How oxygen generators got mired in red tape

When Covid first hit us in March last year, many health tech entrepreneurs raced to create the world-class healthcare products we badly needed such as diagnostic kits, ventilators, and yes, oxygen generators. Today, when faced with our biggest crisis — oxygen — it’s natural to wonder what happened to those oxygen generators?! Therein lies our tragedy, and an opportunity to re-make our future.

The government spent a lot of money in 2020 to buy medical equipment through hastily-assembled tenders to compensate for our weak healthcare infrastructure. One such tender was for oxygen generators of 15 different capacities, ranging from 100 litres/minute to 3,200 litres/minute. As a knee-jerk reaction, this tender had a near-impossible delivery deadline of 75 days. A group of pedigreed innovators filed a bid, but offered realistic delivery commitments. They didn’t win, in fact none of the reputed players did, and the tender went to two unknown players with no track record who bid the lowest, and guaranteed delivery within the crazy deadline. So no surprise when very little was delivered even after 180 days, and India didn’t have these oxygen generators when the second wave hit us. Thoughtless spending during a crisis, and inaction after the crisis has blown over is a big reason why we’ve never created a good healthcare infrastructure.

Why do we face such a situation at all? We have the talent to build great medical equipment. Over 800 innovators have been backed by the government’s own BIRAC (a not-for-profit set up by the Department of Biotechnology) since 2012. But the same companies can’t get government sales orders because the tender requirements are opaque and complex. Without revenues from the government — a big buyer of medical equipment — these companies become unviable, and India continues to import 80% of its needs.

But there’s finally light at the end of this tunnel. Smaller hospitals across the country, especially in non-metro cities, are increasingly saying no to expensive MNC products or unreliable Chinese stuff. They want reliable and affordable domestic products. We could see this trend when the IIT Kanpur-backed NoccarcV310 ventilators, a project I was part of, were introduced in the market.

Will we be better-equipped to deal with the next healthcare crisis when it hits us? We have no option but to be. In a recently published book, Viruses, Pandemics, and Immunity, the authors — both celebrated scientists in the US — point out that “the inhabitants of the 21st century have learned that infectious disease-causing viruses are an existential threat to humanity. They can exact an enormous toll in terms of lives lost and causing economic carnage”

How can India be better prepared? Odisha showed the way while tackling a very different kind of recurring natural disaster — cyclones. After being hit by a massive cyclone in 1999 (official death toll 9,885; unofficial 50,000), Odisha got its act together. When Cyclone Phailin of similar magnitude hit in 2013, only 23 lives were lost. Odisha did four things right — invested in infrastructure, built early warning systems, created community outreach, and ensured clear communication.

Can we replicate this formula in healthcare to save lives? Two of these building blocks are at a tipping point — infrastructure, and community engagement. Recent government policy announcements have the potential to ramp up healthcare infrastructure if executed well. The ‘Production Linked Incentive Scheme (PLI)’, the ‘Promotion of Medical Devices Parks Scheme’ are two examples. Before that, the 2020 Union Budget had funding provisions for creation of ten technology propellers and five manufacturing zones by 2025. These initiatives can help young companies as well as big industrial groups. The launch of Tata Medical and Diagnostics Ltd (TataMD) is the biggest sign that things will change. If TataMD can bring scale and quality orientation to medical devices like Maruti Suzuki did for auto components, we can be assured of a very different healthcare future. The villain in this puzzle is India’s broken regulatory framework.

American and European companies grab global markets because they have FDA and CE certifications respectively. India’s moth-eaten regulations are in the midst of being overhauled but there’s widespread worry that this could become yet another bureaucratic black hole.
Community engagement sprang up from the grassroots during the pandemic to plug gaps in the government machinery. For instance, Pune Platform for COVID-19 Response (PPCR), with over 500 members, worked with 250 plus hospitals and the local administration to expand Covid bed capacity from 4,000 to 31,000 and ventilators from 300 to 1,700 in the last 14 months.

The other two building blocks still need work. Our early-warning systems failed to prepare us for the second wave. We have great epidemiologists and mathematical modellers to create these systems, but they need to be inside truly autonomous institutions insulated from political pressures. What’s more, governments need to heed these early-warning systems and communicate clearly.

We have to get this done fast. Building a robust healthcare infrastructure is a national security issue now. Whether at the LAC or to Covid, precious Indian lives are being lost. So, defend them at the nation’s borders, and defend them at homes and hospitals



Views expressed above are the author’s own.


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