India: Prepare for the next oxygen emergency and improve health services

In May 2021, India found itself at the global epicentre of the COVID-19 pandemic.As the second wave hit, demand for medical oxygen soared tenfold, a tragic scene unfolded as people struggled to get their hands on the life-saving commodity.
The sudden surge in demand has been exacerbated by the concentration of oxygen production plants in India’s eastern industrial belt.Only a few hospitals have in-house facilities to produce this precious gas; most rely on oxygen cylinders or liquid medical oxygen (LMO) delivered from elsewhere.What’s more, the number of cryogenic tankers needed to transport LMOs is too small to handle the sudden surge in demand.
The government responded in a number of ways: by airlifting more tankers from abroad, converting tankers used for liquid argon and liquid nitrogen to carry oxygen, and innovating railroads to introduce oxygen express trains.In addition, hospitals in more than 550 cities and regions were geo-mapped, and an online system was established to track the real-time movement of goods.
Industrial oxygen is transferred from steel mills to hospitals.The government has accelerated the construction of pressure swing adsorption (PSA) plants – which condense oxygen from the air – and has stepped up the procurement and distribution of oxygen generators.
This experience raises the following questions: How should we prepare for the next oxygen emergency, especially when the demand for the gas is unpredictable and the infrastructure costs to produce, store and transport it are higher than the cost of the product itself?Just as importantly, how can we ensure better distribution of oxygen so that it is available wherever it is needed, even in non-emergency situations, so that no one is deprived of this life-saving product?
Over the past few months, India has been developing a medium-term strategy to achieve oxygen self-sufficiency, and the national and state governments have made considerable progress.
Based on the World Bank’s experience with technical assistance provided by the four Indian states (Andhra Pradesh, Meghalaya, Uttarakhand and West Bengal) and central government authorities, we have developed a series of policies to strengthen the country’s medical oxygen Options:
The central government has funded 1,222 PSA plants through the PM Cares Fund, producing 1,750 metric tons of retained oxygen per day.In addition, numerous factories have been established in the states through public sector commitment and corporate sponsorship.
Going forward, it will be critical for governments to leverage the private sector’s capacity to produce, store and transport LMOs and to develop plans to use these capacities when needed.Until now, many large and medium-sized private hospitals (100-200 beds) have been reluctant to do so because of the large capital investment required to install oxygen concentrators in their own facilities.Even so, some large private hospitals did set up their own oxygen production plants during the peak of the second wave, when the government relaxed the rules for setting up medical oxygen production facilities on their premises.
Now, some states are encouraging private companies to build oxygen plants.For example, under its new Oxygen Production Policy 2021, the Bihar government is offering a 30% capital subsidy for building factories and machinery.In other parts of the country, land and utility subsidies, as well as low-interest financing, are also needed to private healthcare providers as incentives to build these factories.
Earlier, some government hospitals were equipped with their own oxygen generators, but these were abandoned as maintenance was not carried out.It is now important to ensure that the extraordinary efforts to create a captive oxygen plant do not suffer the same fate due to a lack of operations and maintenance (O&M) resources.
In addition to ensuring that these plants continue to have high production capacity, it is critical to ensure the efficient operation and maintenance of the entire oxygen supply chain from the plant to the bedside.Of the more than 3,500 plants procured in India, 1,222 plants procured under the PM Cares Fund include a five-year Annual Maintenance Contract (AMC).To ensure long-term sustainability, all plants, storage tanks and conveying systems need to be covered by similar AMC arrangements.
Lack of skills to operate and maintain these new plants could be another stumbling block.India has launched a commendable initiative to train 8,000 technicians to operate and maintain these plants.These online trainings now require hands-on training.Some states like Andhra Pradesh have also made welcome moves to expand the skills of their personnel to maintain these plants and other biomedical and cold chain equipment.
During the second wave, the medical emergency was not so much a shortage of medical oxygen as it was because of the high concentration of medical oxygen in eastern India, the distribution network was unable to meet the tenfold surge in demand.If we are to increase the supply of medical oxygen without adding expensive and infrequently used additional infrastructure, we will need to strengthen our intermodal network, linking supply hubs to demand.Because medical oxygen is relatively inexpensive and transportation is expensive, buffer storage needs to be established in strategic locations to reduce delivery times.
Additionally, as oxygen cylinders will remain an important means of supply, the digitization and tracking of these cylinders will be important.Some states are considering this.For example, in Uttarakhand, 30,000 radio frequency identification (RFID) tags affixed to oxygen cylinders were distributed to medical oxygen suppliers and hospitals.
The government, technology partners and the private sector are working closely together to estimate India’s future oxygen demand based on experiences and lessons learned from previous waves of COVID-19.Many forecasting and modeling techniques have been used to gain a deeper understanding of production, demand, and storage requirements.
States can now track and ensure oxygen delivery at various points in the supply chain with systems such as the Oxygen Demand Aggregation System (ODAS) and the Oxygen Digital Tracking System (ODTS).AI and digital connectivity can also be used to monitor consumption and forecast demand, respond quickly to any potential surge, and manage tricky last-mile logistics.Delhi is one of the states using this technology to improve the efficiency of oxygen logistics and supply systems.
To date, the World Bank Group has provided more than $3 billion to support India’s efforts to combat the COVID-19 pandemic.As part of this, Bank projects at the national and state level are working with India to address critical gaps in its oxygen supply system.
During the peak of the second wave, the Bank Group worked closely with global suppliers to rapidly source and deliver 29,600 high-quality oxygen concentrators to the country.The bank also assists in sourcing other oxygen-related commodities such as oxygen cylinders in India.
Finally, in partnership with the NGO PATH, the Bank provided targeted technical assistance to four states – Andhra Pradesh, Meghalaya, Uttarakhand and West Bengal – to strengthen their Oxygen system and building capacity.It also supports the central government in addressing critical transportation and logistics issues related to medical oxygen in India.
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Post time: Apr-11-2022

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