The oxygen ecosystem refers to holistic efforts, initiatives and resources across health systems, that are required for an optimal and sustainable implementation of oxygen systems. In addition to equipment and the medicine itself, the oxygen ecosystem also covers all of the other activities to ensure that oxygen systems can function safely, effectively and continuously. The ecosystem considers context, policies, guidelines, need-gap assessments, health infrastructure, the selection of appropriate systems, costing and financing, partnerships, implementation, operation and maintenance, training, monitoring and evaluation. And sustaining oxygen ecosystems means revisiting all of these aspects at a set frequency.