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#Post#: 5--------------------------------------------------
Defining our goals
DIR By: drmdobson
Date: January 16, 2018, 11:56 am
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Our brief is “to support access to and utilization of
life-saving oxygen system products in low-resource settings”
A lot of this will be about concentrators, but not all. Here
are some other aspects we may want to consider:
“Access”
Those who need to use the technology must know what is
available, what it can and can’t do, and whether/how it can be
applied in their situation. They need to be able to analyse
their own needs and resources, and know how to contact a
reliable source of advice.
They need to know how to source the right technical resources,
and how to fund the resources they need. If B&M Gates pay for
everything, it’s not development.
How do we create an oxygen expert for each hospital? For each
country would be a start!
“Utilisation”
Making resources available to the right groups of health
workers.
Training health workers to identify those patients who can
benefit from oxygen, using appropriate means of clinical
assessment including pulse oximetry.
Measuring oxygen needs – from “which patients need oxygen” to
“how much oxygen does our hospital need”
Oxygen production – access/utilization/support of each of
Fractional distillation – medical and “industrial” oxygen
Concentrators – small & large. PSA or VSA
Oxygen plants – DIY or ready-made. Purchase or lease?
Becoming an oxygen manufacturer.
Electrochemical generators
Choosing the right technology; who chooses, where do they get
advice?
Ancillary equipment – regulators, flow meters, flow splitters,
patient delivery devices, compressors, pressure storage vessels,
generators, PV arrays, batteries,
Technology support
Training and retaining technicians
Understanding and analyzing the infrastructure (especially
electrical).
Power quality analysis. Matching PQA with recommended
technical solutions.
Matching oxygen systems with hospital and human
infrastructure
Safety issues and hazards
Organizational
What is the role that UNICEF should seek?
Education
Quality control
Catalogue supply
Field support
It seems to me that so far a lot of technical information has
been assembled on the spreadsheet, much of it available
elsewhere, for example in the WHO Oxygen Concentrator technical
Specification booklet and the PATH Oxygen Primer. We need not
duplicate this technical work, but should concentrate on making
things happen. Some clear aims need to be our starting point,
and these should include:
Definition of the infrastructure support actually available in
LMIC's - including quality of electricity supply and
availability of technical support. I have spent considerable
effort trying to discover information about these aspects, and
there is very little. I don't think we can begin to look for
solutions until we have defined the problem, and this probably
means that we need to do our own field research. It's perfectly
possible to design such a research project, which need not take
more than 4% of our budget. Without such information we cannot
evaluate which forms of technology may be required.
Having then defined the problem, we should be in a better
position to state what is required of equipment if it is to
survive and function adequately in what we know are challenging
circumstances.
Having defined the requirements, we must then find a way of
testing individual pieces of equipment to see if they meet the
necessary performance standard. David Peel has already been
involved in work of this kind looking at the effects of voltage
variations and adverse climate, dust etc. Ultimately we need to
test machines against real-life conditions, but a good start
would be to see if they even meet the manufacturers' claims.
Since UNICEF already sells an oxygen concentrator
(manufacturer's name not given on website) that would be a good
place to start.
In regard to the process of our group, we need to be clear
about what we are trying to achieve. We seem to be in
partnership with a larger number of other organisations than can
be expected to agree about anything at all - are they there just
to give street cred, or are they actually expecting to
contribute (and if so, what?). Hopefully they will just be
expecting us to do the work. In any event, if all we produce is
another document, we will have failed.
What I have outlined above is the need for us not to just make
recommendations, of which the world is not short, but to
actually cause a change in the availability of oxygen. Can we
assume that country and regional offices of UNICEF will be
available to support this?
I think that until these questions are answered, it is premature
to focus on the minutiae of the spreadsheet. I am not clear
about how we will make decisions, how we will know when a
decision has been made, and indeed ultimately who will decide,
and on what basis. Hopefully we will reach a stage when we do
need to talk technical details, but that is some way away and we
need to deal with the main issues first.
Making a difference to oxygen availability must involve both
technical and human aspects, and we need to cover both of these.
#Post#: 6--------------------------------------------------
Re: Defining our goals
DIR By: Roberto Ayala CENETEC
Date: January 16, 2018, 12:29 pm
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Good day,
I think the task was clearly outlined by UNICEF when they
invited us to participate, by the following objectives (shared
in a file named "Oxygen Project Brief"):
1. Interagency technical specifications and guidance for
procurement of oxygen system products and components
2. UNICEF catalogue updated with specifications, technical
guidance and new procurement mechanisms to include a more robust
and appropriate selection of oxygen system products
3. Functioning prototype of an oxygen therapy tool developed to
provide strategic and technical support for oxygen system
selection and upgrades at all levels of the healthcare system
Hope it helps to clear the question.
Best regards and greetings from Mexico.
#Post#: 13--------------------------------------------------
Re: Defining our goals
DIR By: SusanN
Date: February 8, 2018, 4:54 pm
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The task of "having a functioning prototype of an oxygen therapy
tool to provide strategic and technical support for oxygen
system selection and upgrades at all levels of the healthcare
system" seems most crucial and likely needs to encompass all the
areas outlined by Dr. Dobson. There is a huge gap to fill in
helping in-country decision makers answer the question "where
should we invest our available resources?". At the most
fundamental level, the question is "should we invest in oxygen?"
At the next level, the question is "how should we invest in
oxygen?"
Would it be within the scope of this group to brainstorm on the
best ways to help decision-makers analyze their needs and
resources, know what options and specific products are
available, and understand how to make choices that will best fit
their situation? Rather than being prescriptive about what is
needed, offering a framework and support for in-country
evaluation and decision-making seems preferable.
As a pediatrician/neonatologist, it would also seem critical to
help decision-makers understand the key differences in safely
delivering oxygen to different age groups - adult, child,
newborn (preterm newborn). These distinctions may not be
immediately apparent to administrators/program managers who are
making procurement decisions. The requirements for delivery
(flow/concentration/patient interface), monitoring (pulse
oximetry in infants at risk for retinopathy of prematurity), and
human resources vary widely. UNICEF is in a strategic position
to bring these issues forward with clarity.
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