Solar powered oxygen systems in remote health centers in Papua New Guinea – a large scale implementation effectiveness trial

Introduction of solar-powered oxygen concentrators into 36 health centres in Papua New Guinea. This project will evaluate the implementation issues in the national scale-up of oxygen concentrators and pulse oximeters in the rural areas PNG, a high mortality developing county. The implementation steps include defining the criteria for facilities where this technology (oxygen concentrators and pulse oximeters) are appropriate, assessment of power supplies and power requirements of each health facility, the optimal design of a solar power system to power the equipment, defining specifications for oxygen concentrators and other oxygen equipment that will function in remote environments, implementation logistics in remote settings, developing the engineering capacity required to sustain such a program at scale, and training on oxygen equipment and the treatment of children with severe respiratory infection. Training is both in workshops in each province, and on-site training, where a team member visits the health facility as part of improved monitoring and supervision, and conducts training at that time. The treatment of pneumonia follows standard WHO treatment based on the Hospital Care for Children guidelines, and the oxygen therapy guidelines (WHO Clinical use of oxygen in children). The implementation is expected to take 6 months, but because it is multifaceted and multi-site it may extend beyond this depending on the feasibility in different locations. The project will evaluate these issues down to a rural district hospital and major health center level (i.e. the smallest health centers that admit children). Implementation involves the National Department of Health, the provincial paediatricians, local technicians, and a solar contractor. The programmatic and implementation issues we will evaluate include technical questions regarding power supply irregularity in remote settings, the role of solar power, the optimal concentrator to use in remote tropical environments, the role and utility of hand-held oximeters particularly when used by nurses and community health workers, training issues in oxygen concentrators and the use of pulse oximetry, program costs, the engineering capacity required to maintain a program, the integration of these technologies with clinical guidelines for the standard treatment of children with pneumonia and integrated case management, and referral problems. These issues have not been addressed in a systematic way in developing countries and they are impediments to progress in improving children’s access to better care for severe pneumonia.