A retrospective analysis of oxygen concentrator maintenance needs and costs in a low-resource setting: experience from The Gambia

Oxygen is an essential medicine for the treatment of pneumonia, the leading cause of death in children under five worldwide. Yet, providing a sufficient and reliable supply of oxygen is a major challenge for many health facilities in the developing world, particularly in paediatric care units. The cost-effectiveness of oxygen concentrators versus compressed gas cylinders as a source of oxygen in low-resource health facilities has been demonstrated, but evidence of their long-term functionality is scarce. The Biomedical Engineering Department at the Medical Research Council Unit in The Gambia manages and maintains 27 oxygen concentrators at several sites across the country, and has kept electronic records of all preventive maintenance checks and repairs on these devices since 2006. Through a retrospective analysis of these maintenance records, the objective of this study was to assess the long-term reliability and maintenance needs of oxygen concentrators in a low-income setting with biomedical engineering technologist support. We found that the majority of concentrator repairs are low-cost and require a low experience level to complete. We estimate that the useful lifespan of oxygen concentrators in low-resource settings could reasonably exceed 7 years provided a system is in place for routine preventive maintenance. We conclude the paper with additional insights on the broader support ecosystem required to manage and maintain oxygen concentrators in low-resource settings.