India now has 20,000 tonnes per day Oxygen capacity. 90% of it lying idle

There are 1,242 liquid medical oxygen tanks in hospitals across India with a capacity of 15,622 tonnes. This is a 104 % rise in the number of tanks and a 131% increase in storage capacity

India has enhanced its overall oxygen capacity including liquid medical oxygen (LMO), and pressure swing adsorption (PSA) plants to over 20,000 tonnes per day in the last one year after the second wave of Covid-19 infections led by the Delta variant wreaked havoc. This is almost a 20-fold increase.

Almost the entire of this infrastructure is now lying idle. Industry estimates the current demand for medical oxygen to be around 1,250-1,300 tonnes per day (tpd). Maintaining the PSA plants is a huge task at hand. Hospitals that had augmented capacities are now finding ways and means to make optimum use of their infrastructure.

The ramp up

Medical oxygen demand touched a peak of 3,095 tonnes during the first wave (on September 29, 2020). In April 2021, the demand for medical oxygen shot up – touching an average of 5,500 tpd in the third week of April last year when the country was in the grips of a raging Delta wave.

Daily LMO production was around 5,700 tpd in August 2020, which was increased to 9,690 tpd in May 2021, Union Health Ministry said. LMO production was increased in steel plants; 1,385 tonnes of LMO was also imported from various countries. India has increased its LMO road tankers by 36 per cent and the transporting capacity by 58 per cent. Currently, the country has 2,540 tankers with a total capacity of 34,588 tonnes, the ministry informed.

The storage capacity of LMO in hospitals has been boosted as well. Currently, there are 1,242 LMO tanks in hospitals across the country with a capacity of 15,622 tonnes. This is a 104 per cent rise in the number of tanks, and a 131 per cent increase in storage capacity compared to 609 tanks with a capacity of 6,759 tonnes in March 2020.

Adding to this, PSA plants were installed at hospitals countrywide. A total of 4,135 PSA plants are being established in the country, of which the government of India helped states to set up 1,225 plants under the PM-CARES. Another 336 PSA plants are from public sector undertakings, and about 2,574 PSA plants are being set up through the state and CSR funds.

About 4,125 PSA plants have already been commissioned with a capacity of 4,852 tpd, and only 10 are pending, health ministry sources informed. 

 

Problem of maintenance and utilisation

According to the All India Industrial Gases Manufacturers Association (AIIGMA), the current demand for oxygen in India for medical purposes is around 1,250 to 1,300 tpd.

Saket Tiku, president of AIIGMA and a member of the Oxygen Committee by the Department for Promotion of Industry and Internal Trade (DPIIT), said that there were problems with the procurement of PSAs (planned by the Centre), and one needs clarity on how many are operational now.

Tiku’s concern stems from the fact that several incidents of breakdowns have been reported for these PSA plants in hospitals. An official with a West Bengal government hospital confirmed that there have been many incidents of plant breakdowns. “We had to follow up with the vendors to fix the problem. And the plant is working without much disruptions of late,” said the official.

Maintenance of PSA plants is the responsibility of the hospital administration. Siddhartha Niyogi, West Bengal Director of Health Services, said that all plants were running but acknowledged that there were some problems with maintenance.

 "Several government hospitals received these PSA oxygen plants for free. Since they didn't pay for these plants, many hospitals are not concerned even as they lie idle. Also, with many of such plants having been imported, spare parts are not available for maintenance, making it worse," said an oxygen manufacturing industry source in Gujarat on condition of anonymity.

Health ministry sources informed that already three mock drills to ensure PSA plants keep functioning have been conducted by states as of September 15, 2022, and another one is expected to be completed by the end of this month.

“To review the progress of PSA plants with other Medical Oxygen Infrastructure, a weekly review meeting is being held by the Joint Secretary and above level at MoHFW,” the official source said.

Private Hospitals try to optimise usage

Private hospitals, however, have taken a more cautious approach primarily for two reasons – one PSA oxygen quality is less pure compared to LMO and thus not suitable for critical patients, and secondly, they did not wish to make bad investments.

 A 100-120 bed hospital in Delhi told Business Standard that they are now straddled by a PSA plant, which they have to run once a week only to keep the machines humming. “It is way cheaper to procure oxygen cylinders for our regular demand. However, we spent almost Rs 40 lakh in installing a PSA plant after the second wave wreaked havoc and the government ordered us to,” said the administrator.

Large corporate hospitals like Manipal Hospitals have long-term supply contracts of LMO and have thus not gone for PSA plants as such.

“At Manipal Hospitals we have adequate storage capacity at all our hospitals and did not need to set up PSA Oxygen plants. Typically, we maintain stock levels of 4-5 weeks’ requirements, which gives us sufficient cycle time for refills. During the pandemic we did enhance the storage facilities at some locations as a matter of abundant caution,” said Dilip Jose, MD and CEO of Manipal Hospitals.

Fortis Healthcare, however, invested in setting up PSA plants in some locations where it deemed fit. Now they are trying to make optimum use of the resource. Bishnu Panigrahi, Group Head, Medical Strategy and Operations, Fortis Healthcare said, “We are blending PSA oxygen with LMO to get the desired concentration for our patients. This reduces our dependence on LMO which is more expensive.”

A source from Apollo Hospitals Enterprise said that the addition of PSA units turned out to be advantageous for all its hospitals as the intake from external sources has declined now.

Oxygen manufacturers revert to supplying industrial demand

A senior official of India’s largest medical oxygen manufacturer Inox Air Products told Business Standard that for major oxygen producers, over 95 per cent of the production was going towards industrial purposes before Covid19.  The majority of the production is again diverted back to industrial purposes. The major oxygen manufacturers in the country include Inox Air Products, Linde India, Atul Oxygen Company, Aims Industries, P K Carbonics, and Vinayak Air Products.

In Gujarat, the industry has reverted to the usual 75:25 supply ratio of industrial versus medical usage. "While demand for medical oxygen has normalized, it has not impacted our industry much because the industrial oxygen demand has replaced the same," said Shwetanshu Patel, director of Aims Industries, a Gujarat-based liquid oxygen manufacturer and supplier.

As fresh Omicron sub-variants BF.7 and BA.5.1.7 are in circulation ahead of winters forcing China to go for fresh lockdowns, India is in good stead with buffer oxygen capacity.