Huge public-pvt effort needed to boost health if there's third Covid wave

Only when both sectors take joint actions, can the country brave another onslaught

For the inevitable third wave of Covid-19, the public and private sector will have to unite for a massive ramp-up of medical infrastructure that goes far beyond hospitals and equipment. 

Experts say India must draw lessons from its own and other countries’ experience by anticipating needs, from fixing the supply chain for medicines, equipment and raw materials to scientific analysis of how the virus might behave in future and the groups likely to be impacted.

One first step, they say, is to understand that India needs at least three times the number of beds from its current capacity of 1.35 beds per 1,000 people (industry estimates). According to rough estimates, India has 100,000 ICU beds. It needs 400,000.

According to industry estimates, there were around 800,000 beds in government hospitals and around 900,000 beds in the private sector last year. 

“We have added around 30 per cent to this capacity overall, but it is not enough, especially if you think of Tier 3 towns,” said Girdhar Gyani, director general, Association of Healthcare Providers, a Delhi-based not-for profit that represents healthcare providers in India. 

Gyani pointed out that Prime Minister Narendra Modi, during the launch of the Ayushman Bharat medical insurance scheme in 2018, had said that he would like to see 3,000 100-bed hospitals in Tier 2 and Tier 3 cities. “To the best of my knowledge, no such hospitals have come up. State governments were supposed to facilitate this,” said Gyani.  

Private hospitals, however, are anticipating demand and ramping up capacity. Fortis Healthcare has added 250 beds in Chennai and is planning to add another 300 beds within its network in the next one year.

Manipal Hospitals added 15 per cent more beds within its existing network in the last one year, taking the total count to 7,300 beds. 

Given the recent crisis when even the top hospitals were begging for oxygen to save patients, many hospitals are setting up their own oxygen plants as well. “We are mostly present in rural areas and small towns where the second wave has hit people massively. We will have an oxygen plant in all our 15 hospitals in the next few months, hopefully before the third wave,” said Shuchin Bajaj, founder director, Ujala Cygnus group of hospitals that has presence in several states in north India. 

In West Bengal, where Covid cases are surging, private hospitals are setting up Covid field units inside stadiums and auditoriums. While the state has more than doubled its bed capacity in the last one month, the shortage of ICU and critical care beds is severe. 

As for ventilators, according to industry estimates, as against an earlier plan to increase their number to 200,000, only around 40,000 ventilators are currently operational.

A leading ventilator manufacturer who did not wish to be named told Business Standard that during the first wave, an order for 60,000 ventilators was placed through the PM Cares Fund but only 10,000 were bought after the first wave ended last year. 

Ventilator manufacturers such as Trivitron and Max Ventilator are expanding their capacity. They believe the additional infrastructure could be used for conventional needs post-pandemic.

Hospitals are concerned that by the time the third wave strikes, many doctors traumatised by the current surge will struggle to continue performing their duties. If this happens, it will exacerbate the already existing manpower shortage in the healthcare sector.  

The government recently announced it was deploying medical interns — final year MBBS students — on Covid duties. Industry feels, however, that education policy is de-linked from its requirements. For instance, for the current 75,000 MBBS, there are less than half the number of postgraduate seats. This ratio has not changed since 2014. 

“We need to encourage more PG diploma courses to have intermediate specialists and make every hospital into a teaching hospital to churn out specialists now,” Gyani added. 

Experts also recommend crash courses for nursing staff, lab technicians and doctors to meet the immediate need of trained manpower.

“We have to create a next rung of healthcare professionals who will then be able to take care of the moderate patients, while those already experienced will look after those who are critical,” said Dilip Jose, MD, Manipal Group of hospitals.

Ruchika Chitravanshi, Sohini Das, Ishita Ayan Dutt and Vinay Umarji contributed to this report