As the Covid-19 pandemic ravages the World, the need and relevance of oxygen in human health has become one of the most important debate topics. Hewa Tele, a Kenyan based social enterprise that provides oxygen to medical institutions in Kenya, and its founder Dr. Bernard Olayo, have become critical to how the region survives the pandemic in Kenya and the region and how the future of healthcare will be formulated in the years to come
Not many people get their names mentioned by US billionaire Bill Gates, leave alone make it to his Heroes in the Field listing.
Since 2017, only 23 individuals have made it to this honourable list that includes some of the most impactful people who, through their actions, are making a change in the public health sphere across the World.
Dr. Bernard Olayo, a doctor and the Founder & Executive Chairman of The Center for Public Health and Development (CPHD), a non-profit organization based in Nairobi, Kenya, is one of them.
A rare accolade for a man who grew up near the edges of River Yala that transverses Western Kenya, as it rolls slowly into Lake Victoria – and bringing with it multitudes of illnesses, including malaria and pneumonia, that pervade the lake basin region – killing thousands of young people and adults alike in its wake every year.
For Dr. Olayo, making it to Bill Gates list in 2019, is an important accolade and a great way to recognize the work he and his company have been doing in Kenya; but the greater recognition is the many thousands of lives that they are saving every year through their Hewa Tele program, which continues to make all the difference across Kenya.
Oxygen is vital for health
As the Covid-19 pandemic continues to cause loss of lives and livelihoods across Africa and the World, one often talked about remedy to managing the pandemic has been oxygen.
Critical in helping manage this debilitating disease especially in a resource poor continent like Africa, the need and importance of oxygen in oxygen in Africa has taken a new dimension with the emergence of Covid-19, and yet it is one of the key elements that continue to hinder the delivery of proper healthcare across the Continent.
Hewa Tele is a social enterprise with a mandate to supply oxygen to needy patients in public and private hospitals in Kenya. Established in 2013, following an assessment in Western Kenya that showed a huge unfulfilled need for medical oxygen in the region, Hewa Tele, which means ‘abundant air’ in Kiswahili, and its affiliate Mediquip Global, support the provision of healthcare by providing affordable oxygen, building essential infrastructure and training healthcare professionals for effective health service provision in Kenya.
“The Hewa Tele name talks about our mission, which was set up as an enterprise that would help to bridge the oxygen gap in hospitals in sub-Saharan Africa. Oxygen is an essential medicine, and if you don’t get it, especially if you have a disease that compromises the function of your lungs, for example pneumonia and most recently, Covid-19, you will end up with many people dying. Our goal is to contribute towards saving these lives through this technology,” Dr. Olayo informs us.
“The gap when we started was huge, and close to half of the children in a setting where the doctor has made a prescription that a child needs oxygen in Kenya do not receive oxygen. That gap is so big that in hospitals, they ration oxygen. You are given oxygen when you are critically ill and about to die, and therefore people associate the administration of oxygen with death.
“That’s why in most of our rural hospitals when you put oxygen on children the parents remove it, because they don’t want their children to die. Most of our hospitals below the provincial level barely have enough supply of oxygen every day,” Dr. Olayo explains, adding that oxygen is an essential medicine that should be available at all health facilities in Kenya and the region.
Dr. Stephen Adudans, who is the Executive Director at CPHD, adds that providing oxygen in the region faces many challenges.
“There are three things that make oxygen very critical when it comes to what we are doing. The first is access. One out of 5 newborns that come to our health facilities in sub-Saharan Africa and especially in Kenya will require oxygen, but almost half of them will not get it.
“Second is affordability. Oxygen is expensive because of the ways that we manufacture it and also because of the terrain we have in sub-Saharan Africa, the cost of distributing it makes it quite expensive. The last issue is safety. Oxygen is a drug, it is a medicine, if it is given in the right way it can be therapeutic but if it is not monitored well, it can cause problems. Babies who are given oxygen within the first days of birth can go blind, therefore oxygen has to be given in a safe manner. We ensure the safety of oxygen by using simple technologies, where we monitor how much oxygen is in the blood and ensure that we are able to stop administering it when the patient has had enough of it.”
Providing more information on the affordability issue, Dr. Olayo informs us that African healthcare facilities are faced with higher prices compared to global prices for medical oxygen.
“A litre of oxygen in Sub-Saharan Africa costs roughly 13 times what it costs in Northern America and 10 times what it costs in Europe,” explaining that while African countries are generally poor, they are paying more than their richer global counterparts for the same commodity. “Our role is to try and work with governments and hospitals to try reduce that price. We have cut our prices by close to half of the prevailing market and we want to continue reducing the prices as we build our economies of scale and build more plants and efficiencies.
“The challenges with providing oxygen are further compounded by lack of training in the administration of oxygen in the hospitals in the region. These are the 3 major gaps we have seen and want to address.”
Dr. Olayo reveals that oxygen being an made an essential drug was only recently given more impetus in 2017, when the World Health Organisation (WHO) decided to enlist it as an essential drug, just like others, meaning that “oxygen has to be available at all levels of care, which is a huge task for the government and for other private sector players.”
Working with public sector and partners
The Center has been operating for the past several years in East Africa to improve healthcare systems through the provision of infrastructure and training programs to complement government efrorts and investments in the region.
CPHD’s award winning Hewa Tele concept was set up in 2013 and in September 2014, it opened its first oxygen plant at the Siaya Referral Hospital, the main government facility in Siaya County in Western Kenya, in partnership with the hospital, the GE Foundation and Frog Design. The plant, which is fully operational, distributes oxygen to over 10 countries, reaching more than 3 million people in Western Kenya.
“We operate a milkman model, where we set a large plant within the busiest hospital in the region, where we produce oxygen for that hospital and then we distribute the oxygen to between 50-60 other health facilities within a radius of 100 miles or 160 kilometers,” Dr. Olayo enlightens us.
The second plant is located at the former Nakuru Provincial General Hospital and a third one is at at the Mama Lucy Kibaki Hospital in Nairobi.
He reveals that the 3 plants have enabled Hewa Tele to meet the needs of almost 156 facilities on a monthly basis.
Dr. Adudans informed us that at the facilities, they have adopted the pressure swing adsorption technology of purifying oxygen gas from the air, which relies on a simple technique that is also less costly. “We use a naturally occurring salt called Zeolite, which has a unique property of getting attached to nitrogen at high pressure and temperature.”
This approach entails passing cleansed air through a seedbed full of Zeolite at high temperature and pressure, which takes out nitrogen in the air, resulting in a relatively high concentration of oxygen, about 95%. The oxygen is then compressed at a pressure of 2000 psi or 170 bars before it is packaged in cylinders for delivery to healthcare facilities in the region.
Once delivered at the hospital, CPHD ensures that the right infrastructure is in place to administer the oxygen to patients using the right tools and with patient safety in mind.
“We can have a lot of oxygen available but if it’s not safety administered to the patients, then there is no need for it. At the hospital, we must have the right piping system, which is very crucial to ensure there is safe delivery of oxygen to patients. One very vital thing is monitoring the amount of oxygen in the blood of the patient because oxygen can also be injurious to the body.”
Dr. Adudans reiterates the critical role oxygen has in the management of the Covid-19 pandemic, explaining that approximately 80% of those with the disease will be asymptomatic and they will never know they had the disease, because they will not develop any symptoms. Another 15% will have some kind of clinical presentation or mild symptoms, while about 5% will have severe symptoms.
“Those with severe symptoms will require oxygen treatment, and if the application of oxygen starts early, we can actually save their lives, without the need for ventilators. My worry is that as a country we have less than 500 functional ventilators. If the number of severe cases go up, we won’t be able to serve them, but if we are able to catch them early, we can put them under oxygen and save their lives.”
Partnerships that work
The operationalization of the Hewa Tele oxygen plants requires a synchronized partnership arrangement between CPHD and the hospitals in which they are built and the entire healthcare system in the region the plant serves.
“The type of approach we used is what we call in public-private partnership field as build-operate-transfer (BOP). I’ll attribute our success to quantifying the program for the government, for them to see the gap in their system and also for them to estimate potential savings that would arise if they go through with the project.
“We are not asking hospitals to seek more budgetary allocation; we are saying that we will offer oxygen at a cheaper price. The savings they make should in turn be allocated to us. For example if they used to buy a cylinder of oxygen at KSH. 4500 (approximately US$45) and we sell it to them at about KSH. 2500 (US$25), the money on top should be allocated to our oxygen eco-system. It was difficult for the first project but simpler for the consequent ones,” Dr. Olayo divulges.
However, he reckons that the three plants are not adequate to service the huge needs of the healthcare system in the country, adding that they are seeking more partners to enable them deliver more of such plants across the country.
“If we were to setup what we would consider our model plant that can serve between 50-60 facilities within a radius of 100 miles in Kenya, that has cylinders, distribution trucks and everything else right, we would need to raise capital of around US$1 million (KSH. 100million). Getting such amount for us is very difficult since we are a small organization.
“If we had no capital limitations we would in the next 3 years expand in Kenya into five high priority areas, where the need is there but is not met adequately, including Mombasa, the Mt. Kenya region, the Meru-Isiolo area, Bungoma county in Western Kenya and in the northern region of Kenya, around Garissa. With 5-10 more plants, we can actually meet the need for oxygen in this country,” he assures.
Capacity and resource gaps
Considering the huge gap between the demand and supply situation of oxygen in the country, Dr. Olayo asserts that the issue of having the right technical knowledge is key to delivering on their mandate, revealing that Hewa Tele is a system that serves the needs of the people across the country because of its focus on delivering oxygen safely and affordably, while working with the right partners and dedicated staff, but the challenge comes in setting the eco-system.
“If you look at the nature of raw materials you need to produce oxygen, then you will think it is easy to set up a good plant. The raw material here is air and it differs from area to area; some places are humid, while others are dry and therefore require different types of adjustments on the plant. Most people go for off-the shelf plants and thus incur more costs in adjusting them to suit their environments. Also, there is the problem of availability of skills, whether it is in maintaining or assembling the plant.”
He explains that working with government agencies has its fair share of challenges, especially in terms of delayed payments and challenges in having the procurement of oxygen being given the urgency and priority it deserves, all the time.
Further, higher costs of electricity in the country negates their focus on delivering affordable oxygen to the hospitals in the country; plus the high costs and supply chain inefficiencies due to the fact that oxygen cylinders have to be imported into the country from overseas due to lack of a local supplier of the specialized cylinders, increase complexity and raise the cost of healthcare in the country.