{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T22:46:20Z","timestamp":1791931580060,"version":"4.3.4"},"reference-count":23,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"unspecified","delay-in-days":72,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Brink","award":["Not Applicable"],"award-info":[{"award-number":["Not Applicable"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,8,20]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Medical oxygen is an essential medicine that is often unavailable for patients when they need it. We explored if \u2018outsourced oxygen to the bedside\u2019 (O2B) pilots, where private providers deliver a package of services, were successful in ensuring reliable oxygen access at the patient bedside.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a sequential explanatory mixed-methods assessment of O2B pilots in Kenya, Nigeria, India, Tanzania and Uganda from September 2024 to January 2025. A quantitative cross-sectional facility audit described facility contexts, tested equipment functionality and assessed healthcare worker (HCW) oxygen knowledge. Qualitative interviews with HCWs and managers explored experiences of O2B pilots.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We studied 28 of the 80 facilities participating in the pilots, 179 HCWs completed the knowledge survey and 59 qualitative interviews were conducted. In the audit, we found O2B provided oxygen equipment more functional and usable than non-O2B equipment: 64.5% vs 40.9%, p&lt;0.001\u2009for cylinders, 95.0% vs 25.7% (p&lt;0.001) for concentrators and 84.0% vs 70.0% (p value=0.172) for pulse oximeters. Overall, 21.8% (39\/179) of HCWs had received training from O2B providers, and their oxygen knowledge was slightly higher than those who had not (mean score 15.3\/24 vs 13.9\/24, p value=0.002). Qualitative interviews highlighted positive changes in oxygen access and the ability to treat patients, but also mixed understandings of the O2B services being provided, and requests for additional services.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>O2B pilots appear to improve medical oxygen access, with effective maintenance and repair services being a key mechanism. However, tailoring to local needs and remaining gaps in HCW capacity need to be addressed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2026-005434","type":"journal-article","created":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T08:30:32Z","timestamp":1789201832000},"page":"e005434","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Pilot implementation of \u2018outsourced oxygen to the bedside\u2019 models in five countries: a mixed methods impact assessment"],"prefix":"10.1136","volume":"4","author":[{"given":"Freddy Eric","family":"Kitutu","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Makerere University School of Health Sciences, Kampala, Uganda"},{"name":"Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, Kampala, Uganda"},{"name":"Department of Women\u2019s and Children\u2019s Health, Uppsala University, Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2972-9210","authenticated-orcid":false,"given":"Celia","family":"Blaas","sequence":"additional","affiliation":[{"name":"Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9334-3211","authenticated-orcid":false,"given":"Pius","family":"Mukisa","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Makerere University School of Health Sciences, Kampala, Uganda"},{"name":"Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3777-2034","authenticated-orcid":false,"given":"Mattias","family":"Schedwin","sequence":"additional","affiliation":[{"name":"Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden"},{"name":"Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8727-7018","authenticated-orcid":false,"given":"Tim","family":"Baker","sequence":"additional","affiliation":[{"name":"Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden"},{"name":"Department of Emergency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania"},{"name":"Queen Mary University of London, London, UK"},{"name":"Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayobami Adebayo","family":"Bakare","sequence":"additional","affiliation":[{"name":"Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden"},{"name":"Department of Community Medicine, University College Hospital Ibadan, Ibadan, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepa","family":"Bishit","sequence":"additional","affiliation":[{"name":"Outline India, Gurugram, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elibariki","family":"Mkumbo","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4575-2447","authenticated-orcid":false,"given":"Jacquie","family":"Oliwa","sequence":"additional","affiliation":[{"name":"Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya"},{"name":"Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8895-0144","authenticated-orcid":false,"given":"Sophie","family":"Namasopo","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Kabale Regional Referral Hospital, Kabale, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacinta","family":"Nzinga","sequence":"additional","affiliation":[{"name":"Institute for Resilient Health Systems, Liverpool School of Tropical Medicine, Liverpool, UK"},{"name":"Health Systems and Research Ethics, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maire","family":"Raune","sequence":"additional","affiliation":[{"name":"FREO2 Foundation, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aishat","family":"Adeniji","sequence":"additional","affiliation":[{"name":"HealthPort, Lagos, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4122-0937","authenticated-orcid":false,"given":"Michael T","family":"Hawkes","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amarpreet","family":"Rai","sequence":"additional","affiliation":[{"name":"Sanrai International, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Njuguna","sequence":"additional","affiliation":[{"name":"Centre for Public Health and Development, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2461-0463","authenticated-orcid":false,"given":"Hamish R","family":"Graham","sequence":"additional","affiliation":[{"name":"Murdoch Childrens Research Institute, University of Melbourne, Melbourne, Victoria, Australia"},{"name":"Department of Paediatrics, University College Hospital Ibadan, Ibadan, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6885-6716","authenticated-orcid":false,"given":"Carina","family":"King","sequence":"additional","affiliation":[{"name":"Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,12]]},"reference":[{"key":"2026091201302487000_4.3.e005434.1","doi-asserted-by":"crossref","first-page":"e528","DOI":"10.1016\/S2214-109X(24)00496-0","article-title":"Reducing global inequities in medical oxygen access: the Lancet Global Health Commission on medical oxygen security","volume":"13","author":"Graham","year":"2025","journal-title":"Lancet Glob Health"},{"key":"2026091201302487000_4.3.e005434.2","unstructured":"Global Oxygen Alliance . Global oxygen strategic framework and investment case: accelerating medical oxygen access to save lives (2025-2030). 2025."},{"key":"2026091201302487000_4.3.e005434.3","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2021-006069","article-title":"Measuring oxygen access: lessons from health facility assessments in Lagos, Nigeria","volume":"6","author":"Graham","year":"2021","journal-title":"BMJ Glob Health"},{"key":"2026091201302487000_4.3.e005434.4","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1007\/s12553-015-0094-2","article-title":"A retrospective analysis of oxygen concentrator maintenance needs and costs in a low-resource setting: experience from The Gambia","volume":"4","author":"Bradley","year":"2015","journal-title":"Health Technol"},{"key":"2026091201302487000_4.3.e005434.5","doi-asserted-by":"crossref","DOI":"10.7189\/jogh.14.04092","article-title":"Functional availability of medical oxygen for the management of hypoxaemia in Cameroon: A nationwide facility-based cross-sectional survey","volume":"14","author":"Saidu","year":"2024","journal-title":"J Glob Health"},{"key":"2026091201302487000_4.3.e005434.6","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.24679"},{"key":"2026091201302487000_4.3.e005434.7","doi-asserted-by":"crossref","first-page":"e1701","DOI":"10.1016\/S2214-109X(25)00328-6","article-title":"Medical oxygen service readiness and service coverage in seven countries in Africa and Asia: a cross-sectional survey and clinical audit","volume":"13","author":"Subhi","year":"2025","journal-title":"Lancet Glob Health"},{"key":"2026091201302487000_4.3.e005434.8","doi-asserted-by":"crossref","DOI":"10.9745\/GHSP-D-21-00781","article-title":"A Comprehensive Approach to Medical Oxygen Ecosystem Building: An Implementation Case Study in Kenya, Rwanda, and Ethiopia","volume":"10","author":"Smith","year":"2022","journal-title":"Glob Health Sci Pract"},{"key":"2026091201302487000_4.3.e005434.9","doi-asserted-by":"crossref","unstructured":"Schedwin M , Graham H , Losneanu A . Exploring the role of \u2018outsourced oxygen-to-the-bedside\u2019 in expanding oxygen access for patients. Global Health: Science and Practice [Preprint] 2026. doi:10.20944\/preprints202412.0478.v1","DOI":"10.20944\/preprints202412.0478.v1"},{"key":"2026091201302487000_4.3.e005434.10","doi-asserted-by":"crossref","unstructured":"Blaas C , Mukisa P , Schedwin M , et al . \u2018Outsourced oxygen to the bedside\u2019 in five countries \u2013 a qualitative implementation assessment. medRxiv [Preprint] 2026. doi:10.64898\/2026.02.20.26346703","DOI":"10.64898\/2026.02.20.26346703"},{"key":"2026091201302487000_4.3.e005434.11","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.4269\/ajtmh.18-0016","article-title":"Usability Testing of a Reusable Pulse Oximeter Probe Developed for Health-Care Workers Caring for Children < 5 Years Old in Low-Resource Settings","volume":"99","author":"Boyd","year":"2018","journal-title":"Am J Trop Med Hyg"},{"key":"2026091201302487000_4.3.e005434.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103208"},{"key":"2026091201302487000_4.3.e005434.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"2026091201302487000_4.3.e005434.14","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-13-117"},{"key":"2026091201302487000_4.3.e005434.15","doi-asserted-by":"publisher","DOI":"10.1007\/s10488-010-0319-7"},{"key":"2026091201302487000_4.3.e005434.16","doi-asserted-by":"crossref","DOI":"10.1186\/s13012-022-01245-0","article-title":"The updated Consolidated Framework for Implementation Research based on user feedback","volume":"17","author":"Damschroder","year":"2022","journal-title":"Implement Sci"},{"key":"2026091201302487000_4.3.e005434.17","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0248101","article-title":"Technical results from a trial of the FREO2 Low-Pressure Oxygen Storage system, Mbarara Regional Referral Hospital, Uganda","volume":"16","author":"Peake","year":"2021","journal-title":"PLoS One"},{"key":"2026091201302487000_4.3.e005434.18","unstructured":"FREO2 Foundation . Annual report: FY24\/25 (1st July 2024 - 30th June 2025). 2025."},{"key":"2026091201302487000_4.3.e005434.19","doi-asserted-by":"crossref","first-page":"e396","DOI":"10.1016\/S2214-109X(24)00510-2","article-title":"Biomedical engineers are crucial for effective health-care systems","volume":"13","author":"Madzivire","year":"2025","journal-title":"Lancet Glob Health"},{"key":"2026091201302487000_4.3.e005434.20","doi-asserted-by":"publisher","DOI":"10.1007\/s11517-011-0786-3"},{"key":"2026091201302487000_4.3.e005434.21","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1001\/jamapediatrics.2018.0228","article-title":"Solar-Powered Oxygen Delivery in Low-Resource Settings: A Randomized Clinical Noninferiority Trial","volume":"172","author":"Hawkes","year":"2018","journal-title":"JAMA Pediatr"},{"key":"2026091201302487000_4.3.e005434.22","doi-asserted-by":"publisher","DOI":"10.5588\/pha.24.0046"},{"key":"2026091201302487000_4.3.e005434.23","unstructured":"World Health Organisation . Guide to infrastructure and supplies and various levels of health care facilities: emergency and essential surgical care (EESC). Geneva, Switzerland World Health Organization; 2012."}],"container-title":["BMJ Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjph-2026-005434","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T08:30:35Z","timestamp":1789201835000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjpublichealth.bmj.com\/lookup\/doi\/10.1136\/bmjph-2026-005434"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":23,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,9,12]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1136\/bmjph-2026-005434"],"URL":"https:\/\/doi.org\/10.1136\/bmjph-2026-005434","relation":{},"ISSN":["2753-4294"],"issn-type":[{"value":"2753-4294","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}