Understanding the limitations of India's healthcare infrastructure during the coronavirus pandemic

The current Coronavirus pandemic is easily one of the most devastating events to hit the global psyche in modern history. The problem is not that the current scenario is unprecedented, but the fact that despite humanity’s previous run-ins with such serious diseases, we really have not been any better prepared in dealing with them than we were a century ago.

Despite all our technological advancements, all of us are still stuck trying to flatten the deadly curve without much success.

Perhaps the most glaring and equally telling issue faced when it comes to dealing with this situation is the lack of proper medical infrastructure to handle the ever-increasing number of critical patients, who are fighting not only for their lives, but also over life-saving medical machinery like ventilators. This, despite the fact that the government and healthcare providers alike have been stuck in firefighting mode for months now, pooling all their resources to deal with this crisis.

One of the reasons for this situation is the fact that the global supply chains have ground to a halt, which has resulted in the imported ventilator market share going down from almost 75% last year to less than 4% during the lockdown.

One would assume that this was the best chance for us to strengthen our domestic healthcare delivery system and build a world-class healthcare infrastructure. However, the bottleneck with regard to this goal is not one of will but of knowledge itself, as the technical know-how required to build the best quality ventilators has been monopolised by a ​few ​companies who have hidden the information behind heavily protected patents in order to maximise their profits.

Unfortunately, this has not stopped some unscrupulous players from trying to take advantage of the current situation by creating sub-par equipment that does more harm than good. As a result, the market has been flooded with defunct products that only serve to add fuel to the fire.

So much so, the domestic ventilator supply has risen from 300 per month to over 30,000 at the peak of the lockdown as reported by the Association of Indian Medical Device Industry (AiMeD).

The rapid adoption of these domestic ventilators has less to do with their ability than their cost and availability, which at an average price of around Rs. 1.5-4 lakhs is less than a quarter of the price of imported ones that can go for around Rs. 10-20 lakhs easily.

If we are to address this problem and the underlying gaps in the system, we first need to focus on certain specific areas highlighted below.

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Boosting the MSMEs

Even as we scramble to build up our capacity to handle more patients, our focus should also be on ensuring that these critical care units are also equipped with the latest medical machinery to handle the problem.

With a population of over 100 crores, we simply cannot rely on established players to handle this burden. The need of the hour is for the government to open up the manufacturing of critical equipment to up-and-coming manufacturers in the SME and MSME segments.

We have already seen that our manufacturers are more than capable of handling this task as 96% of the 60,000 ventilators procured by the government for the Covid crisis have been indigenously produced so far.

This move will not only result in the sharing of the current load, but also ensure that the supply is not hampered if one or two big players are taken out of the equation due to unforeseen circumstances in the future.

The lessons learned through this process will also encourage technical development in this field, which will, in turn, ensure that future medical manufacturing done by domestic companies will be on par with international competitors, thus improving our standing as a credible exporter of medical equipment.

Ensuring quality

Even as we encourage the establishment of new players in the manufacturing segment, we must also advocate strict measures to be taken when it comes to quality control.

The current rush of unregulated players in the field of medical manufacturing has resulted in a slew of low-cost ventilators and other equipment that not only function poorly as compared to precision proprietary scientific tools, but also risk the lives of patients who have no way of telling if they are being treated with proper equipment.

A disheartening and potentially deadly example of this was found in JJ Hospital and St. George’s Hospital in Mumbai, who have had to return close to 100 ventilators due to their failure in boosting the oxygen levels of patients, a task which they were supposedly designed for. This indicates the need for the expert manufacturing community to come together and act as advocates for better quality control.

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Addressing bio-medical waste

During a pandemic as contagious as this, it is expected that we see a rise in medical waste. Syringes, masks, gloves, beddings, PPE kits and other related equipment is being used at an increasing rate and all of it needs to be disposed off properly if we are to avoid further contamination.

Even robust equipment like ventilators, which in general use should have a validity of close to 5-10 years are being treated as throwaway devices.

There have been several instances of low-quality emergency ventilators being used instead to treat patients with the assumption that they will be discarded as soon as the pandemic is behind us. This just adds to the mounting heaps of medical garbage that we will have to deal with if and when we come out of this crisis.

We have to step in to ensure that this does not become a habit as the issue of the shortage of ventilators cannot be addressed with a short-term solution. These are critical equipment and we need to create vital quality and testing standards that should be met before they are sent to the hospitals. Till then, only the certified companies should be allowed to manufacture high-quality ventilators.

If we do not address these problems now, then even if we make it out of this crisis, things will remain status quo and our medical infrastructure will continue to be under-equipped and inept to deal with similar crises, should they arise.