As of today, on 8th May 2021, many big cities in India are facing acute shortage of oxygen, despite the warning of contempt action from the Hon’ble Supreme Court of India. In Delhi, the National Capital, the citizens are being compelled to stand in long queues for eight hours to get their oxygen cylinders refilled. Some of them are successful, while others are unfortunate as they are not able to get their cylinders refilled on time. The healthcare system has collapsed. The centre claims that there is enough oxygen for every state, but still it is not being delivered to the breathless citizens. What is happening? We all know about the oxygen issues. But in this post, I would like to offer a solution for this oxygen shortage problem.
Right to health and health-care facilities
If someone gets infected with COVID-19 virus and she does not get ICU bed or even an oxygen cylinder, then who is to be held responsible? Do we even have a right to health? The answers lie in many authorities. Under the Constitution of India, Article 21 provides that “No person shall be deprived of his life….except procedure established by law.” The provision has been interpreted widely by the Supreme Court of India. The Court interpreted the word ‘life’ to say, every person has a right to health and healthcare facilities. In the case of State of Punjab v. Ram Lubhaya Bagga (1998), the Court observed that, “pith and substance of life is the health, which is the nucleus of all activities of life.” The Court in other case of State of Punjab v. Mohinder Singh Chawla (1996) held that, “government has constitutional obligation to provide the health facilities.” Having said this, it is the State governments who bears the responsibility of public health as per Item 6 of List II of Schedule VII of the Indian Constitution (“Public health and sanitation; hospitals and dispensaries”). But the State Governments have to rely on the Centre for allocation of funds and more importantly, distribution of oxygen. The whole system is centralised when it comes to oxygen production and supply/distribution.
The centre is using different public and private sources to generate oxygen and supply it to the states- but there are logistical barriers for some states, like non-industrial states like Delhi does not have cryogenic tankers to carry oxygen from the plant to their state. So, they are completely dependent on the Centre. After this as well, the individuals who are not admitted in hospitals and are in home-isolation are not getting sufficient oxygen as most of the oxygen is supplied to the hospitals. That is why they are rushing to hospitals as and when their oxygen levels drop below 94%, which in turn leads to scarcity to oxygen beds in the hospitals (where the number of oxygen-beds are already less). But what can be the solution?
Use of Public Distribution System (PDS) and Fair Price Shops
Every State and Union territory has a Fair-Price Shop which has the responsibility of delivering ration and essential commodities to the citizens in more than 714 districts, as per the mandate of the National Food Security Act 2013. In India, as per the NFSA website, there are 5,46,164 Fair Price Shops.
Now, if the Central Government while allocating the oxygen supplies to the States calculate the oxygen needed by the hospitals and the consumption by individuals separately based on previous weeks or month’s data (which can be provided by District Medical Officers/District Magistrates/SDMs/Nodal Officers), then they would get a fair idea as to how much oxygen is actually needed in every state respectively. Then, the state government must create a pool of oxygen. The oxygen required by the hospitals can be delivered to them as usual. But to stop the super-spreading of virus and citizens from standing in long queues outside the oxygen refilling stations, the centre and the states should directly distribute oxygen cylinders/refilling facility to these fair price shops which are located in every locality. Then, the state government must maintain a real time data of the remaining oxygen levels in these shops.
There would be various benefits of this. Firstly, the citizens will not have to travel on roads during lockdown (as observed in various states), which will prevent their extra spending on transportation and refilling of oxygen. Secondly, they will be provided oxygen locally through their Fair Price Shops, where the system would be decentralised and it would be less crowded (at least better than the long queues outside big plants like Vinayak Oxygen Plant in Mayapuri (Delhi) and Vaibhav Oxygen Plant in Mohan Estate (Delhi)). Thirdly, the oxygen supply will reach the rural areas of the country where the virus is now spreading quickly and it will stop the exodus of patients with mild symptoms from villages to cities (due to which the desperate citizens are forced to pay hefty amounts to privately owned ambulances and hospitals). Fourthly, if the supply of oxygen cylinders will be fulfilled by the localised fair price shops, then the mild symptoms patients who require oxygens will not have to run to hospitals to get admitted, which in turn will reduce the burden on the healthcare system as a more critical patient will get a bed.
There are certain concerns which will pop-up with this decentralised approach like black-marketing and hoarding of oxygen supplies by owners of fair price shops as this has been seen in distribution of ration as well, where the poor is denied ration by these astute owners. This would lead to failure of the whole system (yet again). In solution to this, the state governments can direct the Sub-Divisional Magistrates (SDMs) or any other officer of equivalent rank to overlook and manage the whole system. Thereafter, they will have to report to their District Magistrates, who must give daily and/or weekly report to the State Secretary about the supply and need of oxygen to these fair price shops in every district. The Secretaries of the States must, then, coordinate with the centre’s allocation team (now Special Task Force as constituted by the Supreme Court). This will be in line with the principles of Federalism, as no single government would be dominating the whole federal structure.
This can be the most decentralised way to distribute oxygen without invoking politics and federal issues. Once the system is in place, demand for the amount of oxygen can be made by these SDMs as per the needs of the locality on a daily or weekly basis. This system can succeed if the flow of communication and supply of oxygen is coordinated with empathy for the human lives. The authorities need to be reminded about their obligations to the public. Every citizen who dies without oxygen is not a natural death, but is a result of negligence and non-performance of duties by the public officials (and the representatives of the people). Apart from these Fair Price Shops, the LPG gas agencies can also be used to deliver oxygen from door to door, as they have the transport and the human power to deliver. The Government of India must do something to protect the lives of its citizens.