Why India's public healthcare system is gasping for oxygen
The death of 30 children in less than 48 hours in Baba Raghav Das Medical College of Gorakhpur, Uttar Pradesh, shows the rot in our health system. Despite various theories regarding the deaths, it is clear that supply of oxygen was interrupted in the pediatrics ward for a few hours.
The UP government has ordered criminal action against the then principal of BRD medical College, Rajeev Mishra, and oxygen supplier Pushpa Sales. The principal was suspended following the deaths. There have been suspensions and FIRs against many others. It includes Dr Kafeel Khan, head of pediatrics department, who is widely believed to have tried to avert the damage on the night of August 11. These actions must have been important to chief minister Yogi Adityanath to show commitment to his constituency, of which he had been a four-time MP till recently, before he took over as CM.
However, none of them address the real cause behind the deaths, that is, an inefficient supply chain system. India's supply chain of any medical product in public health reeks of criminal negligence, which does not seem to care for human lives. And the worst-affected are the most vulnerable population, such as children.
Pushpa Sales claims that it had to cut supply of oxygen on August 10 due to non-payment of bills. The hospital said it did not receive money from the state government despite repeated requests. The payment of Rs 68 lakh had been due and the supplier had been writing to various state authorities since April asking to clear the bills. Following this delay, the supplier did not send oxygen on the fateful night.
This was not the first time this year that lives of children were at stake due to supply issues. In the month of March, Cipla stopped manufacture of pediatric HIV drug Lopinavir syrup as the payment had been due for two years.
The central government invites annual tender for the drugs. Cipla being the sole producer of these pediatric drugs, applies and sells them to the government’s AIDS programme.
These drugs are lifeline for nearly 3,000 children in India and their shortage can lead to lowering of immunity, exposing children to life-threatening infections. The syrup keeps them alive and ensures healthy life like their counterparts. More than 600 children and their guardians wrote to the prime minister and the health minister appealing to reinstate supply of the drug.
It was only after international agency Global Fund intervened that the matter was resolved and medicines were brought back in public health facilities retail market.
A similar situation arose in 2013 with regard to pediatric TB drugs. There was a massive stock-out of TB medicines for children in the public sector. Doses for children are lower than those given to adults. In case of a stock-out, parents and treatment providers resort to breaking tablets meant for adults and giving them to children. It has high chances of over- or under-dose, which can be devastating for a child in terms of side-effects.
TB activists and civil society organisations had to make emotional appeals to the government for reinstating the drugs. In its press release dated June 17, 2013, international humanitarian organisation, Doctors Without Borders, wrote that in Mon, Nagaland, a 12-year girl, on TB treatment arrived with her father after a long journey to get her medicine. The medicines were out of stock, but luckily there were six days’ worth of drugs available from a patient who had died. The child could be given immediate relief.
We would rather not have a system dependent on dead patients to save the living.
These are just a few examples that arose at national level and made headlines. Stock-outs are a regular feature and procurement agencies across the country have to bring about changes. Only an overhaul of supply-chain system can bring that change.
Most importantly, the tenders have to be placed well in advance. It will require judicious assessment of need for services, diagnostics and medicines, as well as time-taken for such procurements. Simultaneously, application for release of money has to be placed in time with appropriate authority, not to mention responsibility of state governments to release this amount before a crisis hits.
Equally important is the role of private players who supply to the government. Stopping supply of oxygen or medicines is not the best way to force the government to clear the dues. The sufferers of such business deals are consumers of public services who are mostly from the poorer and marginalised sections of society.
The companies have to seek better regulation from the government and the legal system. They cannot run away from taking moral responsibility of these deaths and inconveniences caused to general public.
In the end, it needs political will and intent to move towards a robust healthcare system. To achieve this, efficient procurement system is going to be the key.