On January 5, Peter (not real name), was rushed to a private medical facility in Kampala in critical condition after testing positive for Covid-19. Like most Covid-9 patients, Peter was desperately gasping for breath.
The hospital where Peter was admitted was short on oxygen supply. Oxygen cylinders had been taken for a refill. By the time Peter got hooked onto oxygen, he had slipped into coma. Medical oxygen is a lifesaving commodity. A lack of it can lead to severe complications and death.
"It has been estimated that around one in five people with Covid-19 suffers respiratory distress sufficient to require oxygen therapy," says Dr Priyanka Relan, a Covid-19 clinical management expert at WHO.
"Without that therapy, Covid-19 can be fatal."
At the onset of the Covid-19 outbreak, medical oxygen plants, cylinders and accessories had to be imported to deal with the emergency situation. But the National Medical Stores (NMS) is moving to change that with the installation of a gas plant at its new state-of-the-art pharmaceuticals warehouse in Kajjansi off Entebbe road.
"Many hospitals are asking for oxygen and currently they are competing with welders who pay cash," NMS General Manager Moses Kamabare said.
"If you don't pay cash, it is hard to get oxygen. We now want to secure the future of oxygen in Uganda with a new plant capable of producing 100 cylinders per day," he added.
The structure, which will house the gas plant in Kajjansi, is almost complete. Kamabare said the gas will be supplied to public hospitals across Uganda as well as private facilities.
"During that time when all other oxygen plants are working well and have enough oxygen, ours will be for the private sector," he added.
"At no time should a Ugandan die because of lack of oxygen," Kamabare said.
Currently, Mulago National Referral Hospital has four new fully functioning oxygen plants which are able to generate 2,083 liters of oxygen per minute. In 24 hours, the Mulago plant can generate about 2,999,520 liters of oxygen, which in normal circumstances can serve about 900 patients.
The four are part of the seven plants procured by the ministry of Health to meet the oxygen needs in the country. However, majority of public and private not-for-profit facilities in Uganda do not have sufficient availability of oxygen and pulse oximeters.
The last Uganda Services Availability and Readiness assessment conducted by the Health ministry found that only 36 percent of facilities offering services for chronic respiratory diseases had oxygen. The proportion of oxygen systems availability was even lower when facilities were assessed on availability of diagnostic equipment.
Availability dropped further when assessment looked at staff trained on oxygen equipment which was lowest at general hospitals and HCIVs compared to regional referral hospitals.
At the Kajjansi oxygen plant, floor works will include setting up a ramp at the filling station for easy transportation of refilled cylinders from the plant. The modern medical oxygen plant will allow clients to generate their own oxygen for their medical-grade requirements like EMS (Emergency Medical Services), ambulance, fire departments, small hospitals, clinics, nursing homes, veterinary and animal hospitals, among others.
The plant is mounted over a platform and requires less space. With a simple mounting of the plant, and plugging it in to a standard electrical outlet, NMS will be able to generate medical-grade oxygen to fill cylinders on-site. Within a short time, NMS will be able to have emergency oxygen available. Installation works will be complete by end of this year.
Dr Moses Muwanga, the director, Entebbe hospital, recently said a Covid-19 patient in critical condition consumes about two oxygen cylinders a day.
"And we can only refill these cylinders from manufacturers in Namanve or other facilities or even Nakasongola when the Namanve plants are down," Dr Muwanga said.
Suppliers sell a full oxygen cylinder between Shs 40,000 and Shs 50,000. It is very costly for critical Covid-19 patients to foot bills for the oxygen consumed in ICU. That cost will be slashed when NMS starts producing oxygen. The process of filling and transporting the gas will be simplified too.
Kamabare said the gas distribution process can be simplified with the last mile system of distributing medicines and other health supplies directly to their final destination.
"Once the cost of distribution is fully resolved, the country will be well served with oxygen," said Kamabare, adding, "The advantage here is that NMS has already developed capacity for production of oxygen."
Revenue from the oxygen plant will serve as a new revenue stream to supplement resources from government and development partners. NMS' new strategic plan is premised on repositioning the institution as a center of excellence in essential medicines and health supplies and cold-chain supply in the region.
"The business model adopted by NMS will employ financial viability of business enterprise. The current strategic plan is based on strategic paradigm shift from government financing and pump priming to market-oriented operations where NMS introduces a business arm which operates as an entity capable of recruiting staff, financing operations, provide services, make some profit and sustain her operations without entirely depending on government subvention," Kamabare said.