How can a ministry audit the status of all its oxygen plants?

World Health Assembly resolution WHA76.3 (30 May 2023) urges Member States to assess the scale of medical oxygen access gaps, including at subnational and local health facilities, and to monitor access to safe, affordable, quality-assured medical oxygen. For plants already installed, Build Health International has published an assessment method and training for the Global Fund's Project BOXER.

The assessment team

The Global Fund's Repair and Electrical Assessment Training for PSA plants (25 April 2025) is intended to train a small team to travel to different PSA plants and assess them, with at least one person who can assess a PSA plant (a biomedical engineer, technician or operations staff member) and at least one person with a background in electrical systems. The assessment is done when a plant is not working optimally, covers component functionality and the electrical system, and aims to decide whether the plant can be repaired. Trainees receive a repair assessment form and an electrical assessment form; the training is meant to let local staff carry out repair assessments independently, and its terms of reference can include remote support from Build Health International with the assessments, reports and repair recommendations.

What the repair assessment form records

The Global Fund PSA Plant Repair Assessment form (7 March 2025), whose answers and photos are sent to Build Health International for analysis, asks, among other things, for:

• the installer, the year of installation, whether the hospital supplies cylinders to other facilities, a one-line diagram of how oxygen reaches the bedside, and the hospital's oxygen consumption and demand;
• the type of installation (individual components in a plant room, skid-mounted or containerised) and the plant's manufacturer, model, serial number and capacity;
• for each component, its running hours, the last service date as reported by the operator, visual inspection findings and any error codes;
• whether the oxygen generator is operational and, if not, the cause or suspected cause and how long it has been broken;
• the oxygen purity shown on the display and measured with a handheld analyser, plus a walkthrough video of the plant.

For plants that have just been installed, a separate Global Fund post-commissioning assessment form (12 September 2025) checks that the plant is correctly installed and performing optimally.

Finding out why plants stopped

PATH's analysis of PSA plant failures (November 2023) drew on 43 facility assessment reports covering 50 PSA plants in eight countries in Africa and Latin America, which recorded plant configuration, functional status, maintenance practices and infrastructure. Common issues in plants in disrepair were clogged filters and drains, contaminated sieve beds, compressor and booster failures and leaky valves; 60 percent of the plants were overdue for maintenance, almost all facilities had no spare parts or full tool set on site, and none noted having a maintenance log. The potential causes PATH identifies include a lack of ownership and knowledge among decision-makers, a lack of skilled workforce and inadequate, irregular maintenance budgets, and it recommends that facilities embed recurring plant assessments into routine tasks. See why PSA oxygen plants stop working.

After the survey

WHO's African Region reported in its 2021 COVID-19 response report that its specialists checked the status of oxygen production plants and that, with 26 oxygen plants not operational in Africa, the team set up a maintenance and repair protocol and a tool to calculate oxygen needs and gaps. WHO's Foundations of medical oxygen systems (2023) points to the Biomedical Equipment for COVID-19 Case Management Inventory Tool, with which countries can assess the functional capacity of equipment at facility level and forecast procurement needs, and UNICEF's Oxygen System Planning Tool helps assess, quantify and cost oxygen supply needs at national, subnational and facility level. PATH notes that, depending on a plant's value and age, advanced repairs may be less economical than buying a replacement; see whether an existing PSA plant can be repaired.