Critical condition

Covid’s second surge has exposed the precarious state of India’s hospitals. Across major cities and towns, beds, oxygen, ambulances and medicines are running out. To be fair, the best of health systems will be stretched to their limits in such times, with perhaps over 30,000 patients requiring hospitalisation daily. But India’s health infrastructure leaves much to be desired, anyway. Unregulated facilities dominate the health scene, often without the requisite ICU beds, ventilators and oxygen. Private hospitals, including large corporate chains, have especially been found terribly wanting in this crisis. It is shocking that they do not have their own sources for even something as basic as oxygen and depend instead on third-party supplies from outside. It does not take much investment or time to set up an oxygen plant using pressure swing adsorption technology as a report in this newspaper last week showed. A dairy-run hospital in Gujarat set up an oxygen plant in 72 hours that can meet the needs of 35-40 patients a day. The cost can be recovered in no time from patient billings. Hospitals, at least the large format corporate ones, also ought to have built-in redundancies in terms of beds given that they are premium treatment centres. This should be a precondition for granting them a licence.

The Clinical Establishments Act, which sets conditions for registration of hospitals, laboratories and nursing homes, was passed in 2010 as a model law but has been adopted by less than half the States. Pressure groups have stayed its implementation or narrowed its scope. For instance, nursing homes below a certain size have been left out in some States. While a number of hospitals and its staff, public and private, have been exceptionally dedicated in these times, unethical practices are equally common — with the law not acting as a deterrent. The law (and its rules), which has been modified over time to broaden its scope, divides hospitals into four ‘levels’ on the basis of requirements for registration, and requires them to display rates. According to industry estimates, small hospitals with an average of 25 beds account for well over half the hospital beds in India.

According to data compiled by Princeton University (April 2020), the country has 19 lakh hospital beds, of which nearly 12 lakh are in the private sector; in other words, 16 beds per 10,000 population in all. This is way below Sri Lanka (42) and China (43). The study says there are close to 95,000 ICU beds in the country (just 5 per cent of all beds), of which 59,000 are in the private sector. Clearly, this is woefully inadequate for today’s needs. As for ventilators, there are just over 47,000 of them, with over 29,000 in the private sector. Public investment must be stepped up while private hospitals need to be audited for their facilities and rated on that basis with their charges linked to the rating. Healthcare needs better regulation in this country.

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