During the devastating second wave of COVID-19, hundreds of lives could have been saved had the health infrastructure been in place in India. Demand for ventilator beds skyrocketed across the country and multiple media houses reported on the lack of ICU or ventilators beds in several states.
But was there an actual shortage in the supply of ventilators?
The Quint accessed an RTI response received on 8 July by Nilesh G Prabhu, a businessman, from the Ministry of Health and Family Welfare (MoHF), which reveals that close to 13,000 (12,973) ventilators procured by the Centre were not distributed to the states.
The question is:
Why were nearly 13,000 ventilators not distributed when COVID-19's second wave was at its peak?
"During the second COVID-19 wave there was a distinctive increase in demand in private and public healthcare for ventilator-assisted ICU beds. If the government had an inventory of ventilators but they were uninstalled, then it’s really sad. Lives were lost because of the lack of our country’s capacity to install, commission, operate and train doctors to use these valuable procured resources."Rajiv Nath, Forum Coordinator, AiMeD ( Association of Indian Medical Devices Industry)
Undoubtedly, these 13,000 ventilators could have saved so many lives had they been distributed and installed in hospitals in time.
Prabhu, in his RTI application to the Health Ministry, asked:
Kindly provide details of ventilators purchased by the Health Ministry or PM CARES Fund from April 2020 to June 2021.
Kindly provide names and details of the hospitals to which these ventilators were supplied.
In response to the first question, the Health Ministry stated that 59,873 ventilators were procured by the MoHF by June 2021.
While in response to the second question, the MoHF – instead of sharing the names of the hospitals – shared the names of 36 states and the number of ventilators received by each state from the Centre.
As per the RTI, till 1 June 2021, 46,900 ventilators were supplied by the Centre to 36 States and "Central Institutions". Though the RTI does not clarify what 'Central Institutions' are, the MoHF refers to the hospitals and medical facilities run by the Centre.
Of 36 states, Gujarat got maximum, ie 5,600 ventilators, followed by Maharashtra with 5,555 ventilators, and Uttar Pradesh with 5,316 ventilators. While Sikkim got the least – 10 ventilators.
Simply deducting distributed ventilators (46,900) from procured ventilators (59,873) gives the figure of nearly 13,000 ventilators. These were with the Centre, but unused.
"It shows appalling lapses in government's planning in fight against COVID-19 crisis. Many patients in cities like Ahemdabad and Delhi, were asked to bring their own medical devices like ventilators or oxygen cylinders to the hospitals during the second wave. It's also not just about quantity but also quality. Many hospitals also raised apprehensions about the quality of procured ventilators.Siddhartha Das, member of AIDAN (All India Drug Action Network)
Why Delay in Procuring When Order Was Placed in May 2020?
The MoHF has mentioned ventilators being supplied to Centre and state hospitals but whether it includes the army and Central Armed Police Forces (CAPF) hospitals, is a question which we have asked the ministry and are yet to hear from them. But certainly, all 13,000 ventilators cannot be supplied to the army and CAPF hospitals.
Since Prabhu in its RTI asked for the data between April 2020 till June 2021, one might argue that MoHF might have procured nearly 13,000 ventilators in June itself because of which they could not share the details of the states to which these ventilators were supplied to.
If this is the case then it leads to an even more serious question –
Why was there a delay in procuring ventilators by the central government when the orders were placed in May 2020 with the manufacturers?
Govt Projected Demand of 75,000 Ventilators Till June 2020
A press release issued on 1 May 2020 by the Ministry of Chemical and Fertilizers stated "MoHFW has indicated projected demand of 75,000 ventilators till June 2020... orders for 60,884 ventilators have been placed by HLL Lifecare Limited, a PSU under the MoHF, which is acting as the central procurement agency."
Keeping in mind that the projected demand for ventilators might increase in June 2020, the government placed an order for over 60,000 ventilators in May 2020.
Technically, the government should have procured over 60,000 ventilators by June 2020 based on the projected demand but that was not the case.
In 8 Months, Govt Distributed Only 14,000 Ventilators
Till 15 September 2020, the government had distributed slightly over 50 percent, ie 32,862 ventilators to the states, of which around 20,000 were installed in the hospitals, as per MoHF's response in the Rajya Sabha.
And in the next 8 months, that is, from 15 September 2020 till 1 June 2021, the government managed to distribute only 14,000 ventilators (46,900 subtracted by 32,862); while in six months, between May 2020 and September 2020, the government distributed over 32,000 ventilators.
Did the manufacturers delay in supplying the ventilators to the government?
The Quint's investigative report on 6 May 2021 revealed that the delivery of almost 9,000 Low Flow Oxygen (LFO) ventilators had been held up due to non-payment of dues to the manufacturer, Trivitron Healthcare, a Chennai-based company. However, in course of our investigation we could only find out about one manufacturer.
What happened in case of other manufactures and whether there was a delay in payment by the government which in turn delayed the supply of ventilators remains unknown.
Interestingly, the government allowed export of ventilators from 1 August 2020 citing in its press release, "declining low rate of case fatality of COVID-19 patients.” The release also stated, "as on 31 July 2020, only 0.22 percent of the active cases were on ventilators across the country."
The question is: shouldn't the government have allowed export of ventilators only after manufacturers had met the Indian government's demand?
Experts say that trained staff is required to install and operate ventilators which is a time consuming affair.
"We now need to make sure to deploy these immediately as we prepare for the third wave. The biggest challenge is our capacity to absorb and train medical and paramedical staff to use these high-end oxygen therapy equipment that needs more skills“.Rajiv Nath, Forum Coordinator, AiMeD ( Association of Indian Medical Devices Industry)
As the third COVID wave is imminent, whether the Centre will dispatch these ventilators to the states well in time so that hospitals get enough time to install and train their staff, remains a big question.
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