Dili, December: The COVID-19 pandemic exposed the devastating consequences of medical oxygen shortages worldwide, particularly in low- and middle-income countries. Timor-Leste has taken decisive steps to ensure it is never caught unprepared in the face of a medical oxygen crisis again.
In December 2024, the Ministry of Health and WHO convened the country’s first national consultation to develop the National Oxygen & Pulse Oximetry Scale-up Strategy, a blueprint for creating a sustainable and self-reliant medical oxygen system. Recognized as a critical need, oxygen is now included in WHO’s List of Essential Medicines, vital for treating acutely ill individuals and managing chronic diseases that lead to hypoxemia (dangerously low blood oxygen levels).
This consultation, held on December 4, followed the inauguration of Timor-Leste’s first Pressure Swing Adsorption (PSA) oxygen generation plant at Hospital Nacional Guido Valadares (HNGV) in August with support from WHO. While WHO is setting up the HNGV plant, additional plants are expected in Baucau and Manatuto with investments from The Global Fund and partners.
Earlier, Timor-Leste accessed additional funding from the Global Fund’s C-19 Window with WHO’s technical support, prioritizing investments in around 120 oxygen concentrators and other critical interventions for the continuity of essential services.
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Aerial shot of the PSA Plant at HNGV
Dr Arvind Mathur, WHO Representative, called the consultation a critical first step towards building an oxygen ecosystem in the country. “The functionalization of the HNGV oxygen plant will mark a transformative milestone, as it will be the first time the government health system would produce its own medical oxygen. From here, robust systems for storage, transport, and quality control must be established to ensure a reliable supply,” he said.
The consultation brought together stakeholders from eight key agencies, including the Ministry of Health, HNGV, the National Institute of Pharmacy and Medical Products (INFPM), the National Health Laboratory, representatives from the General Directorate for Hospital Services and Primary Health Care, the Global Fund, and Programme Managers of the National TB, HIV, and Malaria Programs. Discussions covered oxygen production, distribution, quality control, and logistical challenges, including serving rural and remote communities where access to medical oxygen and pulse oximeters remain limited. The meeting was chaired by Dr Flàvio Brandão, Vice-Minister for Operationalization of Hospitals, Ministry of Health.
The National Oxygen Strategy reflects the Ministry of Health’s broader commitment to strengthening infrastructure around emergency care, said Dr Brandão, who emphasized the importance of equitable access. "We aim to not only produce medical oxygen but also train healthcare workers, ensure a continuous supply, promote proper usage, and establish robust monitoring systems," he said.
At HNGV, Timor-Leste’s only tertiary hospital, seamless oxygen supply has been a challenge. The hospital is built in a modular design with different services spread across multiple buildings. While some wards in the buildings have medical gas piping system, which are non-functional, most of them rely on high pressure oxygen cylinders, requiring technicians from transport which is an inefficient, time consuming & unsafe practice.
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The journey to establish an oxygen ecosystem in Timor-Leste began in mid-2023, following yet another oxygen crisis at Hospital Nacional Guido Valadares (HNGV). In response, the Ministry of Health (MoH) approached the WHO Country Office for urgent support. Three independent assessments were subsequently conducted by an expert from the WHO country office, Build Health International (BHI) and the WHO Headquarters team to evaluate the hospitals oxygen needs. Based on their findings, a recommendation was made for a daily oxygen production capacity of 2 x 50 Nm³/hour. Acting on this recommendation, the WHO Country Office sought assistance from WHO Headquarters to install a container-based Pressure Swing Adsorption (PSA) oxygen generation system at HNGV.
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With 451 beds and counting, including about 40 high-demand oxygen beds, the hospital had been reliant on imported high-pressure oxygen cylinders. The hospital has been receiving 40L and 60L high-pressure oxygen cylinders from SAMES, the Ministry of Health's distributor. Previously, oxygen was sourced from a local vendor in Comoro and a liquid oxygen supplier, Daikyo, in Singapore. However, issues with oxygen purity and supply continuity arose with these suppliers. Installing an onsite PSA plant would provide autonomy in production and ensure a continuous oxygen supply.
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While inaugurating the HNGV plant earlier in August, Saima Wazed, WHO Regional Director for South-East Asia, highlighted the critical role of medical oxygen in delivering lifesaving care to patients with respiratory conditions such as COVID-19, pneumonia, and chronic obstructive pulmonary disease (COPD).