A Guiding Force

Background on NTF:

• The SC has set up a 12-member National Task Force (NTF) to guide the central government allocation of medical oxygen to the states.
• The task force will work with NITI Aayog, the Ministry of Home Affairs and the Department of Promotion of Industry and Internal Trade, All India Institute of Medical Sciences, the Indian Council of Medical Research and the Directorate General of Health Services.
• The task force may constitute more sub-groups on specialised areas or regions, seeking the assistance of experts both within and outside government in areas such as critical care, infectious disease modelling, clinical virology and immunology, and epidemiology/ public health.
• Rationale: To facilitate a public health response to the pan- demic based upon scientific and specialised domain knowledge.

12-point Terms of Reference (ToR) of NTF:

• The first five points focus on oxygen supply, including deciding on a methodology for the scientific allocation of oxygen to states and facilitating audits (of oxygen supply, distribution and utilisation) by sub-groups within each state and UTs.
• Review and suggest measures necessary for ensuring the availability of essential drugs and medicines.
• Remaining six ToR of the NTF are aimed at the broader pandemic preparedness and response –
  1. Planning and adopting remedial measures to ensure preparedness for present and future emergencies;
  2. To facilitate the use of technology;
  3. To suggest augmenting the availability of trained doctors, nurses and paramedical staff;
  4. To promote evidence-based research and enhance effective response to the pandemic;
  5. Facilitate sharing of best practices across the nation to promote knowledge about management of the pandemic.
  6. To make recommendations in regard to other issues of pressing national concerns.

Analysing the shortage of medical oxygen: While the shortage reflects the generic challenges of healthcare system in India (insufficient planning; delayed procurement, and weakened supply chain), the situation is dire because of the following reasons:

• Insufficient capacity of state health departments in planning procurement and supply of medicine. For E.g. while a number of states had set up medical procurement and supply corporations, their functioning remains suboptimal in the absence of a trained human resource.
  • This has resulted in a situation whereby even after the presence of free medicine schemes, people continue to have high out-of-pocket expenditure (accounting for 30-40% of healthcare costs).
• Insufficient government funding.

Significance of NTF:

• Ensures participation of independent subject experts in policy decisions, which have often been criticised as being overly led by a techno-bureaucratic process.
• Considers the supply of medical oxygen in the broader context of the shortage of medicines at health facilities and the improved supply and provision of essential drugs and medicines have also been included in ToR.

Challenges in front of NTF:

• They have a short time to look at far broader issues.
• While the members of NTF are qualified, a long term and effective pandemic response needs broader expertise than medical care.
  • They may need to proactively co-opt members with expertise in medical procurement and supply, pharmacology, free medicines and diagnostics, and public health and emergency health response.
• Considering that the availability of diagnostics has similar challenges as medicines, the NTF may consider including that as well in the scope of its work.

Conclusion: The decisions and recommendations of this NTF and how they co-opt members with the right expertise will determine whether India ends up becoming a medicalised care system (which would focus on treating the sick) or a healthcare system that can keep people healthy and respond to future pandemics.