Turning crisis into resilience: How India and Liberia are building sustainable oxygen systems

The COVID-19 pandemic exposed deep vulnerabilities in medical oxygen infrastructure across the globe. In countries like India and Liberia, the crisis catalysed unprecedented investments and partnerships. Today, these nations are transforming emergency responses into robust, sustainable health systems—ensuring reliable access to lifesaving oxygen therapy for millions.

India: From emergency response to enduring oxygen access

The challenge: When COVID-19 struck, India faced an acute shortage of medical oxygen. Over US$250 million was rapidly invested to expand capacity, with states such as Chhattisgarh building public-sector infrastructure capable of producing 250 metric tons of oxygen per day. However, much of this equipment risked falling into disrepair due to limited maintenance funding and a shortage of trained technicians.

The solution: Recognizing the need for long-term resilience, the Chhattisgarh State Health Department, with technical support from Global Oxygen Alliance (GO₂AL) member the Clinton Health Access Initiative (CHAI) and the William J Clinton Foundation (WJCF), launched a comprehensive initiative in 2022. Key actions included:

• Forming district oxygen committees to coordinate planning, maintenance, and rapid response for oxygen needs across 1,032 public health facilities.
• Developing a cascade training model to build the capacity of more than 6,000 technicians and clinicians in oxygen equipment operation and maintenance, creating a self-sustaining knowledge network.
• Optimising oxygen supply chains by redistributing unused oxygen concentrators and establishing a central repository for pressure swing adsorption plant spare parts.
• Integrating improved planning processes by embedding oxygen system reviews into routine state health programme evaluations to ensure ongoing oversight and accountability.
• Improving budget allocations by earmarking domestic funds for equipment maintenance to reduce repair costs and downtime.

Impact: These efforts have led to more efficient supply chains, reduced equipment failures, and a culture of continuous improvement in oxygen system management. By integrating oxygen training into broader disease programmes and including oxygen indicators in state health reviews, India is ensuring that pandemic-era investments support long-term health system resilience.

Medical oxygen is not just a resource; it’s a lifeline. With the support of WJCF, we are strengthening the medical oxygen ecosystem. Their technical expertise, hands-on capacity-building, and consistent systems support have empowered our teams on the ground—from hospitals to health facilities—to respond more effectively and save lives. It is a shared commitment toward a stronger, more resilient health system, rooted in good governance and sustained by meaningful, long-term solutions.

Dr. DK Turre, Deputy Director, Hospital Administration, Directorate of Health Services (DHS), Government of Chhattisgarh; Dr. Anil Shukla, Divisional Joint Director, DHS, Surguja, Chhattisgarh

Liberia: Building capacity for sustainable oxygen therapy

The challenge: Before the pandemic, Liberia’s health system faced severe shortages of trained health workers and lacked national guidelines for oxygen therapy. When COVID-19 arrived, the country had to urgently scale up capacity, stretching already limited resources.

The solution: The Ministry of Health, with support from CHAI, United Nations Children’s Fund (UNICEF), and Partner Liberia, launched an emergency oxygen training programme during the pandemic. Drawing on lessons from the Ebola crisis, this programme was quickly integrated into the national in-service training curriculum to ensure sustainability. Key elements included:

• Rapidly rolling out the training with 144 clinicians within four months, focusing on both theoretical knowledge and hands-on simulations in COVID-19 treatment units.
• Integrating the curriculum and training package as part of Liberia’s ongoing health worker education, led by local facilitators to build in-country expertise.
• Optimising sustainable resource use by retaining equipment procured during the emergency phase for future training, supporting ongoing skill development and system readiness.

Impact: By embedding oxygen therapy skills into the national training curriculum, Liberia has built a foundation for lasting improvements in patient care. This approach ensures that investments made during the pandemic continue to strengthen the health system, equipping health care workers to respond to both routine and emergency needs.

Our partnership with CHAI and UNICEF Liberia, particularly their championing of oxygen training initiatives, was pivotal in addressing critical health care gaps during the COVID-19 pandemic. The work we do today to ensure access to medical oxygen is about building a future where every Liberian can trust in a health system that delivers quality care, no matter the challenge.

Mark B. Luke, Liberia Ministry of Health, Monrovia, Liberia

Lessons learnt and the path forward

Both India and Liberia demonstrate that targeted interventions—such as workforce training, coordinated oversight, and strengthened supply chains—can transform crisis investments into resilient oxygen ecosystems. By focusing on sustainability, local capacity-building, and integrated planning, these countries are ensuring that the gains made during the pandemic will endure, continuing to save lives for years to come.

GO₂AL and its members remain committed to supporting countries as they build stronger, more resilient oxygen systems—because access to medical oxygen should be a guarantee, not a gamble.

About CHAI

CHAI is a global health organisation that operates at the nexus of government, business, and health. Our mission is to save lives and improve health outcomes in low- and middle-income countries by enabling the government and private sector to strengthen and sustain high-quality health systems. Our approach hinges on our trusted relationships with governments to drive change across entire health systems. CHAI is working to expand access to medical oxygen in countries with the highest rates of mortality for pneumonia, with an emphasis on vulnerable groups such as newborns and children. In addition, we support governments and health administrators to improve hypoxemia screening through training and access to critical tools like pulse oximeters, and in reforming national policies and financing to sustain these improvements.

The William J. Clinton Foundation (WJCF), registered as a not-for-profit organisation under Section 8 of the India Companies Act, is an affiliate of CHAI.

About GO₂AL 

GO₂AL is a multistakeholder collaborative consisting of 20 organisations and delegations that volunteered to join the alliance to collaboratively work towards a collective vision to increase oxygen access in low- and middle-income countries. It is not a legal entity or funding mechanism. GO₂AL is coordinated by Unitaid, the World Health Organization (WHO), and UNICEF. It is co-chaired by Unitaid and the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) and vice-chaired by the Africa Centres for Disease Control and Prevention (Africa CDC) and the Pan American Health Organization (PAHO). GO₂AL members include the Access to Medicine Foundation, Africa CDC, Build Health International, CHAI, the Every Breath Counts coalition, the Gates Foundation, the Global Fund, PAHO, Partners In Health, PATH, Save the Children, UNICEF, Unitaid, United Nations Office for Project Services, United States Agency for International Development, WHO, the World Bank, and representatives from civil society and affected communities.