Service and projects
What does an independent review of PSA plant projects assess?
What does an independent technical review of donor-funded PSA oxygen plant projects assess, from demand to cylinder filling?
Short answer
The Global Fund's terms of reference (October 2024) for a Local Fund Agent review of PSA plant implementation cover hospital demand and plant sizing, including cylinder filling, the power supply and site, staffing, warranty, maintenance, spare parts and training, and verification of the reported number of plants installed with Global Fund investment and functional.
The objective set out in the terms of reference is to monitor and verify end-to-end implementation of PSA oxygen plants, identify circumstances and risks that may affect the success of a new plant, and verify the reported indicator "number of PSA plants installed with Global Fund investments and functional". The detailed scope is to be agreed with the Global Fund Country Team before the review starts. It combines a desk review of the budget, procurement documents, plant specifications, maintenance and warranty, human resources and available technical assistance with site visits: discussions with the hospital staff responsible for oxygen, a walkthrough of the campus to observe environmental and geographic constraints, and physical inspection of the plants and of operating records such as daily checklists and standard operating procedures.
What the questions cover
| Area | What the reviewer asks or checks |
|---|---|
| Hospital | Elevation; beds, including expected new beds; operating rooms; whether oxygen reaches the bedside through wall outlets or individual cylinders, and how the outlets are supplied |
| Future plant | Connection to an existing pipeline and its material, leaks or corrosion; any new pipeline; whether cylinders will be filled for other facilities, how many per day and of what size |
| Power | Connection to the utility; outages, voltage fluctuations or other instabilities; an existing backup generator |
| Site and building | Space for the plant building or container; outside flood-prone areas and away from pedestrian traffic; truck access and crane access for containerised plants; at least 10 m from open flames, generators, car exhausts, garbage or other air pollutants; a concrete slab and cylinder storage; if the housing is not built, its budget, responsible entity, project manager and timeline |
| Staff | Who will do day-to-day maintenance and whether that person is on site full-time and salaried or a volunteer; their training; access to hand tools and a handheld oxygen analyser |
| Equipment | Preliminary sizing estimates of oxygen need, air compressor, booster compressor for cylinder filling and generator |
| Assurance | Whether the Principal Recipient understands the warranty terms and the maintenance contract and is in contact with the maintenance contractor; spare parts stored safely; whether the installer's training was adequate |
| Reporting | Whether an adequate reporting system exists, how many plants are reported nationally and visited, and whether there is documented evidence of installation and functionality |
The sizing step uses Table 13 of HTM 02-01, the Health Technical Memorandum on medical gas pipeline systems, to size the plant from bed counts; the terms of reference cite its May 2006 edition (Department of Health), which the NHS England 2026 edition has replaced.
The report and who writes it
The report analyses the issues and risks found, comments on their context and root causes, prioritises them in an executive summary and reviews the budget for gaps that could put full commissioning, maintenance or the warranty at risk. Its recommendations are to be detailed, specific, time-bound, prioritised by risk and to name the main entity responsible. The review is carried out by the Local Fund Agent's designated biomedical engineering expert for oxygen; clear evidence of fraud should be reported to the Global Fund Secretariat and the Office of the Inspector General through the Global Fund Communication Protocol.
Other independent checks
PATH's report on PSA plant disrepair (November 2023) recommends an independent inspection after initial installation by a third party not involved in procurement, and asks public procurement entities to stipulate independent quality checks in tenders, with training, operating and maintenance manuals and spare part lists in the local languages, the manuals where operation and maintenance by facility staff are part of the business model. The 2020 WHO interim specification for PSA plants (superseded by WHO's technical specifications of 31 December 2024), which said it expired 2 years after publication, asked for conformity of installation to be verified by a certified third party.
Under the Global Fund's Project BOXER, Build Health International's technical assistance (26 July 2024) includes an independent review of contractors' bids, a pre-installation assessment of the completed construction against the approved design, a post-commissioning assessment and a repair assessment; it says the post-commissioning assessment does not replace supplier commissioning inspections or other construction inspections required by local authorities. What that assessment checks is on what a post-commissioning assessment of a PSA plant checks.
More questions
Who carries out a Global Fund review of PSA plant implementation?
The terms of reference (October 2024) assign it to the Local Fund Agent's designated biomedical engineering expert for oxygen, who can be supported by other team members.
Does an independent assessment replace commissioning?
No. Global Fund technical assistance (2024) says its post-commissioning assessment does not replace supplier commissioning inspections or other construction inspections required by local authorities.
Sources
- Global Fund, Review of implementation of PSA oxygen generating plants, LFA terms of reference (October 2024)
- PATH, Pressure swing adsorption plants: Common issues and solutions to prevent future disrepair (November 2023)
- WHO, Technical specifications for PSA oxygen plants, interim guidance (8 June 2020)
- Global Fund / Build Health International, Overview: Build Health International Technical Assistance Services (Project BOXER, 26 July 2024)
- NHS England, HTM 02-01 (2026 edition, Parts A and B, published 19 August 2026)
- WHO, Technical specifications for health facility based medical oxygen systems (31 December 2024), note on the oxygen generator plant specification (supersedes the 2020 interim PSA specifications)
Ultra Controlo figures come from its technical datasheets. Third-party facts were read at the source on the date shown.