Background: Given the unprecedented surge in COVID-19 infections, the heightened demand for medical oxygen prompted numerous national and global initiatives to bridge the gap between supply and demand. This was crucial for ensuring adequate treatment for patients suffering from acute respiratory distress syndrome and requiring oxygen therapy. This research aims to explore the factors influencing medical oxygen management in India during the pandemic and beyond, examining both facilitators and barriers.

Method: Through a thorough review of literature, secondary research, and interviews with key stakeholders, critical factors affecting oxygen management were identified. These factors were then analyzed using a modified total interpretive structural modeling (m-TISM) approach and MICMAC (Matrice d’ Impacts croises multiplication applique an classment) analysis to comprehend their hierarchical relationships and driving forces.

Results: The study identifies fourteen key factors that act as facilitators and barriers to oxygen management during the COVID-19 pandemic. These factors also influence medical oxygen management during the non-pandemic period. The development of an m-TISM model gives us the hierarchical interrelationships between these factors, including oxygen management as one of the factors itself. The findings identify key strategic levers to strengthen the national oxygen management ecosystem and cross-sectoral collaborations.

Conclusion: Unlike previous studies, this study moves beyond just identifying the challenges to offering a hierarchical map of pandemic-era and post-pandemic facilitators and barriers in the oxygen management ecosystem in India. This study provides insights into strengthening the oxygen ecosystem, enabling policymakers and program implementers to make informed decisions and implement pre-emptive measures to address future threats from the virus or similar crises.