Oxygen Systems in Indonesian Hospitals: Cross- Sectional Study and Strengthening Roadmap
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Abstract
Medical oxygen is a life-saving medicine essential to modern healthcare; however, ensuring its availability remains a critical policy challenge in low- and middle-income countries. Weaknesses in production, distribution, and preparedness often translate into inequities in access, while the COVID-19 pandemic demonstrated how governance and logistical failures can rapidly escalate into a national emergency. This study aimed to assess the oxygen system readiness in Indonesian hospitals and highlight priority gaps for reform. A cross-sectional survey was conducted in 2022 across 96 hospitals in 18 districts across five provinces. Using an adapted WHO Biomedical Equipment for COVID-19 Case Management Inventory, seven domains of oxygen readiness were evaluated: oxygen source, distribution, regulation, delivery, monitoring, power supply, and maintenance. Findings revealed that only 65% of hospitals had a complete oxygen system, with better readiness among hospitals on Java, public hospitals, and higher-class facilities (A and B). Significant disparities persist, particularly among referral hospitals outside Java and among lower-class hospitals. This study underscores the importance of embedding oxygen management explicitly into health system reform and governance frameworks. Strengthening oxygen supply mechanisms offers practical and managerial opportunities to enhance resilience, equity, and preparedness for future health emergencies.
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MELIALA, Andreasta et al.
Oxygen Systems in Indonesian Hospitals: Cross- Sectional Study and Strengthening Roadmap.
Policy & Governance Review, [S.l.], v. 9, n. 3, p. 382-401, dec. 2025.
ISSN 2580-4820.
Available at: <https://journal.iapa.or.id/pgr/article/view/1288>. Date accessed: 10 mar. 2026.
doi: https://doi.org/10.30589/pgr.v9i3.1288.
Section
Articles
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
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Asian Development Bank. (2022). Strengthening Oxygen Systems in Asia and the Pacific Region
BBC. (2021, 5. July). Indonesia faces oxygen crisis amid worsening Covid surge. https://www.bbc.com/news/world-asia-57717144
Bhatt N., Nepal S., Pinder R. J., Lucero-Prisno, D. E. & Budhathoki, S. S. (2022). Challenges of Hospital Oxygen Management during the COVID-19 Pandemic in Rural Areas of Nepal. The American Journal of Tropical Medicine and Hygiene, 106(4), 997–999. https://doi.org/10.4269/AJTMH.21-0669
CNN Indonesia. (2021, 16. July). Menkes Sebut Kebutuhan Oksigen Naik Jadi 2.000 Ton per Hari. https://www.cnnindonesia.com/ekonomi/20210716145116-532-668639/menkes-sebut-kebutuhan-oksigen-naik-jadi-2000-ton-per-hari
EpiC. (2023). Strengthening the Medical Oxygen Ecosystem. FHI 360. https://www.fhi360.org/wp-content/uploads/drupal/documents/resource-epic-covid-19-oxygen-synthesis-brief.pdf
The Federal Ministry of Health. (2021). National Policy on Medical Oxygen in Health Facilities. The Federal Republic of Nigeria. https://stoppneumonia.org/wp-content/uploads/2023/09/National-Policy-on-Medical-Oxygen-in-Health-Facilities_1661783417.pdf
Global Oxygen Alliance. (2023). Global Oxygen Alliance (GO 2 AL) Strategy: executive summary 2024–2030. https://pharosglobalhealth.com/ wp-content/uploads/2023/11/GO2AL_StrategyExeSummary_2024-2030.pdf
Graham, H. R., King, C., Rahman, A. E., Kitutu, F. E., Greenslade, L., Aqeel, M., Baker, T., Brito, L. F. de M., Campbell, H., Czischke, K., English, M., Falade, A. G., Garcia, P. J., Gil, M., Graham, S. M., Gray, A. Z., Howie, S. R. C., Kissoon, N., Laxminarayan, R., … Ssengooba, F. (2025). Reducing global inequities in medical oxygen access: the Lancet Global Health Commission on Medical Oxygen Security. The Lancet. Global Health, 13(3), e528–e584. https://doi.org/10.1016/S2214-109X(24)00496-0
Ibrahim, N. H., Wallace, J., Piaggio, D. & Pecchia, L. (2025). Design and maintenance of medical oxygen concentrators in sub-Saharan Africa: a systematic review. BMC Health Services Research, 25(1), 1–15. https://doi.org/10.1186/S12913-025-12315-6/TABLES/3
Institute for Transformative Technologies and Oxygen Hub. (2021). Closing The Medical Oxygen Gap in Sub-Saharan Africa: A case for a decentralized hub-spoke network of pressure swing adsorption plants. www.transformativetechnologies.org
Kementerian Kesehatan. (2022). Permenkes No. 40 Tahun 2022 tentang Persyaratan Teknis Bangunan, Prasarana, dan Peralatan Kesehatan Rumah Sakit. https://peraturan.bpk.go.id/Details/245559/permenkes-no-40-tahun-2022
Kementerian Kesehatan. (2025, 5. May). Transformasi Kesehatan Indonesia Kemenkes RI. https://kementeriankesehatan.com/transformasi-kesehatan-indonesia-kemenkes-ri/
Kingdon, J. W. (2014). Agendas, Alternatives, and Public Policies (2nd ed.). Pearson Education Limited. www.pearsoned.co.uk
Liyanage, D. H., Krishanth, M. D. A., Wickramaratne, P. N., De Alwis, A. K. S. B., Pannapitiya, P. W. C., Perera, U. A. A. S. & Yaddehige, I. S. (2022). Sri Lanka Oxygen Readiness and Strategies Adapted for Covid-19 Patients’ Management. Indonesian Journal of Health Administration (Jurnal Administrasi Kesehatan Indonesia),10(1), 133–142. https://doi.org/10.20473/JAKI.V10I1.2022.133-142
Mahendradhata, Y., Andayani, N. L. P. E., Hasri, E. T., Arifi, M. D., and Siahaan, R. G. M., Solikha, D. A. & Ali, P. B. (2021). Capacity of the Indonesian Healthcare System to Respond to COVID-19. Frontiers in Public Health, 9, 649819. https://doi.org/10.3389/FPUBH.2021.649819
McCollum, Rosalind., Ralalicia Limato., Lilian Otiso., Sally Theobald., Miriam Taegtmeyer. (2018). Health System Governance Following Devolution: Comparing Experiences of Decentralization in Kenya and Indonesia. BMJ Global Health. 2018;3:e000939. https://doi.org/10.1136/bmjgh-2018-000939
Ostrom, E. (2010). Polycent ric systems for coping with collective action and global environmental changes. Global Environmental Change, 20(4), 550–557. https://doi.org/10.1016/J.GLOENVCHA.2010.07.004
PATH. (2018). Market Assessment and Recommendations to Increase Access to Oxygen and Pulse Oximetry in Indonesia. https://media.path.org/documents/Indonesia_Country_Report.pdf
Smith, V., Changoor, A., McDonald, C., Barash, D., Olayo, B., Adudans, S., Nelson, T., Reynolds, C., Cainer, M. & Stunkel, J. (2022). A Comprehensive Approach to Building a Medical Oxygen Ecosystem: An Implementation Case Study in Kenya, Rwanda, and Ethiopia. Global Health Science and Practice, 10(6), e2100781. https://doi.org/10.9745/GHSP-D-21-00781/-/DCSUPPLEMENTAL
UNICEF. (2021, 19. July). Indonesia’s COVID-19 Surge Raises Concerns | UNICEF USA. https://www.unicefusa.org/stories/new-covid-19-epicenter-indonesia-coronavirus-cases-surpass-indias
World Health Organization (WHO). (2020, April 4). Oxygen Sources and Distribution for COVID-19 Treatment Center: Interim guidance. https://iris.who.int/bitstream/hand le/10665/331746/WHO-2019-nCoV-Oxygen_sources-2020.1-eng.pdf?sequence=1
World Health Organization (WHO). (2021). WHO COVID-19 Essential Supplies Forecasting Tool (COVID-19 ESFT): An overview of the structure, methodology and assumptions used. In Interim Guidance. World Health Organization (WHO). https://www.who.int/publications/i/item/WHO-2019-nCoV-clinical-2021-1
World Health Organization (WHO). (2023). World Health Organization Model List of Essential Medicines – 23rd Edition. The selection and use of essential medicines 2023. World Health Organization (WHO). http://apps.who.int/ bookorders.
World Health Organization (WHO). (2023). WHA76.3: Increasing Access to Medical Oxygen. https ://www.who.int/publications /i/ item/9789240049505,
World Health Organization & UNICEF. (2019). WHO-UNICEF Technical Specifications and Guidance for Oxygen Therapy Devices. In the WHO Medical Device Technical Series. World Health Organization and United Nations Children’s Fund (UNICEF). http://apps.who.int/bookorders.
Wu, X., Ramesh, M. & Howlett, M. (2015). Policy capacity: A conceptual frameWork for understanding policy competences and capabilities. https://doi.org/10.1016/j.polsoc.2015.09.001
World Health Organization (WHO). (2023). Statement on Access to Quality and Safe Medical Oxygen. World Health Organization (WHO). https://list.essentialmeds.org/files/trs/D9GThPSnias5fEHb YKtzasG6vrq4VAyOisH7IyJN.pdf