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Time of India

Unprepared for another Covid: Defunct medical oxygen infrastructure

Unpreparedness : During the COVID-19 pandemic, India swiftly mobilised emergency medical oxygen infrastructure across the country. Plants and systems were rapidly commissioned to meet the unprecedented demand. However, whatever infrastructure was put up during the pandemic is now largely defunct, owing to lack of maintenance, fragmented operations, and insufficient regulatory clarity. No programs are drawn to train and upskill the healthcare professionals in operating and maintenance of PSA generators. As a result, many of these systems cannot deliver the required purity of medical oxygen— providing nothing more than compressed air. Over the last three years all of the generators have mostly neither be regularly operated nor serviced. Mock drills failed to restart this defunct machinery. This has led to a growing dilemma among the medical fraternity. Health Directors across all the Indian states unanimously acknowledge this concern. It signals an urgent need to reimagine how the nation prepares for future health emergencies for medical oxygen —especially in rural regions where the challenges are acute and critical. Two important lessons learnt from COVID – 1. The need to minimize the migration of patients from villages to cities. 2. Need to strengthen public healthcare infrastructure with innovative and India centric technologies to address the emerging challenges. Decentralization : Nearly 65 per cent of India's population resides in villages, where even now access to medical oxygen remains limited. Their availability at the right time and place can mean the difference between life and death. The lack of decentralized oxygen infrastructure forces patients to travel long distances to urban centres, often under dire circumstances. This not only worsens outcomes including exploitation but also places an unsustainable burden on territory hospitals which are mostly in cities. Adding medical oxygen generating capacities is not the solution. The nuance is in understanding that oxygen cylinders save more lives!! This justifies decentralization through commissioning containerised mobile PSA cylinder filling stations at every District headquarters. This will effectively maintain the supply chain logistics of medical oxygen cylinders up to the PHC level hospitals where required and beyond in their respective districts. These containerised plants will get seamlessly integrated with the existing infrastructure and also meet the demand for refilling of medical oxygen cylinders, without remaining idle and contributing to the state exchequer. Deregulation : The path to addressing the future challenges requires more than infrastructure—it requires regulatory reform in equal measure. Central Government has last month released new guidelines 'Medical Oxygen Management' however, a critical lacuna remains—Without provisions for mobile cylinder filling stations, such guidelines risk being disconnected from the practical challenges on the ground. There is an urgent need for the health ministry to put up a strong representation to the ministry of commerce and industry (under which the PESO regulates) to bring in suitable amendments and frame new guidelines to include Mobile containerised PSA captive oxygen generation plants, in keeping with the global practices. This is critical in building a resilient healthcare infrastructure for our country. Medical Oxygen Grid : The post-COVID era demands a fresh blueprint, one that can address the twin challenges of preparedness and last-mile delivery. To address this, CPDMED, TBI at the Indian Institute of Science, Bangalore has developed a comprehensive national level model focused on strengthening medical oxygen readiness and response across the country. At the heart of this initiative is the creation of a Medical Oxygen Grid —a decentralized system of containerised captive oxygen plants with inbuilt cylinder refilling stations, positioned at every district headquarters. Designed for a resilient plug-and-play use, such modular units can be swiftly integrated into existing healthcare infrastructure and in emergency moved to any secondary hospitals, filling a long-standing gap in India's emergency preparedness. Beyond civilian healthcare, the proposed grid has significant strategic importance. In times of war or natural calamities, this network can serve as a reliable support system for the defence forces and Humanitarian Assistance and Disaster Relief (HADR) application. Skilling Programme : CPDMED has designed a comprehensive national level training programme for skilling and training healthcare professionals. It is offering a certified training progamme on its campus. Leveraging Technology : Our vision bridges this gap through technology and data driven tools. By leveraging geospatial mapping, IoT-based monitoring systems, hub and-spoke distribution models, and predictive analytics, the Medical Oxygen Grid can ensure real-time visibility, accountability, and responsiveness across the supply chain. This digital backbone will be key in transforming the way oxygen is produced, distributed, and consumed—district by district, facility by facility. We propose this National grid will be driven by a Toll-Free number that will ensure : ▪ Availability : 24x7x365 days ▪ Accessibility : Till the last village and the last patient at home. ▪ Accountability : ensuring correct volume, pressure and purity of oxygen. ▪ Affordability : at DPCO rates. India stands at a crossroads. The near defunct state of existing epidemic ready infrastructure is a wake-up call—not a failure, but a powerful reminder of the need to build smart, resilient, and sustainable systems. A decentralized, digitally empowered Medical Oxygen Grid offers not only a solution, but a national strategy to strengthen medical oxygen delivery, protect rural lives, and support national security. This article is written by Dr. Srinivas M Kandada, Principal Consultant & Head of Operations-CPDMED, IISc Bangalore (DISCLAIMER: The views expressed are solely of the author and does not necessarily subscribe to it. shall not be responsible for any damage caused to any person/organisation directly or indirectly)