The investigators will use a concurrent mixed-methods design, with an overarching
comparative case study methodology. The investigators will adopt an iterative approach,
using co-design to adapt the study methodology to the specific context of each country
and annual learning team meetings with stakeholders to refine the final case study topics
(sub-study 3) and methodology.
Three embedded sub-studies are planned:
Sub-study 1 (Stakeholder Analysis) aims to understand the policy environment for medical
oxygen services across different country contexts. This will be informed by the MOXY
baseline survey, which includes data on oxygen-related facility readiness and clinical
practices across the MOXY program areas. Data sources will include stakeholder interviews
with participants from different levels (national, provincial, local) and policy
perspectives (government, implementing/advising partners, practitioners, beneficiaries).
Results will inform sub-study 2 and MOXY program implementation.
Sub-study 2 (Policy-Implementation Gap Analysis) aims to critically analyse the gap
between policy intentions and actual implementation. This will be informed by the
baseline facility readiness and clinical practice data. Data sources will include a desk
review of oxygen-related policies, stakeholder in-depth interviews, and program
administrative data. Results will inform implementation of country oxygen strategies and
feed into prioritization of focus areas for sub-study 3.
Sub-study 3 (Comparative Country Case Studies) aims to compare oxygen programs across
countries, focusing on particular challenges or unique solutions identified in sub-study
1 and 2. Data sources will include repeated desk review of oxygen-related policies and
program administrative data, follow-up stakeholder interviews, and triangulation with
quantitative survey results on facility readiness and clinical practices.
This research will also draw on national stakeholder dialogues - both to review, refine,
and validate preliminary findings of the study team and to draw out feasible
solutions/alternatives for both policy and practice and oxygen eco-system. In year 1 the
investigators will generate key evidence about how the current strategies and polices are
being translated into action, identifying key opportunities for implementing partners to
focus support. Over years 2 and 3, the investigators will learn how these activities have
affected medical oxygen service coverage, drawing lessons across country contexts and
across different implementation approaches.