Sandra Georges, EpiC Project Director, FHI 360 
Lambert Koffi Ayékpa, Senior Program Officer, FHI 360 
Marius Kouamé, Biomedical Engineer, FHI 360 
Yolande Yahi, Procurement Officer, FHI 360 
Kouassi Ange Aka, Finance Manager, FHI 360 
Kouamé Hilaire Ahoué, IT Officer, FHI 360 

COVID-19 pandemic reveals shortcomings in the Ivorian health system 

The COVID-19 pandemic revealed gaps in the ability of the Ivorian health care system to provide medical oxygen in health care facilities during periods of increased demand. Previously, private companies supplied oxygen to hospitals in Abidjan. During the COVID-19 pandemic, Côte d’Ivoire acquired six oxygen-producing pressure swing adsorption (PSA) plants located at health facilities. Deferred maintenance resulted in the PSAs malfunctioning and the subsequent unavailability of oxygen. 

Investing in liquid oxygen in Côte d’Ivoire 

Thanks to an investment of more than US$6 million from USAID, more than 8 million people living in Côte d’Ivoire will have access to oxygen by October 2024. Through investments in liquid oxygen (LOX) infrastructure, the Meeting Targets and Maintaining Epidemic Control (EpiC) project, funded by USAID, is strengthening the capacity to provide medical oxygen in seven hospitals—Yamoussoukro Regional Hospital Center (CHR), CHR Korhogo, CHR Daloa, CHR Man, CHR Bouaké, San Pedro General Hospital, and CHR San Pedro r—covering 54 districts. These sites, selected by the Ministry of Health (MOH), are located in regional hubs across the country that have experienced shortages of oxygen. The project is being carried out under the technical leadership of the Direction des Infrastructures, de l’Equipement, de la Maintenance et du Patrimoine (DIEMP)—the government department that oversees facility construction, maintenance, and asset management.  

LOX is the most affordable option—in terms of cost per liter—for supplying oxygen to high-demand facilities. Therefore, it is one of a few large-scale initiatives to address medical oxygen shortages. Under the leadership of DIEMP, a feasibility study was conducted at the seven target hospitals to identify oxygen needs and requirements and confirm the selection of these sites by the MOH. For each of the seven hospitals, EpiC set up physical infrastructure including a building, cryogenic tank, atmospheric heater, manifolds, gaseous oxygen compressors, gaseous oxygen tank, 50 new cylinders, and tablets for telemetry and data collection. The project provides technical assistance at each supported health facility, including setting up systems for the regular supply and storage of LOX, filling cylinders on site, and training providers on the use of oxygen for patient care across all applicable medical units.  

In March, EpiC Côte d’Ivoire and Gaz Industriel et Médical et Services de Côte d’Ivoire (GIMSCI) organized a training on LOX system safety and operations. Twenty-two staff from CHR San Pedro and HG San Pedro were trained, including biomedical technicians, clinicians, pharmacists, and administrative staff. Since then, an additional 50 staff have been trained across five additional sites. The training modules covered topics including general information on medical gases and safety; information on equipment and materials installed at the facility; and oxygen cylinder handling, maintenance, and risks associated with use. EpiC also conducts monthly monitoring site visits to ensure the quality of installations and equipment. 

Launch event at CHR San Pedro 

In March 2024, EpiC Côte d’Ivoire officially commissioned and handed over a medical LOX infrastructure expansion project at CHR San Pedro. Since that initial launch event, LOX systems have been certified at five additional hospitals, now covering six of the seven project hospitals, with oxygen being delivered to approximately 14,00 patient beds. 

The Minister of Health, Public Hygiene and Universal Health Coverage, Mr. Pierre N’Gou Dimba, symbolically cut the ribbon. He was accompanied for the occasion by the Ambassador of the United States in Côte d’Ivoire, Jessica Davis Ba.  

Sustainability planning 

To plan for the LOX project’s long-term future, a sustainability plan has been drawn up with the DIEMP team. This document, still awaiting validation by the MOH, includes elements such as continuity of the supply of liquid oxygen, ongoing maintenance of the physical infrastructure, implementation of operational procedures, roles and responsibilities of the teams working on the LOX sites, technical assistance, and training sessions for technical and administrative staff. The modules and themes covered by the sustainability plan are:  

  • LOX equipment, maintenance, handling of cylinders, and technical assistance  
  • Safe management and operation of the LOX system  
  • Use of medical oxygen and oxygen therapy equipment  

A national technical working group has also been established to ensure effective implementation of the sustainability plan. 

Featured photo: Inauguration ceremony for the LOX project in Côte d’Ivoire. From left to right: Dr. Kissiédou, Director of CHR San Pedro; Ms. Sandra Georges, EpiC Project Director. Jessica Davis Ba, U.S. Ambassador to Côte d’Ivoire; Mr. Pierre N’Gou Dimba, Minister of Health, Hygiene and Universal Health Coverage; Ms. Cissé Nakaridja, Mayor of San Pedro; and the midwives of CHR San Pedro. Photo by EpiC Côte d’Ivoire