Healthcare services: Driving first response

India has two different yet overlapping publicly funded ambulance systems, with both popularly known by their helpline numbers, 108 and 102.

By Sudhir Mehta & Sahil Deo

Emergency response is an important aspect of healthcare services, and ambulances play a critical role in this. Unfortunately, most of India’s population does not have adequate access to pre-hospital trauma care. In India, few victims receive treatment at the scene, and fewer can still hope to be transported in an ambulance. As a result, many victims may die at the scene or during the first few hours following injury. Critical procedures like blood group identification, monitoring oxygen levels, etc, could be initiated in the ambulance after equipment upgradation.

India has two different yet overlapping publicly funded ambulance systems, with both popularly known by their helpline numbers, 108 and 102. Between them, they have more than 25,884 ambulances across 33 states and Union Territories, under the National Ambulance service system of the National Health Mission, along with 900,000 community health volunteers and 178,000 paid staff. The WHO for ambulance penetration recommendation is one per 1 lakh population to meet the crucial 15-minute attention period. Besides the centralisation of 108 and 102 helpline, it is imperative to update the National Ambulance Service System on bed vacancy and occupancy at hospitals . This will help the patient to reach the destination trauma facility within the critical time period. The recommended ratio cannot be accurately assessed because India has a multitude of providers, especially in urban areas. Despite this, the average time to reach a person in distress is between 41 -47 minutes. With increasing hospitalisation due to the pandemic, there is a shortage of ambulances. There is also the issue of overcharging.

In the wake of the rising number of Covid-19 cases, there is a need to deploy additional ambulances. Besides, since they are giving transport access to patients, ambulance operators need specialised attention in the present situation. This includes PPE kits, temperature control within the vehicle, and disconnected air circulation system, to operate with the PPE and other precautionary gear on for long hours. Moreover, obligation of vehicle sterilisation is also a major factor due to the high chances of transmission of the virus. Ambulance fares need to capped and standardised, as recently directed by the Supreme Court.

However, the government also needs to make urgent structural changes to encourage more private enterprises to buy ambulances for public health service as part of Emergency Response Services (ERS). Therefore, the first step is the reduction of tax levied on ambulance from 28% to 12%, shifting it into the same category as medical equipment. Second, there is a need for centralisation of the 108 and 102 system. Last, there has to be access to easy loans as most ambulances are purchased against bank finance. If such loans can be brought under the “priority sector lending” category, it will ensure bankers/financial institutions provide easy and affordable loans. The recent revision and expansion of RBI’s priority sector lending basket did not include enterprises providing healthcare services.

New enterprises can integrate within the existing startup ecosystem to improve services. Besides improving the healthcare service, it will also help slow the growing unemployment. With a rapid rise in Covid-19 cases, there is going to demand for ambulances and an upgraded ERS.

Mehta is chairman, Pinnacle Industries & President, MCCIA, Pune. Deo is co-founder, CPC Analytics

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