Updated: May 11, 2021 8:38:34 am
In the wake of the oxygen supply crisis in Covid-19 management in India, the Supreme Court has set up a 12-member National Task Force (NTF) to guide, inter alia, the central government allocation of medical oxygen to the states. The task force will work with senior officials of NITI Aayog, the Ministry of Home Affairs and the Department of Promotion of Industry and Internal Trade as well as the All India Institute of Medical Sciences, the Indian Council of Medical Research and the Directorate General of Health Services. The Supreme Court has also mandated that the task force may constitute more sub-groups on specialised areas or regions to assist in its work and also to consider, if appropriate, seeking the assistance of experts both within and outside government in areas such as critical care, infectious disease modelling, clinical virology and immunology, and epidemiology/ public health. The rationale for setting up the task force has been to facilitate a public health response to the pandemic based upon scientific and specialised domain knowledge.
It is hoped that the establishment of the NTF will help the decision-makers with inputs that can enable them to go beyond ad hoc solutions to the unprecedented challenge. In the 12-point terms of reference (ToR) of the NTF, the first five points focus on oxygen supply, including, deciding on a methodology for the scientific allocation of oxygen to states and facilitating audits (of oxygen supply, distribution and utilisation) by sub-groups within each state and UTs. The task force will also review and suggest measures necessary for ensuring the availability of essential drugs and medicines. The remaining six ToR of the NTF are aimed at the broader pandemic preparedness and response, which include planning and adopting remedial measures to ensure preparedness for present and future emergencies; to facilitate the use of technology; to suggest augmenting the availability of trained doctors, nurses and paramedical staff; to promote evidence-based research and enhance effective response to the pandemic; facilitate sharing of best practices across the nation to promote knowledge about management of the pandemic and to make recommendations in regard to other issues of pressing national concerns. The tenure of the task force shall be six months initially.
The Supreme Court’s order to set up the task force is highly significant, considering that India is struggling to mount an effective response to the second wave of the pandemic. It ensures the participation of independent subject experts in policy decisions, which have often been criticised as being overly led by a techno-bureaucratic process. It is very significant that the Court has considered the supply of medical oxygen in the broader context of the shortage of medicines at health facilities and that the improved supply and provision of essential drugs and medicines has been included as one of the ToRs.
The shortage of medical oxygen in the Covid-19 response reflects insufficient planning, delayed procurement, and weakness of supply chain management — issues which plague medicine supply in the public healthcare sector in India. The only differences are i) that the shortage of medical oxygen is more acute and urgent and ii), while people can buy medicines from the private sector, medical oxygen is short across the board. The root cause of this situation is the insufficient capacity of state health departments in planning, procurement and supply of medicines, an issue which is widely known. This is further aggravated by insufficient government funding. The importance of such a mechanism cannot be underestimated. For instance, Tamil Nadu had set up the medical supply corporation in 1994 and has better supply management than most other Indian states. In recent years, a number of states have set up medical procurement and supply corporations, but their functioning remains suboptimal in the absence of sufficient and trained human resources. As a result, though most Indian states have started free medicine schemes, people continue to spend on medicines from their own pockets. The coexistence of free medicine schemes and high out-of-pocket expenditure (which accounts for nearly 30-40 per cent of healthcare costs paid by the people from their pocket) on medicines is a comment on the performance of these schemes. The presence of many private chemist shops just outside every government hospital across India, speaks volumes, too. Therefore, looking at the shortage of medical oxygen through a broader lens is a great start.
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The work of the NTF will not be without challenges. They have a short time to look at far broader issues. The members of NTF have the needed qualification and expertise to advise on clinical matters and oxygen supply; however, they may need to proactively co-opt members with expertise in medical procurement and supply; pharmacology, free medicines and diagnostics; and public health and emergency health response. Also, considering that the availability of diagnostics has similar challenges as medicines, the NTF may consider including that as well in the scope of its work.
However, the NTF may face a bigger challenge in delivering on its ToRs on the broader pandemic response. All 10 of the 12 independent members of the NTF (the other two are government officials, ex-officio) are leading clinicians, critical care specialists and virologists. They may be the best in their area of work; but a long-term and effective pandemic response needs broader expertise than medical care. The NTF will have the responsibility to ensure that India should not end up with a medicalised response to a public health challenge. The decisions and recommendations of this NTF and how they co-opt members with the right expertise will determine whether India ends up becoming a medicalised care system (which would focus on treating sick) or a healthcare system which can keep people healthy and respond to future epidemics and pandemics.
This column first appeared in the print edition on May 11, 2021 under the title ‘A guiding force’. Lahariya is a public policy and health systems expert. He is the co-author of Till We Win: India’s Fight Against The COVID-19 Pandemic
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