COVID-19 pandemic exposed major creeks in healthcare: India needs to upgrade critical care health infra

The COVID-19 induced pandemic revealed major creaks in healthcare systems across the globe. In India, the void of a limited number of hospitals, debilitating medical infrastructure and restricted access to healthcare was felt the strongest for 72 years of the countrys independence. As state and central governments recognized the gaps, it can be sufficiently said that the pandemic completely changed the dynamics of the Indian healthcare ecosystem for years to come.

Ventilators and PPE kits became the face of the pandemic as the country scrambled to provide critical healthcare to its citizens. According to data from the Center for Disease Dynamics, Economics & Policy and Princeton University, India had only 48,000 ventilators at the time of the pandemic's outbreak against the requirement for 1,50,000 ventilators. This scenario now is undergoing a major change and at a rapid pace.

A number of domestic manufacturers like Bharat Electronics Limited (in collaboration Skanray Technologies), AgVa Healthcare (in collaboration with Maruti Suzuki Limited), MedTech Zone, Mahindra & Mahindra, Hyundai Motor India Ltd, have successfully manufactured and delivered ventilators to meet the need gap.

At the same time many global players came with world class medical technology. Brands like Hamilton Medical, GE Healthcare supplied cutting edge ventilators to various health care facilities during these times. Hamilton Medical, a specialist ventilator brand from Switzerland and a world leader in ventilator technology is in the process of installing a batch of 1500 ventilators across central government run hospitals, which include the AIIMS in Gorakhpur, Bhatinda, Raebareli and Nagpur as well as many government hospitals in tier 2 towns such as Tripura, Dimapur, Dibrugarh, Imphal, Silchar and others. Earlier availability of such advanced ventilators in tier-2 towns were unheard of, making critical care infrastructure limited to metros. Philips, a global leader in health technology, recently introduced its mobile Intensive Care Units (ICUs) for India

In the 2021 Union Budget of India, the government announced a 137% increase in healthcare spends, with the goal to address the long pending need to grow more on health as a percentage of the GDP. This additional spend is envisaged to go towards all round upliftment, from vaccination, to preventive health and to augment the national medical infrastructure with specific focus on critical care.

Already, some progress has been made. Through the pandemic period, India progressively saw growth in the number of ICU beds, number of ventilators and oxygenated beds. As per the Ministry of Health & Family Welfare in April 2020, India's ICU bed count stood at 27,360. By January 2021, this had increased to 36,008. The country's oxygenated bed count rose by over 152% in the same period. The Central government procured a total of 38,867 ventilators at a cost of Rs 1,850.76 crore for distributing among the States and the Union Territories.

Dr. Debendra Kumar Tripathy, Additional professor (Dept of Anesthesiology and Critical Care) and Vice Dean (Innovation) at AIIMS, Rishikesh says, "In the pre-Covid era India was severely lacking ventilators, monitors and trained manpower to run critical care facilities. This pandemic has been able to draw the attention of healthcare policymakers towards the need for more intensive care units. Many states have today grown their ICU infrastructure 2 to 3-fold and in cases even 5 to 7 fold. Even district headquarters have better infrastructure and trained manpower today. At AIIMS Rishikesh we expanded the critical care capacity from just one ICU to now 7 ICU's during the pandemic. Today, after the reduction in pandemic related patient load these ICUs are being utilized to provide tertiary care to routine patients."

The pandemic set forth a global crisis for the critical care manufacturing sector. There was global shortage of ventilators as countries scrambled to upgrade their healthcare infrastructure. The disruption created by the pandemic in the global supply chain added to this challenge. Due to the worldwide spread of coronavirus, exports of medical equipment including ventilators came to a halt. The situation was so taxing that as many as fifty-four countries stopped exporting medical goods including ventilators.

Speaking on the importance of delivering critical care support to critical patients, Dr. Vasudevan, HoD JIPMER, Puducherry said, "We had a good infrastructure in place until the pandemic struck. Suddenly, ventilators became crucial equipment to maintain patients' conditions. We had to ramp up our facilities and we received ventilators under PM cares program. These were both home-grown and some from international companies. However, to run this equipment is a challenge and some of these especially the imported ventilators were based on Artificial Intelligence and automated functioning. This made it easy for us to monitor patients."

COVID-19 in essence proved to be a disruptor of India's healthcare sector by pushing it for its much-needed crucial upgrades and pivotal implementation. The progress of Critical care infrastructure is now not only taking place in metro cities but also expanding to 2-3 tier cities. However, with that came the challenge of finding trained healthcare professionals to manage and operate many ventilators at a time. That is where advanced technological interventions and expertise in manufacturing becomes pivotal.

The onus now lies in ensuring effective critical care management and infrastructure is present in every scale of government, public and private healthcare setups. India needs to move beyond minting doctors and building hospitals. It is essential that doctors and hospitals are equipped to deliver healthcare using advanced tools.