Hospitals in low- and middle-income countries urgently need to improve their oxygen systems for COVID-19 and other health emergencies. We share practical tips to improve pulse oximetry and oxygen use, support biomedical engineers to optimize existing oxygen supplies, and expand existing oxygen systems with robust equipment and smart design. Key Messages The COVID-19 pandemic has highlighted and exacerbated deficiencies in hospital oxygen systems globally but is also an opportunity to “build back better.” Our collated field experience from African and Asia-Pacific contexts reveal practical strategies whereby hospitals can rapidly improve their oxygen systems. We share guidance documents (all open access) for local use and adaptation. Key Implications Using our practical guides, hospital staff can help: Improve pulse oximetry and oxygen use Optimize existing oxygen supplies Expand existing oxygen systems with robust equipment and smart design Policy makers and program managers can use our recommendations to ensure that investments in oxygen systems are deployed and implemented more effectively and efficiently. ABSTRACT Oxygen therapy is an essential medicine and core component of effective hospital systems. However, many hospitals in low- and middle-income countries lack reliable oxygen access—a deficiency highlighted and exacerbated by the coronavirus disease (COVID-19) pandemic. Oxygen access can be challenged by equipment that is low quality and poorly maintained, lack of clinical and technical training and protocols, and deficiencies in local infrastructure and policy environment. We share learnings from 2 decades of oxygen systems work with hospitals in Africa and the Asia-Pacific regions, highlighting practical actions that hospitals can take to immediately expand oxygen access. These include strategies to: (1) improve pulse oximetry and oxygen use, (2) support biomedical engineers to optimize existing oxygen supplies, and (3) expand on existing oxygen systems with robust equipment and smart design. We make all our resources freely available for use and local adaptation.
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