By Noha El-Ghobashy and Olatunji Ayimora
Across sub-Saharan Africa, progress has been made in expanding access to medical oxygen — a vital intervention for COVID-19, pneumonia, maternal care, and surgical procedures. But there’s a dangerous blind spot in our oxygen infrastructure that continues to grow quietly and dangerously: the recertification of high-pressure gas cylinders.
While medical oxygen plants and concentrators have received donor attention, the cylinders that transport and store oxygen are too often neglected. These cylinders operate under intense pressure (up to 300 bar), and international safety standards require that they be inspected and recertified every five years to ensure structural integrity. When neglected, these cylinders can corrode internally, develop leaks, or rupture under pressure — posing severe risk to filling plant operators, patients, hospital staff, and surrounding communities.
Anecdotal evidence from industry insiders suggests that a significant majority of medical oxygen cylinders in sub-Saharan Africa are overdue for recertification, especially in countries like Nigeria, Kenya, and Ethiopia where maintenance infrastructure is scarce or nonexistent. In Nigeria, only two facilities — operated by multinational gas firms — offer proper cylinder recertification, and both are commercially inaccessible to most third-party cylinder owners. In Kenya and Ethiopia, no certified maintenance facility could be identified in recent assessments.
Although there is no public data yet to quantify the exact percentage, the lack of widespread infrastructure, regulation, and awareness make it plausible that thousands — potentially tens of thousands — of cylinders are in unsafe condition.
This is not just a regulatory oversight; it is a public safety threat.
If an uncertified oxygen cylinder fails during filling, transport, storage, or patient use, the consequences could be catastrophic:
The irony is that these outcomes are entirely preventable. Recertification is a low-cost intervention that dramatically extends the lifespan of a cylinder — often cheaper than replacement and far safer than running blind.
A storage space with weathered oxygen cylinders, with worn exterior paint and visible rust
A close-up of a worn, threaded valve opening of an oxygen cylinder
A storage space with weathered oxygen cylinders, with worn exterior paint and visible rust
A close-up of a worn, threaded valve opening of an oxygen cylinder
Failing to address this infrastructure gap threatens to undo years of progress in Africa’s oxygen scale-up efforts. If a single cylinder explodes in a hospital setting, the human and political cost could be devastating. Even more insidiously, unsafe cylinders undermine trust in oxygen delivery systems — making providers hesitant to use them, and governments reluctant to invest further.
This is more than a technical problem. It’s a public health emergency waiting to happen.
The good news is that the solution is within reach and economically viable. A single maintenance workshop, with the right equipment and trained personnel, can recertify 50 cylinders per day — enough to serve a regional hub or metropolitan area. With an investment of $400,000 to $500,000 per facility, such a center can inspect, hydrotest, clean, and safely recondition cylinders of all gas types, not just oxygen.
This isn’t just about safety. It’s about sustainability and cost-efficiency. Recertifying a cylinder costs a fraction of buying new ones — yet extends its usable life for another five years. For countries trying to build resilient health systems with limited budgets, this is smart economics.
We call on governments, donors, development partners, and the private sector to act on this urgent, overlooked issue. Specifically:
Let’s not wait for a tragedy to remind us that safety is not optional in medical gas delivery. If we are serious about building strong health systems, then every link in the oxygen supply chain — including the steel cylinder itself — must be built on safety, compliance, and care.
If you’re interested in supporting this initiative, partnering on pilot sites, or learning more about our analysis, please get in touch.