Nigeria has issued a tender for the repair of oxygen plants in Federal Tertiary Hospitals in Nigeria, with 31 sites across the country requiring repairs under the scope of the works.

The tender was issued on 5th August, with deadlines for submissions due later this week (12 noon, 19thAugust).

The Global Fund for AIDS, Tuberculosis and Malaria project in the National Agency for the Control of AIDs (NACA) intends to use funds from the COVID 19 RM (C19 RM) grant for the repair of these oxygen plants.

gasworld understands this is viewed as a ‘big sign of progress’ by those who have been lobbying for greater access to medical oxygen in low and middle-income countries (LMICs), as it not only improves critical oxygen facilities in the region but also demonstrates the active use of the global fund.

Nigeria’s oxygen struggles

Nigeria has long struggled with its appropriate access to medical oxygen for all citizens, even prior to the Covid-19 pandemic.

In recent years, the country’s Federal Ministry of Health published its National Policy on Medical Oxygen in Health Facilities, which explained that more than 625,000 deaths annually occur due to diseases associated with hypoxaemia – insufficient oxygen in the blood or low blood oxygen saturation.

In children, hypoxaemia is a major fatal complication of pneumonia, accounting for 120,000 under-five deaths in Nigeria per year, the policy paper goes on to state. Evidence from secondary health facilities in Nigeria also shows that 25% of neonates and 12% of under-five children admitted to hospital with pneumonia are hypoxaemic on admission.

Read more: Beyond Covid-19 – Why unprecedented oxygen agreements are such a breakthrough

The policy explains that in Nigeria, as in other countries in sub-Saharan Africa, lack of access to oxygen and pulse oximeters can be attributed to a host of prevailing conditions that it sets out to address. The absence of an enabling environment in terms of coordinated policies and regulations is cited in particular, as well as fragmented supply and distribution systems for oxygen and facility-level barriers to oxygen access for patients.

The country’s new policy therefore seeks to lay the foundation for sub-national policies, for a national strategy for the scale-up of oxygen, and for clinical guidelines on oxygen therapy that taken together will improve access to life-saving oxygen.

Every Breath Counts, a public-private coalition of global health organisations, has been warning of life-threatening oxygen shortages in LMICs across Africa, Asia and Latin America for years.

Coalition members had been striving to coordinate greater access to oxygen in LMICs as far back as 2013 and had identified this as a risk to life in the global south, where there were already many hospitals without any kind of oxygen and a large number of fatalities in those regions were among children that were simply not getting access to oxygen.

Leith Greenslade, Founder and CEO of JustActions and Coordinator of the Every Breath Counts Coalition, previously told gasworld, “It’s been a long, long process. I’ve been working on Access to Oxygen since 2012/13, well before the pandemic when we identified this (access to oxygen) as a risk in low and middle-income countries. Mainly we’re talking Africa, Asia and Latin America where we already had many hospitals without any kind of oxygen, liquid or plants or concentrators. Largely the oxygen-related deaths in those regions were among children – kids that we’re not getting access to oxygen, children with pneumonia for example.”

“…We’d built a coalition, the Every Breath Counts coalition, and we were starting to talk to industry. But I think prior to Covid, there was no obvious way to engage companies – because governments weren’t funding oxygen, global health agencies weren’t funding it, and it was almost like industry didn’t have a partner on the other side of the table.”

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Nigeria braced for third wave of Covid

gasworld reported in January (2021) that Nigeria had approved N6.45bn ($16.9m) plans to set up 38 oxygen plants in sites nationwide to help treat Covid-19 patients, as oxygen usage surged during a second wave of infections.

Having previously contained its first and second wave of the virus relatively well, however, reports suggest Nigeria is now bracing for a third wave of Covid-19,

Earlier this month, the World Health Organization (WHO) donated 26 ventilators and more than 3,500 fingertip oximeters for the management of patients in isolation and treatment facilities, as well as home-based patients in Nigeria.

Every Breath Counts has in recent weeks said as many as 70 LMICs are currently dealing with oxygen shortages or are at risk of facing the crisis, with clusters in southern, eastern and west Africa. Nigeria is confirmed on its crisis risk list (updated 15th August) which profiles the LMICs with high (>2,000 cubic meters per day) and rising oxygen needs and low levels of full Covid-19 vaccine coverage.

MAP: Countries at risk of oxygen shortages

Source: Every Breath Counts

This is affirmed by the COVID-19 Oxygen Needs Tracker from PATH, the Clinton Health Access Initiative (CHAI) and Every Breath Counts. An interactive tool to help advocates, decision-makers, and implementers communicate the urgency of investing in access to medical oxygen and related technologies in LMICs, it provides daily-updated estimates on a country-by-country basis. Its latest update on Nigeria (correct as of 16thAugust) suggests the country has a current need for 27,227 cubic meters of oxygen per day.

This demand has visibly surged since 1st July (2021).

According to the latest data from the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University, Nigeria has recorded 4,579 new confirmed cases of Covid-19 in the past week. In the past 24 hours, it has recorded 584 new cases.

Oxygen agreements

Groundbreaking new agreements were announced in June that see both Air Liquide and Linde plc commit to providing greater access to medical oxygen in low and middle-income countries (LMICs).

Estimates from PATH suggest that around one million critically-ill Covid-19 patients in low and middle-income countries need two million oxygen cylinders (14.2 million cubic metres) per day at present.

Unprecedented agreements – in the form of non-binding and non-exclusive Memoranda of Understanding (MoU) – are now in place with Air Liquide and Linde after months of intense engagement with many of the world’s major oxygen suppliers by the Covid-19 Oxygen Emergency Taskforce, a group of partners led by Unitaid and Wellcome under the ACT-Accelerator Therapeutics pillar.

Nigeria’s oxygen repairs tender – more information

More information on the tender for the repair of oxygen plants in Federal Tertiary Hospitals in Nigeria can be found here:

https://naca.gov.ng/invitation-to-tender-for-the-repair-of-oxygen-plants-in-federal-tertiary-hospitals-in-nigeria-2/

The Standard Bidding Document (SBD) can be downloaded from this link;

https://naca.gov.ng/wp-content/uploads/2021/08/2021.08.02-SBD-for-Oxygen-Plant-Repair.pdf