This blog is adapted from an article titled ‘Increasing equitable access to pulse oximetry: progress and considerations for sustainable scale-up in a changing global health landscape.’ The peer-reviewed commentary was published in BMJ Global Health
If we want to save lives faster – and at scale – the priority is not only to develop new tools, but to ensure that the ones we already have reach people consistently.
Across child health, many effective interventions already exist. Yet too often, they do not reach children in time or are not used routinely at the point of care. Closing this gap – between availability and consistent use – is one of the most immediate opportunities to accelerate impact.
Pulse oximetry offers a clear example.
For years, many frontline health workers had to rely largely on visible clinical signs to determine whether a child was seriously ill. But dangerously low oxygen levels are not always obvious. Pulse oximeters provide a simple, reliable way to check a child’s oxygen levels – helping to quickly identify those who may need urgent treatment. This is particularly important because respiratory conditions remain a leading cause of child mortality.
But experience introducing pulse oximetry has revealed an important lesson. Making a tool available is only the first step. To improve outcomes, health workers must use it routinely, referral systems must function, and treatment – including oxygen when needed – must be available. In many settings, these wider system requirements proved just as important as the device itself.
This has led to a clearer understanding of its role. Pulse oximetry is most effective when used as part of a broader package of care for children with respiratory illness—linking early identification to timely treatment and ensuring that oxygen and other essential care can be delivered without delay.
From access to consistent delivery
In practice, the use of pulse oximetry and related respiratory care tools remains uneven. Devices may be present but not consistently used. Oxygen may be available but not reliably delivered. Supply systems can be fragmented. Health workers, often managing high patient volumes, must balance multiple priorities within a limited time.
These challenges are not unique to pulse oximetry—they are common across child health.
They highlight a central insight: impact depends not only on what is available, but on how reliably it is delivered – every day, in every facility.
Strengthening the foundations of delivery
Alongside developing new tools, there is a need to strengthen the foundations that allow existing ones to deliver impact at scale.
Experience with pulse oximetry points to four factors that determine whether innovations succeed at scale:
These elements are often less visible than the tools themselves, but they can determine whether innovations deliver lasting impact.
Connecting evidence to implementation
Across recent experiences, a consistent pattern is emerging. Progress is strongest where evidence, policy and delivery systems are aligned.
Pulse oximetry has shown that evidence and policy are only part of the equation. Real impact depends on new tools being integrated into routine care – and that requires strong partnerships.
No single actor can deliver integrated packages of care alone. Progress has been driven by coalitions of governments, implementers, technical partners and manufacturers working together – linking product introduction with guideline updates, training, procurement and service delivery improvements.
It also means recognizing the central role of health workers – whose time, capacity, and working conditions ultimately determine whether these tools and packages are used effectively.
Looking ahead
Pulse oximetry is one example – but the broader lesson applies across maternal, newborn and child health.
From oxygen systems to essential medicines for newborn care, the opportunity is not only to expand access to innovations, but to ensure they are delivered consistently, efficiently and at scale.
This is what makes this moment a turning point.
It is an opportunity to build on a strong foundation of innovation, while strengthening the systems and partnerships that turn those innovations into everyday practice – reaching more children, more reliably, when and where they need care.
For Unitaid and partners, this means continuing to bridge both worlds: supporting innovation, while investing in the markets, delivery systems, and partnerships that allow solutions to take hold and deliver lasting impact.