2020/21 | Half Year IMPACT REPORT

It seems such an understatement to say that 2020 was a worked well together and have strengthened our ability year that changed the world. The global pandemic has to support communities. Above all, they have kept the challenged health systems, thrown economies into chaos lifesaving oxygen flowing. and disrupted even the best laid plans - unfortunately FREO2 was no exception. On the local front, we’ve reorganised ourselves internally with a clear focus on accountability for scalability. We Our plans to mobilise in-country were hampered by our have our go-to market strategy and business model, inability to travel, our manufacturing facility in Germany ready to be ratified by the board. We have a clear plan ceased production and access to our labs in Melbourne to realise our social enterprise model. We have created was hindered. Yet, a crisis can also provide an new foundational business capabilities in operations, opportunity to move ahead. marketing and donor engagement. We are very excited about the calibre of people who have joined the team We are pleased to report that despite these setbacks throughout the year. we’ve made significant progress across many facets of the foundation during the year. This was largely driven And what an amazing Christmas present we received. by a decision to pivot our strategy to focus on After many years of hard work, our first child was opportunities that were within our control. treated with oxygen from the FREO2-Siphon in (Western ), literally on Christmas Day! This is an Embracing the spirit of sharing, we concentrated on in- important milestone and a world first; providing life country empowerment, building our foundational saving oxygen supplied from flowing water. It means we business capabilities and cross product innovations that can confidently start to deploy the system to the most have enhanced the entire product roadmap. remote regions in the world.

Throughout this year, the capabilities and Most importantly the number of children treated with accountabilities of our in-country teams have grown our lifesaving systems across Uganda, Tanzania, Nigeria substantially. In Uganda we’ve appointed a new country and Kenya continues to grow. This is what excites us manager as well as a clinical studies coordinator. As we most and drives all of our efforts. With your help and write, we are in the process of hiring a business continued support we plan to grow this number even development manager and another technician in further in 2021. Tanzania. With gratitude, Despite all of the COVID challenges, our teams have The FREO2 team MILESTONES

What we've achieved in the last 12 months

2 2 0 , 0 0 0 1 1 8 7 Total catchment area for Children treated health facility with FREO2

8 > 9 9 % Health facilities where Oxygen avaliability across FRE02 oxygen is available. all health facilities

9 9 4 In country staff employed to Health workers trained maintain FREO2 systems

PROJECT ROADMAPS

Production

Oxylink

22 clinics

Social Enterprise

Prototype deployed Oxypump

Field trials Solar

6 month expected outcome (January 2021) 12 month outcomes (June 2021) REACH

Nigeria Sacred Heart Hospital, Abeokuta, Nigeria (test system)

Uganda Mbarara Regional Referral Hospital Kalisizo General Hospital Bugoye Health Centre

Kenya The Ruben Centre, Nairobi, Kenya

Tanzania Dongobesh, Mbulu. Bashnet, Manyara Region

Mozambique Manhiça Health Research Centre (test system)

SUCCESSES World first Siphon in operation ODS finished one month ahead of deadline Take A Breath podcast up and running Showcased by BBC World Service Team growth Shipment of 20 oxygen systems to assist with covid treatment in Uganda CHALLENGES Embargo on international travel Social media blackout due to Ugandan election Production halted due to manufacturing shutdown in Germany Lack of access to logistics, rapid escalation of freight Supply chain distrupted DELIVERING ON OUR PROMISES

SOCIAL ENTERPRISE Our social enterprise is active in Uganda and Tanzania and uses a swap-and-go technology maintenance model that strives for 100% availability of oxygen 100% of the time. We have 5 new sites ready for installation and over the next year we will bring 17 additional sites into the program. This will increase our reach to 800,000 people and treat 2,600 children per year. Our swap-and-go hubs will become skills development hubs for aspiring entrepreneurs and aims to create an employment ecosystem for young people and contribute to community wellbeing.

We have chosen a not-for-profit approach to ensure we serve the 99% who die of pneumonia, due to lack of resources. Our IP is royalty free to developing countries. We have started in Sub-Saharan Africa because of the sheer number of children dying from pneumonia. We also know there is a definitive need closer to home, in the Pacific islands.

OXYLINK FREO2 OxyLink is manufactured in collaboration with Krober in Germany. Our teams have worked closely to integrate power management and stabilization, as well as improve filtration and seamless integration of external backup sources. During the pandemic, we have had to constantly adjust our production plans, as the tyranny of distance has not allowed us to work closely together. To compensate for the COVID delays, some of the electronics are being manufactured in Australia and later shipped to Germany for integration. The first units will be ready for testing March 15. Our in- country teams will install, maintain and assess their performace. Our plan is to then produce 25 units with the purpose of demonstrating our capabilities. By Q3 of 2021 we will be ready for large scale production. TRANSLATING RESEARCH @UOM

Our approach to innovation is leverage the strengths, agility and strong interdisciplinary culture of the students and staff at the University of Melbourne. The driving force is to translate our research into public good as we strive to solve global societal challenges.

F R E O 2 S O L A R Is a novel approach to producing oxygen using solar power. By storing oxygen rather than electricity we eliminate the need for expensive chargers, inverters and the use of environmentally harmful lead-acid batteries which typically account for more than 60% of the cost of installation. The technical work in this project leverages the previous FREO2 innovations, Siphon and LPOS and aims to rapidly develop a pre-production prototype. During the last 6 months we have achieved continual operation of our novel solar- powered oxygen concentrator. And during the extended lockdowns in Melbourne, the system has operated without maintenance (or human interaction) for months. We are now integrating the LPOS storage and real- time Data Acquisition systems, in preparation for field trials in Uganda.

OXYPUMP Safe referral of hypoxic children needs Oxygen on the Go. This will offer critical medical treatment which wouldn’t otherwise be accessible in low- resource settings by providing a continuous, reliable supply of oxygen to hypoxic children during transport to medical care. Oxypump can run on a car battery or any portable power source. In the past 6 months, we have completed the preliminary design work for Oxypump and will soon begin the technical work to produce proto-types. Our colleagues from Save the Children have agreed to oversee the technical evaluation and assess the suitability of Oxypump. We expect that this evidence will help galvanise support for wide-scale deployment. WHAT WE'RE PROUD OF

DESIGN EXCELLENCE

We would like to take this opportunity to celebrate and share the achievements of our Engineering Team. In early July 2020, we welcomed two new engineers and a graphic designer to the team. Andy Drain, Abigail Neave and Kate Abfalter combined forces with Kevin Rassool to form a world class engineering team. The new team didn’t waste any time getting down to business and with their combined talents and experience delivered a physical prototype of our first Oxygen Distribution System one month a head of schedule. The Oxygen Distribution System (ODS), delivers oxygen from an oxygen supply source room, to a ward at a distance of up-to 35m. The ODS has been designed to function in hot, humid and dusty climates and allows delivery of flow controlled oxygen to five bedside outlets.

In developing the ODS, the team embraced a best practice Technology Development Approach with a strong focus on user centred design. With significant limitations around in-country travel, digital communication platforms were utilised to ensure the broadest possible participation. Insights were gleaned from health workers, engineers and development experts from over 15 countries including Uganda, Nigeria, Cambodia, Nepal, India and Vanuatu.

This process led the team to a product requirement and specifications document and conceptual design, which was validated through internal and external workshops; including one with the renowned Dr Robert Ssekitoleko from Makerere University, Uganda. With a validated concept, detailed design, modelling and simulations, physical testing was completed. Over summer, the team have brought this design into physical prototypes, ready for implementation in the Uganda TTS2 pilot.

Throughout the process, the team have generated a documentation structure aimed at delivering safety, quality and a smooth regulatory path for the ODS, strengthened by a partnership with Brandwood CKC regulatory consultants and the experience of Andy and Abigail from their previous roles at Fisher&Paykel Healthcare. We are very proud of the enthusiasm and laser focus the team brought to this project. Overcoming many design challenges and roadblocks the team collaborated effectively and delivered an outstanding prototype. We look forward to seeing the ODS sitting on many walls across our health facilities in the coming months, delivering oxygen safely. A DIVINE GIFT FOR CHRISTMAS

It was the 24th of December in Bugoye, a small-town set in remote western Uganda. The threat of pneumonia is high in this region and many children are lost to the disease every year. Robert, Shem and the FREO2 team had been working hard for months to get the novel FREO2 Siphon system operational. The water from the nearby River was finally powering the system and providing the vacuum required to deliver a steady supply of oxygen to the clinic. On this morning in December, Robert powered up the system and waited in anticipation for the first patient to arrive.

Meanwhile three kilometres outside Bugoye a mother called Birra Dallen was concerned that her young baby Devine didn’t seem himself. He had stopped feeding and his chest was congested. It would be a difficult journey by foot over rough terrain to get to the closest health clinic, but her instincts told her that baby Devine needed to receive urgent medical attention. By the time they arrived at the clinic, Devine was extremely ill and was struggling to breathe. A blood oxygen reading confirmed that he had severe hypoxemia and required oxygen support urgently. This was the moment that our question would finally be answered, Is it possible to provide life-saving oxygen without any electricity? The team at the clinic was relieved that they had oxygen and were eager to treat Devine with the new FREO2 Siphon.

As the oxygen began to flow, Devine's condition gradually improved. The distant sounds of the river gently spread relief. We could see Birra Darra visibly relax as a quiet calm slowly spread across Devine's tiny body. It took 4 more days of continuous oxygen before he was well enough to breath alone. Baby Devine was the first patient on the planet to receive life-saving oxygen produced from flowing water completely independent of electricity! This was truly a Christmas gift to the entire FREO2 Team and our partners! If baby Devine had arrived just one day earlier, there would have been no oxygen and the only choice referral to Hospital, at least an hour away by motor bike. Often a family has to mortgage a portion of land to meet the medical, transport and accommodation costs associated with referral.

Needless to say, we are all so pleased that the system was ready to go just in time for baby Devine. Birra Dallen generously agreed to share her story and has been interviewed so we can better understand barriers to care seeking from a mother’s perspective. We look forward to incorporating these learnings as we realise our vision to ensure every child can breathe, live and thrive. INTRODUCING 'TAKE A BREATH' PODCAST

A FREO2 PODCAST SERIES FREO2's Take A Breath podcast is a series where we ask some of the amazing people who work within our FREO2 commmunity to sit with us, take a breath and tell us their stories. We hear all about the passions, heartaches, hopes and fears of our friends who dedicate their lives to giving breath to others. Our host Helen Palmer spoke to Lizzie Webb, Chair of the FREO2 Board, where she talks about pathways to the not-for-profit/purpose sector and her passion for reducing health inequality. Our second guest, Sheillah Bagayana, Manager of FREO2 Uganda spoke about her passion for working in healthcare innovation. To listed to our podcast, go to: https://shows.acast.com/take-a-breath

Thank you to Jennifer Hansen for collaborating with us, Helen Palmer from Selfunlimited for hosting, Hugo Wood-Freeman for editing and Peter Cassimento for imagery. Baby Francis in particular represents that every single life is important and is part of our aspiration to make sure that

every health centre around the world, particularly those where power supply is unreliable, can provide consistent oxygen

and children like Francis don't don't go without.

LIZZIE WEBB, Chair of the FREO2 board A BIG THANK YOU TO OUR SUPPORTERS

Our work is made possible through research at the University of Melbourne and the generous support of our program partners. A special thank you to the teams at Kröber, SuperGas and Cyclotek - with your help we were able to send 24 emergency oxygen systems to Tanzania and Uganda to help with COVID. With the support of SMC we also developed emergency ventilators in case Australia needed them - thankfully not! As Eleanor Loudon, CEO of Engineers Without Borders (EWB) says "with the COVID-19 pandemic impacting, we all understand now more than ever how critical a reliable oxygen supply in health centres is.” We are delighted to have the support of EWB as we scale.

To our many donors through the University campaign we say thank you for your belief in our work. With your support, we are able to save more children. FREO2 is about translating research into public good. We are guided by the four I's - Ideas become Innovations, which we Implement to have Impact.