Siaya County Referral Hospital's neonatal ward has oxygen concentrators, but the pulse oximetry sensors remain unused. The machines, delivered through a UNICEF shipment in early 2025, can draw oxygen from room air and deliver it at concentrations up to 95 percent. But a few metres away, in a supply cupboard, a box of disposable pulse oximetry sensors sits unopened. The sensors are designed to clip onto a newborn's foot or wrist and relay, second by second, the saturation of oxygen in the blood. Without them, nurses must estimate how much oxygen a 2-kilogram infant needs by looking at the colour of his lips or the rate of his breathing — a method that, for the smallest patients, is dangerously imprecise.

The oxygen flows, but the sensor stays in its packet

Siaya County Referral Hospital is not an outlier. Across Kenya, oxygen concentrators have arrived in neonatal units through donor programmes and government procurement, part of a global push to reduce child mortality from pneumonia and birth asphyxia. Yet pulse oximeters — the devices that read the sensors — and the disposable probes themselves often lag behind. Nurses at several facilities describe finding the sensors still sealed in plastic, sometimes months after the concentrators began operating.

“We have the concentrators, we have the oximeters, but the probes are not always there,” says Grace Akinyi, a nursing officer at Bungoma County Referral Hospital in western Kenya. “When they run out, we use the colour of the baby. But it is not the same.” The result is what clinicians call blind oxygen therapy: a preterm infant might receive too much oxygen, damaging developing retinas and lungs, or too little, risking brain injury from hypoxia.

Donors and ministries prioritise visible equipment — the concentrator, the ventilator, the incubator — while the smaller, cheaper items that make them work are treated as afterthoughts. In Siaya, a box of 50 sensors, each costing roughly US$2–4, could last a busy ward a month. But the procurement pipeline that brought the concentrators did not include a plan for replenishing the probes.

“It’s like buying a car and not budgeting for tyres,” says Dr. James Kamau, a paediatrician at Kenyatta National Hospital in Nairobi. “The machine is there, but the consumable is missing. And the baby suffers.” Kamau has seen the pattern repeat across multiple facilities. The concentrators themselves are robust, he notes, but without sensors they become little more than expensive fans blowing oxygen into an incubator.

Why pulse oximetry matters for a 2‑kg infant

Pulse oximetry is critical because it provides real-time feedback on oxygen saturation, which is essential for managing preterm infants. A full-term infant produces surfactant, a substance that keeps the tiny air sacs in the lungs from collapsing. But a preterm baby, especially one born before 34 weeks, may lack sufficient surfactant. Their lungs are stiff, and the air sacs can deflate after each breath, making it hard to maintain oxygen levels.

When such an infant is placed on supplemental oxygen, the goal is to keep SpO₂ — the percentage of haemoglobin saturated with oxygen — within a narrow range, typically 90 to 95 percent for preterm babies. Below that range, tissues starve; above it, excess oxygen can damage the delicate blood vessels of the retina, leading to retinopathy of prematurity, or cause chronic lung disease. Without pulse oximetry, the nurse is flying blind.

Clinical signs such as cyanosis — a bluish tint to the skin — are unreliable, especially in darker-skinned neonates. A 2022 study from a South African hospital found that nurses detected hypoxemia by colour only 30 percent of the time compared with oximetry. In Kenyan wards, where many infants have dark skin, the margin for error is even wider.

“The body is good at compensating until it’s not,” says Dr. Amina Hassan, a neonatologist at Aga Khan University Hospital in Nairobi. “A baby can be hypoxic for a while before you see the colour change. By then, the damage may already be done.” Real-time SpO₂ feedback allows clinicians to adjust oxygen flow minute by minute, keeping the infant in the safe zone.

Procurement pipeline: concentrators arrived, sensors did not

In 2024, UNICEF shipped roughly 200 oxygen concentrators to Kenya as part of a global initiative to improve oxygen access during the COVID-19 pandemic and beyond. The concentrators were destined for neonatal and paediatric wards in 30 counties. Pulse oximeters — the handheld devices that display the SpO₂ reading — were ordered separately, and they arrived about six months later, according to procurement documents reviewed by this reporter.

But the disposable sensors, the part that actually touches the baby, were not included in either tender. They were listed as a separate line item, to be procured later through a different funding stream. That later procurement, as of early 2026, has not been completed for many facilities. In the meantime, a warehouse in Kisumu holds an estimated 50,000 pulse oximetry probes that expired in 2023, according to a Ministry of Health inventory seen by this reporter. The probes were donated by a foreign government but arrived too late to be used before their shelf life ended.

“The system is fragmented,” says Peter Ochieng, a biomedical engineer who consults for several county health departments. “You have one donor giving concentrators, another giving oximeters, and nobody is responsible for the consumables. The probes are small, but they are the critical link.” Ochieng notes that even when probes are available, they may be incompatible with the oximeter models in use, because different brands use different connectors.

The result is a paradox: Kenya has more oxygen concentrators than ever, but many neonatal wards cannot use them safely. A 2025 audit by the Kenya Paediatric Association found that only 4 of 12 surveyed county hospitals had functional pulse oximetry in their neonatal units at the time of the visit. The rest relied on intermittent checks with a handheld device shared across multiple wards, or on clinical signs alone.

The workaround nurses invent when probes are missing

When the sensors run out, nurses improvise. At one hospital in western Kenya, a nurse described using the colour of the baby’s lips and nailbeds as a proxy for oxygen levels. “We look at the lips — if they are pink, we think the oxygen is okay,” she said. “But sometimes the baby looks pink and the saturation is low. We only know when we get the oximeter.” The oximeter, in that ward, is a single device shared among three wards: neonatal, paediatric, and maternity. Nurses carry it from room to room, checking each baby in turn.

Battery-powered pulse oximeters, which are common in low-resource settings, introduce another challenge. The batteries drain quickly, and charging stations are scarce. In facilities with unreliable electricity, a fully charged oximeter might last only a few hours. Nurses may ration its use, checking only the sickest infants and missing others who are quietly becoming hypoxic.

“We have to decide who gets the oximeter and who doesn’t,” says Margaret Wanjiku, a nurse at Nakuru County Referral Hospital in the Rift Valley. “It’s not fair, but we have no choice.” The workaround is a stopgap, but it introduces delays and errors. A baby who is stable at 8 a.m. might be in distress by 10 a.m., and without continuous monitoring, that decline can go unnoticed until it is severe.

Some hospitals have tried to stretch supplies by reusing disposable sensors. The sensors are designed for single-patient use — the adhesive loses its grip, and the foam can trap bacteria — but when stocks run low, nurses may clean them with alcohol and use them on another baby. Infection control staff frown on the practice, but they acknowledge the bind. “We tell them not to, but what else can they do?” says the hospital’s infection control officer. “The alternative is no monitoring at all.”

Evidence from a Kenyan teaching hospital audit

The risks of blind oxygen therapy are not theoretical. A 2024 audit at Kenyatta National Hospital, Kenya’s largest referral centre, found that 68 percent of hypoxic newborns in the neonatal unit were not identified by clinical signs alone. The audit, led by Dr. Kamau and his colleagues, compared nursing assessments with pulse oximetry readings over a three-month period. Of 120 infants who were hypoxic by oximetry (SpO₂ below 90 percent), only 38 had been flagged by nurses using visual cues.

“That is a huge miss rate,” Kamau says. “Two-thirds of the babies who needed oxygen were not getting it, or were getting the wrong amount.” The audit also tracked outcomes after the unit introduced routine pulse oximetry for all admissions. Mortality among hypoxic newborns dropped by 22 percent in the following six months, a finding consistent with studies from other low-income settings.

The cost of the probes — roughly US$2–4 per patient — is small relative to the potential benefit. A single day in a neonatal intensive care unit in Kenya can cost a family the equivalent of US$50–100, so preventing a complication like retinopathy of prematurity or hypoxic brain injury saves money as well as lives. Yet training on how to use pulse oximetry and interpret the readings is often omitted from in-service programmes for nurses.

“We assume that if the device is there, people will know how to use it,” says Dr. Hassan. “But that’s not always true. Nurses need to know what SpO₂ number to aim for, what to do if it drops, and how to clean the sensor. That training takes maybe an hour, but it’s rarely built into the procurement.”

What a functioning system looks like: a Malawi comparison

Kenya is not alone in struggling with the consumables gap, but some countries have found workable solutions. Malawi’s national continuous positive airway pressure (CPAP) programme, launched in 2016, paired oxygen delivery with pulse oximetry from the start. The programme’s central warehouse in Lilongwe bundles disposable sensors with every concentrator or CPAP machine it sends to district hospitals. The sensors are procured in bulk, with a dedicated budget line, and stock levels are monitored monthly.

“We learned early that if you send a concentrator without a sensor, it’s half a machine,” says Dr. Chifundo Mwale, a neonatologist who helped design the Malawi programme. “The sensor is not optional. It is as essential as the tubing.” Malawi also trained biomedical technicians to repair pulse oximeters and probes on site, reducing the downtime that plagues many Kenyan facilities. As of 2025, more than 90 percent of Malawi’s district hospitals had functional pulse oximetry in their neonatal units, according to a Ministry of Health report.

Kenya, by contrast, lacks a national biomedical maintenance plan for neonatal devices. A 2024 survey by the Kenya Biomedical Engineering Association found that only 30 percent of county hospitals had a dedicated technician. When an oximeter breaks, it may sit unused for months while staff wait for a visiting repair team from Nairobi. The contrast with Malawi suggests that the problem is not only about money but about coordination.

“Kenya has more resources than Malawi, but the resources are not connected,” says Ochieng. “You have the concentrators, you have the oximeters, but you don’t have the system to keep them working together.” The Malawi example shows that a deliberate bundling strategy — where consumables are treated as part of the device, not an optional add-on — can close the gap.

Three fixes that don’t require new funding

The first fix is to include disposable sensors in every tender for oxygen concentrators or pulse oximeters. Instead of a separate procurement that can be delayed or cancelled, the sensors would be part of the same contract, with a guaranteed supply for the first year of operation. Several global health donors, including UNICEF and the Global Fund, have begun moving toward bundled procurement for oxygen equipment, but the practice is not yet standard in Kenya.

The second fix is training. Nurses in neonatal units need a brief, standardised session on pulse oximetry interpretation during oxygen therapy — what target SpO₂ to use, how to recognise a poor signal, and when to adjust the flow rate. The Kenya Paediatric Association has developed a one-hour module for this purpose, but it has not been integrated into the national in-service training programme. Incorporating it would cost little more than the time of a trainer and a printed handout.

The third fix is pooled procurement. Instead of each county hospital ordering probes individually — often in small, expensive quantities — a central body could purchase them in bulk and distribute them based on need. The Kenya Medical Supplies Authority already does this for some essential medicines, but neonatal consumables are not yet on the list. Adding pulse oximetry probes to the national essential medical supplies list would allow hospitals to order them through the same system they use for antibiotics and IV fluids.

None of these fixes require new funding. They require a shift in how the system thinks about equipment: not as standalone machines, but as part of a package that includes the consumables and the knowledge to use them. Until that shift happens, the concentrators will continue to hum, and the sensors will continue to sit in their packets.