Oxygen for all: Why measurement matters as much as availability

Medical oxygen is not merely a clinical supply; it is a lifeline that sustains patients every minute in hospitals and their homes. Bangladesh has expanded oxygen plants, concentrators, and hospital pipelines in recent years. However, due to a lack of measurement, we are in the dark about whether oxygen is being used appropriately.

Oxygen is indispensable in saving lives from acute medical emergencies such as pneumonia, sepsis, obstetric complications, and trauma. The Lancet Commission on Medical Oxygen Security estimates that over 105 million people globally need oxygen for acute medical care each year, most of them in low- and middle-income countries, including about two million in Bangladesh. For surgical procedures, around five million, and for chronic respiratory diseases such as COPD, nearly 0.2 million people in Bangladesh rely on oxygen therapy every year. These numbers tell us that oxygen need is not rare, yet it remains poorly documented in the systems meant to manage it.

To understand oxygen coverage, we need to know how many patients required oxygen and how many actually received it. A multi-country study conducted in Bangladesh, Nepal and Tanzania, published in the Journal of Global Health in 2022, illustrated this problem. In two large Bangladeshi hospitals, oxygen was administered to almost half of the newborns treated for infection, yet very few had oxygen saturation documented in their case notes. Without pulse oximetry data, it is impossible to tell whether the therapy was appropriate or wasteful. Poor documentation could mask both under-treatment and overuse. This is not a technical oversight; it is a system-wide blind spot. The cost of this lack of documentation is substantial. In private hospitals, the cost of oxygen therapy can result in high out-of-pocket payments for the patients. For public hospitals, oxygen generation and delivery can consume a large part of total operating costs.

When oxygen is used without a clear clinical indication or documentation, both patients and facilities face unnecessary economic strain. An article published in The Daily Star during the pandemic shared the financial struggles of people due to the high cost of oxygen therapy. Jannatul, a 45-year-old woman, was admitted to a hospital in Chattogram with breathing difficulties and required oxygen support for 10 straight days. When the time came for discharge, her family received an oxygen-only bill of over Tk 3 lakh, while the total hospital bill exceeded Tk 6 lakh. They pointed out that hospitals had to source oxygen from private suppliers at inflated market rates. In other cases, some facilities explained that their billing systems were not designed to differentiate oxygen consumption by duration or flow rate, so fixed or estimated charges were applied to cover overall maintenance. Others emphasised that without government subsidies or price ceilings, private hospitals had little flexibility to absorb the increased costs of oxygen procurement and logistics. The scenario emphasises the necessity to ensure oxygen is given only when it is needed, and to do that, addressing the measurement gap is obligatory. When oxygen use is not measured, it not only clouds clinical judgment but also opens the door to uncontrolled costs and inequity. Therefore, both overuse and underuse stem from the same problem: lack of measurement.

Bangladesh has made commendable progress in improving oxygen infrastructure and monitoring supply. The Directorate General of Health Services (DGHS) now publishes a daily update through its Oxygen Management Information System (OMIS), showing figures such as total oxygen availability and the number of hospital beds equipped with oxygen. These dashboards are an important step forward and demonstrate the government's commitment to data-driven decision-making. Yet, they describe only the supply side of oxygen, not who receives it. The system does not show how many patients were hypoxaemic, how many had their oxygen saturation measured, or how long oxygen therapy lasted. Without patient-level indicators, it is impossible to track coverage, identify inequities, or ensure rational use.

At the population level, surveys should include questions on hospitalisation, oxygen need, and whether oxygen was received during treatment. These additions would help capture how people access life-saving oxygen beyond facility records and highlight inequities across regions and socioeconomic groups. At the same time, facility-based systems must routinely document hypoxaemia, indication, and outcomes in real time. Linking population surveys with routine facility data will be essential to generate a complete picture of oxygen access and use in Bangladesh, as recommended by The Lancet Commission.

Oxygen sustains life, but the absence of data on its use keeps health systems blind. Creation of a real-time oxygen measurement system that connects patient needs to oxygen delivery is as important as building new oxygen plants. When we know how many patients were hypoxemic, how many received oxygen, and how long they were treated, we can allocate resources more equitably across regions and facility types. Data showing high oxygen use but low saturation monitoring in certain districts could trigger targeted training and supervision, while identifying hospitals with chronic undersupply would enable redistribution and timely procurement. Patient-level information would also improve efficiency by reducing unnecessary oxygen use, preventing wastage, and ensuring that oxygen reaches those who truly need it first. Integrating these data streams into national health information systems would transform current dashboards from inventory trackers into decision-making tools to plan, act, and save lives more effectively. When every breath counts, measurement ensures that no one is left struggling for air.

Aniqa Tasnim Hossain is associate scientist at the Maternal and Child Health Division (MCHD) of icddr,b. She can be reached at aniqa.hossain@icddrb.org.

Views expressed in this article are the author's own. 

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