"Outsourced oxygen to the bedside" in five countries: a qualitative implementation assessment

IntroductionAccess to medical oxygen remains a challenge, with 60% of the worlds population lacking access to quality oxygen services. We explored whether outsourced oxygen to the bedside (O2B), where private providers offer bundles of oxygen services, could be adopted and scaled across diverse health systems, to improve patient access to oxygen. MethodsQualitative interviews were conducted with healthcare workers (HCWs), facility management staff and district medical officers in India, Nigeria, Tanzania, Kenya and Uganda, who had taken part in an O2B pilot. Interviews were conducted between 19th November 2024 and 25th January 2025, and explored the feasibility, fidelity, acceptability, perceived benefits and weaknesses of five O2B models. Analysis used a pragmatic codebook approach, with inductive and deductive coding, informed by implementation science frameworks. ResultsWe conducted 59 interviews, with managers and HCWs from 20 health facilities. We identified five themes relating to the potential for O2B pilots to be adopted within the health system: effect on oxygen culture, feasibility of whole of facility solutions, promotion of local ownership, being willing but unsure about the ability to pay, and the desire for hybrid tailored service models. HCWs and facility staff raised several positive factors within these themes but highlighted that understanding local facility needs and tailoring the services to embed within existing structures were important for sustainability. ConclusionOverall, the O2B service approach shows potential for implementation beyond the pilots, but more understanding of how to optimize service delivery packages to different facility needs, while also prioritizing affordability is needed.