗余；并确保自给自足的途径。As a result, LMICs are at the mercy of other nations and entities who may withhold oxygen during a crisis or fail to adequately distribute supply. It is time for aid organizations and governments to become more efficient and effective at solving this systemic problem by establishing global governance and investing in and enabling LMICs to become self-sufficient by establishing national infrastructure for oxygen generation, distribution, and delivery.
We propose transforming current interventions by centering the concept known asOxygen as a Utility（OAAU）从根本上重新构想了一个国家的医疗氧基础设施作为公共公用事业，并由私人投资和稳定的价格支持，以创建一个可行，公平的市场，以实现必要的公共卫生。随着白宫的共同响应团队在未来几个月内关闭，美国国际开发署的全球卫生局has a unique opportunity to take a global leadership role in spearheading the development of an accessible, affordable oxygen marketplace. USAID should convene a global public-private partnership and governing coalition called the Universal Oxygen Coalition (UOC), pilot the OaaU model in at least two target LMICs (Tanzania and Uttar Pradesh, India), and launch a Medical Oxygen Grand Challenge to enable necessary technological and infrastructure innovation.
For every COVID-19 patient who needs oxygen, there are at least five other patients who also need it, including the 7.2 million children with pneumonia who enter LMIC hospitals each year. [Ehsanur et al, 2021]. Where it is available, there are often improperly balanced oxygen distribution networks, such as high-density areas being overstocked while rural areas or tertiary care settings go underserved. OnlyLMICS中10％的医院有能力获得脉搏血氧仪和氧气治疗，这些资源更好的医院往往在更接近现有的氧气递送提供者的较大城市中。
This widespread lack of access to medical oxygen in LMICs threatens health outcomes and well-being, particularly for rural and low-income populations. The primary obstacle to equitable oxygen access is lack of the necessary digital infrastructure in-country. Digital infrastructure provides insights that enable health system managers and policymakers to effectively establish policy, manage the supply of oxygen to meet needs, and coordinate work across a complex supply chain composed of various independent providers.在建立可复制且负担得起的数字基础设施之前，LMIC将没有必要的资源来管理国家氧气输送系统，预测需求，计划适当的氧气生产和采购，保障公平分配并确保可持续消费。
Common contributing causes for fragmented oxygen delivery systems in LMICs include:
- No national digital infrastructure连接，跟踪和监视医疗氧气供应和利用，例如预测需求并确保提供可靠的服务提供的电力。
- No centralized way to monitor manufacturers, distributors,以及各种交付提供商，以确保协调和遵守当地政策。
- In many cases,没有建立氧气和医疗保健法规的地方政策or no means to enforce local policy.
- Lack of purchasing optionsfor healthcare providers, who are often forced to buy whichever oxygen devices are available versus the type of source oxygen that best fits their needs (i.e., concentrator or liquid) due to cumbersome tender systems and lack of coordination across markets.
- 缺乏训练有素的专家来维护和维修设备，including limited national standardized certification programs, resulting in the premature disposal of costly medical devices contributing to waste issues. Further, lack of maintenance fuels the vicious cycle of LMICs requiring more regular funding to buy oxygen devices, which can increase reliance on third parties to sustain oxygen needs rather than domestic demand and marketplaces.
医用氧气投资是实现全球健康成果和本地化政策目标的独特机会。美国国际开发署投资5,000万美元以扩大医疗氧气通道通过其global COVID-19 response for LMIC partners, but this investment only scratches the surface of what is needed to deliver self-sustainment. In response to oxygen shortages during the peaks of the pandemic, the WHO, UNICEF, the World Bank, and other donors shipped hundreds of thousands of oxygen concentrators to help LMICs deal with the rise in oxygen needs. This influx of resources addressed the interim need but did not solve the persisting healthcare system and underlying oxygen infrastructure problems. In 2021, the World Bank made emergency loans available to LMICs to help them shore up production and infrastructure capabilities, but not enough countries applied for these loans, as the barriers to solve these infrastructure issues are complex, difficult to identify without proper data and digital infrastructure to identify supply chain gaps, and hard to solve with a single cash loan.
美国国际开发署最近宣布an expanded commitmentin Africa and Asia to expand medical oxygen access, including market-shaping activities and partnerships. Since the pandemic began, USAID has directed $112 million in funding for medical oxygen to 50 countries and is the largest donor to The Global Fund, which has provided the largest international sums of money (more than $600 million) to increase medical oxygen access in over 80 countries. In response to the pandemic’s impacts on LMICs, theACT-ACCELERATOR（ACAT-A）氧气紧急工作队，由Unitaid和Wellcome Trust共同主持，已提供7亿美元氧气供应供应75多个国家，并催化大型氧气供应商和非政府组织领导者支持LMIC和国家医疗部。这个工作队汇集了行业，慈善事业，非政府组织和学术领导者。尽管美国国际开发署不是直接合作伙伴，但全球基金是工作队的主要捐助者。
需要初始投资来在每个LMIC中创建永久性氧基础架构，以将招标系统从设备和服务或实物辅助模型转变为购买氧气作为实用工具模型。该规模的行业业务模型转型将需要多方利益相关者的努力来包括国内协调。当前的氧气输送基础设施由许多不以协调方式工作的个人资助者以及许多个人资助者和公共利益相关者组成。在这项关键的医疗氧气供应时，美国国际开发署的召集能力，捐助者的支持和专业知识应得到利用，以更好地指导这笔支出以创造创新的机会。这普遍的氧气将建立全球联盟policy, standards, and oversight; identify waste and redundancy; and ensure viable paths to oxygen self-sufficiency in LMICs. The UOC will act similarly to electric cooperatives, which aggregate supplies to meet electricity demand, ensuring every patient has access to oxygen, on demand, at the point of care, no matter where in the world they live.
Plan of Action
为了使管家和催化OAAU，美国国际开发署应利用其全球平台来召集资助者，供应商，制造商，分销商，卫生系统，金融合作伙伴，慈善事业和非政府组织，并发起呼吁采取行动以动员资源并引起医疗氧气不平等。美国国际开发署全球卫生局, along with the its私营部门的联系点，以及国务院的Office of Global Partnershipsshould spearhead the UOC coalition. Using USAID’s Private Sector Engagement Strategy andEDGE fundas a model, USAID can serve as a connector, catalyzer, and lead implementer in reforming the global medical oxygen marketplace. The Bureau for Global Health should organize the initial summit, calls to action, and burgeoning UOC coalition because of its expertise and connections in the field. We anticipate that the UOC would require staff time and resources, which could be funded by a combination of private and philanthropic funding from UOC members in addition to some USAID resources.
To achieve the UOC vision, multiple sources of funding could be leveraged in addition to Congressional appropriation. In 2022, State Department and USAID funding for global health programs, through the Global Health Programs (GHP) account, which represents the bulk of global health assistance, totaled $9.8 billion, an increase of $634 million above the FY21 enacted level. In combination with USAID’s leading investments in The Global Fund, USAID could deploy existing authorities and funding from发展创新企业（DIV）and leverage Grand Challenge models like出生时挽救生命to create innovation incentive awards already authorized by Congress, or the newly announced边缘基金专注于灵活的公私部门合作伙伴关系，将资源指向所有人获得公平的氧气获取。这些变革性投资还将为诸如本地化之类的美国国际开发署政策优先事项提供服务。UOC将与美国国际开发署和每一个呼吸计数通过将基本的参与者（卫生系统，氧气供应商，制造商和/或分销商以及金融合作伙伴）带入统一的整体方法来确保可靠的氧气提供和可持续的基础设施支持来重新构想这个持久的问题。
Recommendation 1. USAID’s Bureau for Global Health should convene the Universal Oxygen Coalition Summit to issue an OaaU co-financing call to action and establish a global governing body.
全球卫生局应组织峰会，召集UOC联盟，并发出呼吁为OAAU的国家飞行员提供诉讼。UOC联盟应将LMIC政府召集在一起；地方，区域和全球私营部门医疗氧提供者；本地服务和维护公司；设备制造商和分销商；卫生系统；私人与发展金融；慈善组织；全球健康非政府组织社区；卫生部； and in-country faith-based organizations.
一旦完全建立,UOC大学会邀请印度河try coalition members to join to ensure equal and fair representation across the medical oxygen delivery care continuum. Potential industry members include Air Liquide, Linde, Philips, CHART, Praxair, Gulf Cryo, Air Products, International Futures, AFROX, SAROS, and GCE. Public and multilateral institutions should include the World Bank, World Health Organization, UNICEF, USAID country missions and leaders from the Bureau for Global Health, and selected country Ministries of Health. Funders such as Rockefeller Foundation, Unitaid, Bill & Melinda Gates Foundation, Clinton Health Access Initiative, and Wellcome Trust, as well as leading social enterprises and experts in the oxygen field such as Hewatele and PATH, should also be included.
UOC members would engage and interact with USAID through its Private Sector Engagement Points of Contact, which are within each regional and technical bureau. USAID should designate at least two points of contact from a regional and technical bureau, respectively, to lead engagement with UOC members and country-level partners. While dedicated funds to support the UOC and its management would be required in the long term either from Congress or private finance, USAID may be able to deploy staff from existing budgets to support the initial stand-up process of the coalition.
Progress and commitments already exist to launch the UOC, with Rockefeller Philanthropy Advisors planning to bring fiscal sponsorship as well as strategy and planning for the formation of the global coalition to the UOC with PATH providing additional strategic and technical functions for partners. The purpose of the UOC through its fiscal sponsor is to act as the global governing body by establishing global policy, standards, oversight controls, funding coordination, identifying waste & redundancy, setting priorities, acting as advisor and intermediary when needed to ensure LMIC paths to self-sufficiency are available. UOC would oversee and manage country selection, raising funding, and coordination with local Ministries of Health, funders, and private sector providers.
- Advise LMICs on identifying barriers and knowing best next steps.
第一次UOC峰会将发出行动呼吁，以从开发银行，慈善机构和援助机构中做出新的重要承诺，以共同提供OAAU飞行员计划，在目标LMIC中建立买入，并从事市场塑造活动和基础设施对医用氧气供应链的投资。这Summit could occur on the sidelines of the Global COVID-19 Summit or the United Nations General Assembly. Summit activities and outcomes should include:
- 金融commitmen宣布启动和安全ts from public and private funds for piloting OaaU in at least one national context.
- Identify and prioritize criteria for selecting pilot locations (regions or nations) for OaaU and select the initial country(s) for holistic oxygen self-sufficiency investment.
- Create the UOC Board representing manufacturers, global health experts, LMIC leaders, funders, multilateral institutions, and health providers who are empowered to identify geographic areas most in need of oxygen investment, issue market-specific grants and open innovation competitions, and leverage pooled public and private funds.
- Research, prioritize, and select at least two models of OaaU within a national marketplace to focus attention of all stakeholders on fixing the oxygen marketplace.
USAID shouldco-finance an OaaU pilot model through investments in domestic supply chain streamlining and leverage matched funds from development bank, private, and philanthropic dollars. This fund should be used to invest in the development of a holistic oxygen ecosystem starting in Tanzania and in Uttar Pradesh, India, so that these regions are prepared to deliver reliable oxygen supply, catalyzing broad demand, business activity, and economic development.
这objective is to deliver a replicable global reference model for streamlining the supply chain and logistics, eventually leading to equitable oxygen catering to the healthcare needs that can be rolled out in other LMICs and improve lives for the deprived. The above sites are prioritized based on their readiness and need as determined by the2020路径市场研究supported by the Bill and Melinda Gates Foundation. We estimate that $495 million for the pilots in both nations would provide oxygen for 270 million people, which equates to less than $2 per person. The UOC should:
- Invest in local providers:这将产生经济发展和高薪工作，在整个供应链中。
- Create an in-country deployment coalition for each pilot country:由于氧气市场在每种情况下都是独特的，因此在每个国家 /地区都有一个基于市场的部署联盟，涉及私人，公共和社会部门合作伙伴对于协调资源的部署和维持实施工作至关重要。部署联盟可以由美国国际开发署国家任务执行或监督。
- 提供试点模型资金to enable Ministries of Health and the deployment coalition to streamline and fix supply chains.
- 发行采取行动电话for interested parties and stakeholders to submit plans to address both the immediate medical oxygen needs in the country of choice and the long-term infrastructure barriers. These plans could help inform strategy for deploying resources and making oxygen infrastructure investments.
Recommendation 3. The UOC and partner agencies should launch the Oxygen Access Grand Challenge to invest in innovations to reduce costs, improve maintenance, and enhance supply chain competition in target countries.
We envision the creation of a replicable solution for a self-sustaining infrastructure that can then serve as a global reference model for how best to streamline the oxygen supply chain through improved infrastructure, digital transformation, and logistics coordination. Open innovation would be well-suited to priming this potential market for digital and infrastructure tools that do not yet exist. UOC should aim to catalyze a more inclusive, dynamic, and sustainable oxygen ecosystem of public- and private-sector stakeholders.
这Grand Challenge platform could leverage philanthropic and private sector resources and investment. However, we also recommend that USAID deploy some capital ($20 million over four years) for the prize purse focused on outcomes-based technologies that could be deployed in LMICs and new ideas from a diverse global pool of applicants. We recommend the Challenge focus on the creation of digital public goods that will be the digital “command and control” backbone of a OaaU in-country. This would allow a country’s government and healthcare system to know their own status of oxygen supply per a country grid and which clinic used how much oxygen in real time and bill accordingly. Such tools do not yet exist at affordable, accessible levels in LMICs. However, USAID and its UOC partners should scope and validate the challenge’s core criteria and problems, as they may differ depending on the target countries selected.
Activities to support the Challenge should include:
- Assessing technology and cost gaps在医疗保健基础设施的目标伙伴国家中，特别关注供应链和氧气提供。这项研究将为挑战设计和重点提供介绍。
- Establishing an official framework of best practicesfor OaaU that includes core metrics of success and replicable models that interested healthcare ministries could use to develop a system in their own nations.
USAID can play a catalytic role in spearheading the creation and sustainment of medical oxygen through a public utility model. Investing in new digital tools for aggregation of supply and demand and real-time command and control to radically improve access to medical oxygen on demand in LMICs can unlock better health outcomes and improve health system performance. By piloting the OaaU model, USAID can prove the sustainability and scalability of a solution that can be a global reference model for streamlining medical oxygen supply chain and logistics. USAID and its partners can begin to create sustained change and truly equitable oxygen access. Through enhancing existing public-private partnerships, USAID can also cement a resilient medical oxygen system better prepared for the next pandemic and better equipped to deliver improved health outcomes.
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这oxygen market is competitive and consists of many manufacturers, each of which bring added variations to the way oxygen is delivered. While WHO-UNICEF published minimal technical specifications and guidance for oxygen therapy devices in 2019, there remains variation in how these devices are delivered and the type of data produced in the process. Additionally, oxygen delivery requires an entire system to ensure it safely reaches patients. In most cases, these systems are decentralized and independently run, which further contributes to service and performance variation. Due to layers of complexity, access to oxygen includes multiple challenges in availability, quality, affordability, management, supply, human resources capacity, and safety. National oversight through a digital oxygen utility infrastructure that requires the coordination and participation of the various oxygen delivery stakeholders would address oxygen access issues and enable country self-sustainment.
Unlike prior approaches, OaaU is a business model transformation from partial solutions to integrated solutions with all types of oxygen, just like the electricity sector transformed into an integrated grid of all types of electricity supply. From there, the medical facilities will buy oxygen, not equipment—just like you buy amounts of electricity, not a nuclear power plant.
Investing in oxygen as a utility through on-demand infrastructure can improve access and mortality rates globally. Healthcare experts propose how an international coalition led by USAID can transform the medical oxygen marketplaces of low- and middle-income countries to ensure every patient has the oxygen they need.
在一个火灾季节转向火年的环境中，北美各地的夏季天空充满了远至另一个海岸的野火烟雾，对科学准确的野外火灾政策的需求从未如此大。在过去的几个月中，Compass Science Communication一直与[…]合作合作
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