ReALiSE: REAL-MOXY

REAL-MOXY

Status: Active

Working with health facilities to understand how oxygen care is delivered, identify challenges and opportunities, and improve emergency and hospital care for children.

The REAL-MOXY program is informed by systematic reviews highlighting medical oxygen is an essential, life-saving intervention, especially in treating hypoxaemia across all ages. Despite this, oxygen access remains highly inequitable, and evaluation frameworks are needed to examine how and why oxygen interventions function in various settings. The program therefore includes targeted engagement with the populations of three Cambodia provinces (ten hospitals) as well as group discussions with healthcare workers and policy makers, and interviews with patients and caregivers, to ensure community engagement and inclusion of end-user perspectives. The protocol specifically aims to sample across facility types and locations and include the perspectives of all stakeholders (from provider to user).  

Cambodia Ministry of Health and Clinton Health Access Initiative (CHAI) were involved in co-design of the program, reflecting strong institutional collaboration and alignment with national health priorities. Recognising the political sensitivity surrounding oxygen access, the program adopts a mixed methods approach which captures stakeholder perspectives while maintaining the ability for independent analysis and interpretation. Furthermore, to minimise the burden on healthcare workers and mitigate language or hierarchical barriers, flexible data collection is led by local clinical research assistants embedded within the participating facilities. It is assumed that the findings from selected facilities will be transferrable to the broader Cambodian health system.           

Cambodia has made progress towards universal health coverage; however, high out-of-pocket expenditure, accessibility constraints and perceived quality of care continue to influence healthcare-seeking behaviour for children. Gender and household decision-making dynamics may further affect timely access to services. These contextual factors, alongside national priorities to improve affordable oxygen access for women and children, inform the design and implementation of REAL-MOXY activities.

This program intends to directly inform national policies and strategy around oxygen services and acute care for children. Risks related to political sensitivity and inaction are being actively addressed through close involvement of the national Ministry of Health, including the Director of Medical Services. Our local partner, KHANA, are closely involved with the Ministry of Health and are well placed to navigate the political complexity at national and subnational levels. 

The REAL-MOXY project is led by Prof Hamish Graham in collaboration with KHANA Center for Population Health Research, Cambodia, Clinton Health Access Initiative (CHAI) Cambodia, Cambodia Ministry of Health 

Supported by the Australian Government through the Partnerships for a Healthy Region Initiative.