Building the Missing Middle in practice
How our partners are delivering oxygen access on the ground
Hello there,
In our first two editions of Breathing Room, we explored why the future lies in Doing Oxygen Differently and why solving for the Missing Middle is the next frontier.
This time, we’d like to share how that strategy is beginning to take hold — through new tools, growing recognition, and, most importantly, the collaboration of partners across the ecosystem.
A new path for oxygen access
You may have already seen it on LinkedIn, but we’re delighted to officially present the Target Services Profile (TSP) briefing paper.
In this new paper, we define and break down the concept of a TSP - a practical framework for guiding oxygen procurement practices away from purchasing one-off products to purchasing performance-based services. Bringing this to fruition will need many perspectives, from implementers to governments. For us as the Oxygen CoLab, it is a natural continuation of the ‘CoLab approach’: co-designed, evidence-led, and rooted in practice.
We’ve been encouraged to see a lot of engagement with this paper already from our allies, partners and friends, including challenges, reflections, new ideas, and adjacent examples. This is just what we hoped for, so if there is something on your mind in response to this paper - we want to hear it! Please get in touch with Jason at jason.houdek@dt-global.com.
👉🏾 Read and share the TSP briefing paper
Doing oxygen differently in Uganda & Nigeria
The last few months have been filled with activity for the Oxygen CoLab in Uganda, from our grantees FREO2 and AFHIA showcasing their work at the British High Commission event in Kampala to exciting partnership developments with Uganda’s National Drug Authority.
Our goal in Uganda is to co-develop a capacity-building roadmap with the National Drug Authority (NDA) as well as new regulatory approaches that can better empower SMEs to scale service based models, which provide a reliable oxygen supply to local health facilities. This work will help to build the “Missing Middle” - the gap between oxygen production and oxygen delivery that emerges when large-scale oxygen production can’t meet the oxygen needs of local health facilities. Ultimately, we are aiming to create a self-sustaining oxygen market in Uganda that ensures oxygen is always available when and where it is needed.
The message across these forums was consistent: Nigeria has made real progress on oxygen policy and investment, but the gap between resources and patient care remains. As Dr. Aishat Adeniji, Co-founder of the Oxygen-as-a-Service initiative HealthPort, reminded us, “having oxygen onsite doesn’t necessarily mean it’s available for the patients.” The challenge lies less so in production, and more in service delivery, financing, and maintenance. “State governments today are putting oxygen in their annual operational plans and including budgets for oxygen, maintenance, and training,” noted Dr. Gilbert Shetak, National Oxygen Desk Officer at the Federal Ministry of Health and Social Welfare (FMOH), demonstrating that progress is steady.
For the CoLab, these meetings reinforced why building the “Missing Middle” is critical. Local innovators, such as HealthPort, are also demonstrating how service-based models and biomedical engineering solutions can make oxygen consistently available at the bedside. We are now:
Supporting Nigeria’s work to reduce cylinder import duties.
Working with the Nigeria Governors Forum and FMOH to embed oxygen financing KPIs into state health scorecards.
Launching a national oxygen supplier mapping exercise to inform the mid-term review of Nigeria’s National Oxygen Scale-Up Plan.
Join our team
As we step into this next phase, we’re growing our teams in Nigeria and Uganda. If you know someone who could help us advance service-based models, build market credibility, and keep oxygen flowing to patients, please share our open roles with them:
✎ Senior Nigeria Health Policy & Implementation Lead
✐ Nigeria Medical Oxygen Supplier Mapping & Market Engagement Consultant
✎ Uganda Medical Oxygen Supplier Mapping & Market Engagement Consultant
See you in the next edition,
Miranda, on behalf of the Oxygen CoLab.